Cmc Asset Application Form - Colorado Mountain College printable pdf download

Office Use Only

Tuition Classification

Colorado Mountain College

ASSET Application Form

_____________________

Staff Signature

Full Name

_____________________________________ CMC Student ID Number __________________________

Physical Address __________________________________ City/Town ___________________ Zip____________

Dates at this address

Present

(mm/dd/yyyy) _ _ _ _ _ _ _ _ _ _ / _ _ _ _ _ _ _ _ _ _ _ / _ _ _ _ _ _ _ _ _ _ -

1) Have you continuously lived in Colorado for the last 18 months?

Yes

2) Did you graduate, or will you be graduating, from a Colorado High School?

Yes

Name high school:

Location ______________________Graduation date ________

a.) If you did not graduate from a Colorado high school, did you receive your GED in Colorado?

Yes

List GED Completion location________________________ GED diploma date __________

3) Did you, or will you, have attended at least three years of high school in Colorado?

Yes

List the name(s) of high school(s), grade level, dates/terms attended and location

Grade Level Dates of Attendance

Location (city/town)

Name of High School

From MM/YYYY to

MM/YYYY

4) If it has been a year or more since you graduated high school or completed your GED in Colorado, please list the

name of the Colorado college or university you were accepted to immediately after your high school graduation/

GED completion date

Name of College or University ________________ _ Location ________________Date of Acceptance____________

I certify, under penalty of perjury, that the information presented on this form is true and complete. If asked by an authorized official,

I agree to give proof of the information I have provided. If the student is under 18 years of age at the time the application is

completed, the student’s parent or court appointed guardian must sign this application.

Signature

Date

AFFIDAVIT

If the following statement is true, please check the box AND sign the affidavit below.

“I do not have lawful immigration status. I am seeking in-state tuition based solely on attendance at a high school in Colorado for at least three

years immediately preceding the date I either (1) graduated from a Colorado high school OR (2) completed a general equivalency diploma (GED)

in Colorado

I hereby swear or affirm under penalty of perjury under the laws of the state of Colorado that I have applied for lawful presence in the United States OR will apply for

lawful presence in the United States as soon as I am able to do so. I understand that this sworn statement is required by law. I further acknowledge that making a false,

fictitious or fraudulent statement or representation in this sworn affidavit may constitute a violation of the criminal laws of Colorado as perjury in the second degree

pursuant to Colorado Revised Statute 18-8-503.

Signature

D ate (MM/DD/YYYY)

Cmc Asset Application Form - Colorado Mountain College

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