Application For Virginia In State Tuition printable pdf download

ApplicAtion for virginiA in-stAte tuition

Completion of this form is required by the commonwealth of Virginia if you are claiming entitlement to Virginia in-state tuition rates pursuant to Section 23-7.4 Code of Virginia. All

For office

questions must be answered. When not applicable, mark the N/A box. Section A must be completed by the applicant. Section B of this form must be completed by the parent/legal

use only.

guardian or spouse if the applicant is a dependent. Supporting documents and additional information may be requested. Return this form with your application for admission. If this

Term

form is not submitted, you will be classified as a non-Virginia resident.

Section A - Applicant

(Please Note: While this information is not required for admission consideration, it is necessary for applicants who wish to be considered for financial aid and Hope Scholarship/Lifetime Learning tax credit

to provide a Social Security number to the university.) To protect your privacy, your Social Security number will not be used as your student identification number.

1. Name _______________________________________________________________________________________

2. Social Security Number ___ ___ ___-___ ___-___ ___ ___ ___

Last

First

M.I.

Other (Last Name)

3. Date of Birth ___ ___-___ ___-___ ___ 4. Citizenship

U.S.

Permanent resident alien, political asylum or refugee

Non-U.S. If non-U.S., give visa type ________________________

5. Where have you lived in the past two years? (List current address first. Include dates.)

Street address

City

State

ZIP Code

From (MM/DD/YY) To (MM/DD/YY)

___________________________________________________________________________________________________________________________________________________

6. Students under the age of 24 are presumed to be dependent on a parent or legal

13. Is your parent/legal guardian or spouse a member of the U.S. Armed Forces?

guardian unless one of the following applies? (Place a check mark beside all that apply.)

Yes

N/A

If No, go to No. 14.

Age 24 or older as of the first day of the semester in which you intend to enroll

a. Have income taxes been paid to Virginia on all military income for the last year?

Veteran or active duty member of the U.S. Armed Forces

Yes

N/A

Graduate or professional student

If No, have income taxes been paid to another state?

Yes

N/A

Ward of the court or was a ward of the court until age 18

b. Does the current Leave/Earnings Statement reflect Virginia withholding?

Both parents are deceased, no adoptive or legal guardian

Yes

N/A

Legal dependents other than a spouse

If Yes, effective date of change to Virginia: ______________________________________

Independent student (attach federal and state tax forms)

(Attach a copy of your LES and DD-2058.)

Married

c. Has your parent/legal guardian or spouse claimed you as a dependent for federal and state

7. Do your parents or legal guardian provide over half of your financial support or claim

income taxes?

Yes

N/A

you as a tax dependent?

Yes

N/A

14. Is your parent/legal guardian or spouse a retired military member, who currently

8. If you are married, do you wish to claim eligibility for in-state tuition rates based on

resides in Virginia and resided in Virginia at the time of their retirement?

your spouse’s domicile?

Yes

N/A

Yes

N/A

If Yes, does your spouse provide more than 50 percent of your financial support?

If No, go to No. 15. If Yes, effective date of change to Virginia: ________________________

Yes

N/A

(Attach a copy of your LES and DD-2058.)

If “Yes” to either No. 7 or 8, Section B must be completed by a parent/legal guardian or spouse.

15. If your spouse is in the military, will you have:

9. Will you have filed a tax return or paid income taxes to any state other than Virginia

a. Resided in Virginia for the past year?

Yes

N/A

during the past year?

Yes

N/A

b. Paid income taxes to Virginia on all earned income?

Yes

N/A

If yes, which state(s)?_________________________________

16. If your parent/legal guardian is in the military, will the nonmilitary parent/legal

10. For at least one year prior to the semester in which you will enroll,

guardian have:

will you have:

a. Resided in Virginia for the past year?

Yes

N/A

a. Filed a tax return or paid income taxes to Virginia on all earned income?

b. Paid income taxes to Virginia on all earned income?

Yes

N/A

Yes

N/A

c. Claimed you as a dependent for federal and state income tax purposes?

b. Been a registered voter in Virginia?

Yes

N/A

Yes

N/A

c. Held a valid Virginia driver’s license?

Yes

N/A

17. If you have lived outside Virginia for the past year, will you have:

11. Do you own or operate a motor vehicle?

Yes

N/A

a. Paid Virginia income taxes on all taxable income earned in Virginia during the past year?

If “Yes,” has it been registered in any state other than Virginia during the past year?

Yes

N/A

Yes

N/A

b. Lived in a contiguous state to Virginia?

Yes

N/A

12. Are you a member of the U.S. Armed Forces?

Yes

N/A

18. If your parent/legal guardian or spouse has lived outside Virginia for the past year,

If No, go to No. 13.

will the parent/legal guardian or spouse have:

a. Have income taxes been paid to Virginia on all military income for the last year?

a. Paid Virginia income taxes on all taxable income earned in Virginia during the past year?

Yes

N/A

Yes

N/A

If No, have income taxes been paid to another state?

Yes

N/A

b. Lived in a contiguous state to Virginia?

Yes

N/A

b. Does the current Leave/Earnings Statement reflect Virginia withholding?

c. Claimed you as a dependent for federal and state income tax purposes?

Yes

N/A

Yes

N/A

If Yes, effective date of change to Virginia: ____________________________________

(Attach a copy of your LES and DD-2058.)

I certify that all of the information I provided in this application is true and accurate. I understand that this application is a legally binding document and that if I provide fraudulent information, I may be

subject to repayment of tuition or dismissal. I agree to furnish the university with supporting documentation related to my application, if I am requested to do so.

Signature of applicant (required) ______________________________________________________________________________ Date ______________________________________

Office of Records & Registration

Grace E. Harris Hall

1015 Floyd Ave., 1st Floor

P.O. Box 842520

Richmond, VA 23284-2520

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