Residence Reclassification Request Form Page 3
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4CAMPUS WIDE ID:
CSU
Residence Reclassification Request Form
THIS FORM MUST BE RETURNED TO THE CAMPUS FROM WHICH YOU ARE REQUESTING RECLASSIFICATION
.
Name
Social Security No.
First
Middle Initial
Last
Present Address
Birth Date
/
/ Month
Day
Year
Phone No. (
)
City
State
Zip Code
Term applying for
CSU Campus
Email:
Term
Year
Specify Campus Location
The information requested is deemed relevant and necessary to a proper determination of your residence status for tuition purposes pursuant to Education Code Section 68041. Failure to
answer all questions may cause you to be classified as a nonresident. You may submit other information that you believe will establish your California residence. Questions about residence
regulations should be referred to a campus residence specialist. A summary of the regulations is printed in campus catalogs and in the application for admission booklet. If you disagree with
the campus residence determination, you have the right to appeal that decision to the Office of General Counsel, The California State University, 401 Golden Shore, 4
th
Floor, Long Beach, California 90802-4210 within 120 days from the date of the residence determination. Note: You may be requested to furnish documentation in support of your
responses.
1. If you will be 19 years of age or older by the residence determination date, check here and
Residence Determination Dates
○
Answer 2 through 16 as they pertain to you.
Quarter Calendars
Semester Calendars
Fall……….………September 20
Fall…………….……September 20
If you will be younger than 19 years of age by the residence determination date, check here
Winter………………..January 5
Winter ...……………… January 5
and answer 2 through 16 as they pertain to the natural or adopted parent with whom you most
Spring …………………..April 1
(Stanislaus only)
○
recently resided and whose name and whereabouts you will provide below.
Summer……….…………July 1
Spring …………………January 25
Summer……….……………June 1
Name/Relationship
CalState TEACH
Stage 1 ..………….September 20
Stage 3 ……………….…….June 1
Present actual whereabouts
Stage 2 ..………………January 5
Stage 4 ……………..September 20
2.
What state do you regard as your permanent home?
3. If California, when did your present stay begin?
/
/
Month Day Year
○
○
4. Are you claimed as a dependent on the military record of any member of the U.S. armed forces? Yes
No
If “yes,” explain the relationship and answer No. 6 as it pertains to the military member. Member’s relationship to student is
○
○
5. Member or veteran of U.S. armed forces? Yes
No
Date joined
From what state
Date separated from active duty, if any
6. Most recent permanent address on military records
Stationed at
From
To
○
○
Last Voted
/
/
7. Ever registered to vote? Yes
No
If yes:
State
Date registered
/
/
Month Day Year
Month Day Year
State
Date registered
/
/
Last Voted
/
/
Month Day Year
Month Day Year
○
○
State
Date issued /
/
Month
8. Possess driver’s license and/or ID Card? Yes
No
If yes:
State
Date issued
/
/
Month Day Year
Day Year
9. Current registration of all vehicles owned or operated in CA
State
Date issued
/
/
State
Date Issued
/
/
Month Day Year
Month Day Year
○
○
10. Are all personal effects located in California? Yes
No
If “No,” attach explanation.
11. List all places you have lived prior to your most recent arrival in California, the dates you lived in each place and the parent you resided with.
If you need more room, please attach an explanation on a separate sheet of paper.
From (Date)
To (Date)
State or Country
Parent you resided with
(Rev. 08/07)
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