Application For Virginia Instate Tuition Rates printable pdf download

Application For Virginia Instate Tuition Rates

Application for Virginia

Rev. 12/2013

In-State Tuition Rates

Instructions: All students must complete this form to apply for the in-state rates. Students who do not complete this form will automatically be

charged the out-of state rate. Please complete the form in its entirety including the signature of the student and parent(s) or legal guardian. If a

legal guardianship exists, copies of the court order must accompany the completed application. All relevant documentation in support of the

student’s claim to in-state tuition should accompany this application. Completed applications must be received in the Office of the Registrar prior to

the first day of the term. Applications received on or after the first day of the term will be considered for the subsequent term.

A. Applicant Information

LEGAL NAME:

(Please Print)

CNU STUDENT

SOCIAL SECURITY

ID NUMBER:

NUMBER:

HOME PHONE NUMBER:

WORK PHONE NUMBER:

CELL PHONE NUMBER:

E-MAIL ADDRESS:

MAILING ADDRESS:

1. Are you a U.S. citizen?

Yes

Non-Permanent Resident/Visa Type: ____________________

2. How long have you resided in Virginia? _____Years _____Months

3. Where have you lived in the last two years? Please list current address first:

Street Address

City

State Zip

From (mo/yr)

To (mo/yr)

__________________________________________________________________________________________

Do your parents/legal guardian/spouse provide 51% or more of your financial support OR claim you as a tax

dependent?

Yes

If YES, sign Section D and request your parent/legal guardian/spouse to complete sections B and D. Section

C does not have to be completed. If NO, you must complete sections C and D.

B. Parent, Spouse, or Legal Guardian Information

NAME

(Please Print)

SOCIAL

RELATIONSHIP

Mother

Father

Legal Guardian*

SECURITY

TO APPLICANT

Spouse

NUMBER

DATE OF BIRTH

HOME PHONE NUMBER:

WORK OR CELL

E-MAIL ADDRESS:

PHONE NUMBER:

MAILING ADDRESS:

Application For Virginia Instate Tuition Rates

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