Arizona Domicile Affidavit
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4ARIZONA DOMICILE
AFFIDAVIT – SPRING 2014
NEW OR TRANSFER
CONTINUING UNDERGRADUATE
GRADUATE STUDENT
STUDENT
STUDENT
(NEWLY ADMITTED)
(CURRENTLY ENROLLED)
SPRING 2014 term
SPRING 2014 term
SPRING 2014 term
Submit this petition by the
Submit this petition by the
Submit this petition by the
JANUARY 24, 2014 deadline to:
JANUARY 24, 2014 deadline to:
JANUARY 24, 2014 deadline to:
Office of the Graduate College
Office of Undergraduate Admissions
Office of the Registrar
Ashurst/Old Main Building 11,
Sechrist Resource Center
Gammage Building 01, Room 112
Room 107
Sechrist Hall Building 42
P.O. Box 4103
624 S. Knoles
P.O. Box 4084
Flagstaff, AZ 86011-4103
Flagstaff, AZ 86011-4125
Flagstaff, AZ 86011-4084
Phone: (928) 523-5359
Phone: (928) 523-4348
Phone: (928) 523-5511
This ARIZONA DOMICILE AFFIDAVIT is designated for students dependent on parents who are domiciled in Arizona.
First Day to Submit AZ Domicile Affidavit
Monday – October 28, 2013
Graduate Students may submit petition prior to this date.
Deadline to Submit AZ Domicile Affidavit
Friday – January 24, 2014
Deadline to File Reclassification Appeal
Friday – February 21, 2014
This affidavit is provided to assist students and parents who wish to claim an Arizona domicile. The normal one year
requirement for residency can be waived for those students who can document the following two criteria:
(1) Both the student and his/her parent(s) are domiciled in Arizona AND
(2) The person is eligible to be claimed by his/her parent(s) as an Arizona tax dependent.
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ANY SECTION LEFT BLANK MAY JEOPARDIZE THE STUDENT'S CASE FOR RESIDENCY.
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This form must be completed, notarized, and returned to the Residency Classification Office. Submit this affidavit and
supporting documents to the appropriate office as indicated above.
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Supporting evidence must be provided as clear and legible photocopies.
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The student will be contacted if the office requires further information.
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The student will be notified of the classification decision by mail.
PART I: STUDENT INFORMATION
NAU ID #
Undergraduate New/Transfer
Undergraduate Cont. Student
Graduate
Full Legal Name _________________________________________
E-mail Address _________________________________
Complete Mailing Address __________________________________________________________________________________
Street
City
State
Zip
Phone Number (
)
Date of Birth _________________________
Age ______________
Place of Birth
Date/Location of High School Graduation _____________________________
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