Richard Bland College In State Tuition Application printable pdf download

Mail to – Registrar, Richard Bland College, 8311 Halifax Road, Petersburg, VA 23805

FAX - 804-862-6189

Scan and email to

registrar@rbc.edu

Richard Bland College In-State Tuition Application: SIDE A

MUST BE COMPLETED IN INK by the

Applicant

Pursuant to Section 23-7.4 of The Code of Virginia, applicants must complete this form as well as the Supplemental In-State Residency

Information Form. Failure to do so will result in automatic assignment of out-of-state tuition rates.

Applicant’s Legal Name: ____________________________________________________________ Social Security Number __________________________________

EVERY APPLICANT MUST COMPLETE SIDE A.

IF A BOX IS NOT CHECKED, YOUR ANSWER IS ASSUMED TO BE “NO.”

Do any of the following characteristics apply to you? (Please place an “X” in the appropriate boxes.)

IF YOU DO NOT CHECK

“YES” TO ANY OF THE

Yes……….I will be age 24 or older before the first day of classes.



FOLLOWING QUESTIONS

Yes……….I am a veteran of the United States Armed Forces.



Yes……….I will be enrolled in a graduate or professional program (beyond a Bachelor’s).

then your parent or legal guardian must



complete the Supplemental In-State

Yes……….I am married.



Residency Form (side B). Your parent

Yes……….I am an orphan or a ward of the court, or I was a ward of the court until age 18.



or legal guardian’s signature is required

Yes……….I do have legal dependents (other than spouse).



for the Supplemental Residency Form

Yes……….I can present clear and convincing evidence that I am self-sufficient.

to be complete.



Yes……….I am married and wish to claim eligibility for in-state tuition

If you answer “YES” to EITHER question at the right, then your spouse

rates based on my spouse’s domicile.

must complete the Supplemental In-State Residency Form (side B). Your

spouse’s signature is required for the Supplemental In-State Residency



Yes……….My spouse provides over 50 percent of my financial support.

Form to be complete.

For the applicant, how long have you lived in Virginia? _____________________

What is your present city or county of residence? _________________________

Are you a citizen of the United States? ________ If you are a non United States citizen, please indicate your type of VISA __________________________________

Where have you lived for the past two years? List all addresses beginning with the most recent.

From

Street Address

City

State

Zip Code

(mm/yy)

___/____

_______________________________________

_________________________________________

_____________

____________

___/____

_______________________________________

_________________________________________

_____________

____________

Do any of the following characteristics apply to you? (Please place an X in appropriate boxes.)

□ Yes □ No

My legal guardian/spouse provides 50 % or more of my

□ Yes □ No

I owned or operated a motor vehicle during the past year.

financial support.

□ Yes □ No

I have filed taxes to another state. (Please indicate the state

□ Yes □ No

For at least one year prior to the term in which I will

to which you paid taxes.) _______________________.

enroll at Richard Bland College, I have been employed.

□ Yes □ No

I am a registered voter in another state. (Please give the

□ Yes □ No

For at least one year prior to the term in which I will

name of that state.) ______________________________.

enroll at Richard Bland College, I have filed a tax return

□ Yes □ No

I do not have a valid Virginia driver’s license. I have a

or paid income taxes to Virginia on all earned income.

driver’s license from the state of ____________________.

□ Yes □ No

I am a registered voter in Virginia.

□ Yes □ No

I did not own or operate a motor vehicle in this state, but I

□ Yes □ No

I have a valid driver’s license in the state of Virginia.

did have a motor vehicle registered in the State of _______.

: [If you answer YES to any question below, the following documents must be submitted to the Registrar’s Office along with this

Military Service

application before it can be processed.] Copies of (1.) Leave & Earnings Statement; (2.) Orders; and (3.) Copy front & back of Student (dependent’s)

military ID

□ Yes □ No

I am a member of the United States Armed Forces at the present time.

□ Yes □ No

My legal guardian/spouse is presently a member of the United States Armed Forces.

□ Yes □ No

I have attached a copy of the most recent Leave and Earnings Statement from the person who is a member of the US Armed Services.

□ Yes □ No

Virginia income taxes have been paid on all military income for one year prior to the term in which I will be enrolled.

□ Yes □ No

My legal guardian/spouse is in the military. I have resided in Virginia, been employed, earned income that equates to 50 weeks x 40 hours each

multiplied by current minimum wage and paid income taxes to Virginia for at least one year prior to the term in which I will be enrolled.

□ Yes □ No

I/ my legal guardian/spouse have/has changed his/her state of legal residence to Virginia effective on this date __________________.

I have attached a copy of the military orders or other military-acknowledged documentation, which verifies this change.

Answer this question only if you live outside Virginia but work in Virginia:

□ Yes □ No

I have lived outside Virginia, worked in Virginia, earned income that equates to 50 weeks X 40 hours each week X current minimum wage, and

paid Virginia income taxes on all taxable income earned in the Commonwealth for at least one year prior to the term in which I will enroll.

I certify that the above statements are true and correct to the best of my knowledge.

_______________________________________________________________________________________

___________________________________________

Applicant’s Signature

Date

(This form is not complete without a signature.)

Richard Bland College In State Tuition Application

Related Articles

Related forms

Related Categories