Supplemental Residency Questionnaire Template Page 2
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4PART C - TO BE COMPLETED BY STUDENTS WHO ARE NOT UNITED STATES CITIZENS
1. What is your immigration status? (Check one)
(a)
[ ] Nonimmigrant Visa Holder
Type:
_______________
Date Issued: _______________ Expiration Date: ______________
Entry D ate: _______________ Admitted Until: ______________
(b)
[ ] Lawful Permanent Resident Alien (Green Card Holder)
Adjustment Date: ___________________________
Alien Number:
___________________________
(c)
[ ] Applicant for Lawful Permanent Residence
Date Applied:
___________________________
If you have an immigrant visa, enter type: ________
(d)
[ ] Lawful Temporary Resident (or Applicant for Lawful Temporary Residence)
Adjustment Date: ___________________________
Alien Number:
___________________________
If an applicant, date applied: ____________________
(e)
[ ] Political Asylee or Asylum Applicant
Date Applied/Granted: ________________________
(f)
[ ] Refugee
Date Applied/Granted: ________________________
(g)
[ ] Family Unity Program Beneficiary (or Applicant)
Date Applied/Granted: ________________________
(h)
[ ] Temporary Protected Status (“TPS”) (or Applicant for TPS)
Date Applied/Granted: ________________________
(i)
[ ] Violence Against Women Act (“VAWA”) Self-Petition Grantee (or Applicant for Self-Petition)
Date Applied/Granted: ________________________
(j)
[ ] Undocumented
Check here if you entered the United States without the authorization of
the U. S. Bureau of Citizenship or Immigration Services or if your visa expired.
2. If you have a Work Authorization Card (e.g., I-688B), enter the following:
Category (i.e., Provision of Law): ______________________
Card Valid From: ___________________________________
Expires: __________________________________________
Please bring documentation of your immigration status with you. If you are under 19, please bring documentation of your parent’s or
guardian’s immigration status as well.
PART D – TO BE COMPLETED BY STUDENTS WHO ATTENDED THIS COLLEGE IN THE PAST YEAR
1. Where do your parents live? (Indicate the state or country)
Mother’s residence: ______________________________
Father’s residence: _______________________________
2. Do your parents contribute to your financial support?
[ ] Yes
[ ] No
3. Check all sources of your financial support in the current year and the past year:
[ ] Parents
[ ] My employment
[ ] My spouse
[ ] Financial aid
[ ] Someone else
4. Please bring a copy of your federal and state tax returns for the most recent year. If your earnings, as shown on your tax return, are less than
$12,000, also bring a copy of your parents’ most recent state and federal tax returns.
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