Supplemental Residency Questionnaire Template (Page 3 of 4) in pdf

PART E - SPECIAL EXCEPTIONS TO BE COMPLETED WHERE APPLICABLE

In some cases, even if you have not been in California for more than a year and a day, you may still qualify for either residence classification

or a tuition/fee waiver under one of the following special exceptions provided by law. Check if any one of the following exceptions applies,

and please bring the requested documentation (an original and one copy) with you.

[ ] Self Support

[ ] To Be Hired By a Public Agency as a Peace Officer

If you are under 19 years of age, and you have supported yourself

If a public agency (e.g., city, county, district or other local authority

financially for at least one year and a day, please provide the

or public body of or within the state of California) intends to classify

following:

you as a peace officer upon successful completion of a police

(1) Documentation of employment (either your W-2 forms or a

academy training course at an LACCD college, please provide the

letter from your employer showing earnings for the past year),

following:

(2) A statement that you have actually been present in California for

(1) Evidence that you have passed all other requirements of the

the past year, AND

hiring public agency AND

(3) A statement showing all your expenses for the past year.

(2) Evidence that the public agency intends to classify you as a peace

officer.

[ ] Dependent of a Military Member

If you are a child or spouse of a member of the armed forces of the

[ ] Agricultural Laborer for Hire (or Child of Such Laborer)

United States who is stationed in California, please provide the

(“Agricultural labor for hire” means seasonal employment in

following:

connection with actual production of agricultural crops, including

(1) A statement from the military person’s commanding officer or

seeding, thinning and harvesting. ) If your parent earns a livelihood

personnel officer AND

by performing agricultural labor for hire, please provide the

(2) Evidence that you are a dependent of the military person’s for

following:

federal tax purposes.

(1) Evidence that your parent with whom you live earns a livelihood

primarily by performing agricultural labor for hire and has performed

[ ] Military Member on Active Duty in California

such labor in California for at least two months in each of the two

If you are a member of the armed forces of the United States

preceding years,

stationed in California on active duty and not assigned for

(2) Evidence that your parent lives within the district, AND

educational purposes to an LACCD college, please provide the

(3) Proof that your parent claims you as a dependent on his/her

following:

income tax return, if your parent had sufficient income to incur

(1) A statement from your commanding officer or personnel officer

personal income tax liability.

that the assignment to active duty in California is not for

educational purposes AND

If you are a agricultural laborer for hire, please provide evidence

(2) Evidence of the date of assignment to California.

showing that you earn a livelihood primarily by performing

agricultural labor for hire and that such labor has been performed in

[ ] Military Member Remaining in California After

California for at least two months in each of the preceding two years.

Discharge

If you were: (1) a member of the armed forces of the United States

[ ] Relocated Federal Civil Service Employee (or Child of

who was stationed in this state on active duty for more than one

Such Employee)

year immediately prior to being discharged AND (2) have remained

If you or your parent is a federal civil service employee who moved

in California after your discharge for less than a year and a day, you

to California as a result of a military mission realignment action that

may be eligible for resident classification. Please provide a copy of

involved the relocation of at least 100 employees, please provide:

your Military Discharge Form, DD-214.

(1) Evidence of such employment AND

(2) Evidence of the reassignment to California.

[ ] Public School Employee With a Valid Credential or

Emergency Permit

[ ] Graduate of a School in California Operated by the United

If you hold a valid credential or a valid emergency permit

States Bureau of Indian Affairs

authorizing service in the California public schools, are employed

If you are a graduate of any school located in California that is

by a school district in a full-time position, and are enrolling in an

operated by the United States Bureau of Indian Affairs, including,

LACCD college to fulfill credential requirements, please provide

but not limited to, the Sherman Indian High School, please provide a

the following:

copy of your diploma.

(1) A statement from your employer showing that you are employed

in a full-time position requiring certification qualifications AND

[ ] Surviving Dependent of Any Individual Killed in the

(2) A copy of your credential.

September 11

Attacks

If you are a surviving dependent of an individual killed in the

[ ] Full-Time Employee of a California State Agency

September 11, 2001 terrorist attacks (i.e., the World Trade Center in

Assigned to Work Outside California (or Child or Spouse of

New York City, the Pentagon in Washington, D.C., or the crash of

Such Employee)

United Airlines Flight 93 in Pennsylvania) and you were given

If you, your parent or spouse is a full-time employee of a California

written notice of eligibility for a tuition and fee waiver by the

state agency (i.e., any office, department, division, bureau, board or

California Victim Compensation and Government Claims Board,

commission of the state of California) and assigned to work outside

please provide a copy of your notice of waiver.

California, please provide the following:

(1) Evidence of such employment AND

(2) Evidence of the out-of-state assignment.

Page 3 of 4

Supplemental Residency Questionnaire Template Page 3

Related Articles

Related forms

Related Categories