Uccs Petition For In State Tuition - University Of Colorado (Page 3 of 4) in pdf

UCCS PETITION FOR IN-STATE TUITION

FIRST DAY OF SEMESTER

DEADLINE FOR SUBMITTING ALL MATERIALS:

STUDENTS UNDER THE AGE OF 23 WHO ARE CLAIMING EMANCIPATION

If you were married 12 months prior to the semester for which you are petitioning, you can submit a copy of your marriage

certificate and leave numbers 12 and 14 blank.

12. List all financial support provided by your parents in the past 12 months.

Month_______ Year________ Amount________

Month_______ Year________ Amount__________

Month_______ Year________ Amount________

Month_______ Year________ Amount__________

13. What is the last year either of your parents claimed you as a dependent on their Federal Tax Return?__________

(Attach copies of your parents’ FEDERAL income tax returns for the period you are claiming emancipation and have your

parents complete the Parent(s) statement for a minor claiming emancipation on last page)

14. List your parents’ home address and all dates you resided there in the past two years:

Address:

Dates you resided there:

__________________________________________________ From_____________________ to________________

15. List your sources of income from employment, loans, financial aid, savings, trust funds, and gifts from friends, relatives,

and parents since emancipation began. (Attach copies verifying EACH source of income, savings, trusts, etc.)

Amount_______ Source__________________________________________________________ Date____________

16. List and compute your expenses for the entire 12-month waiting period:

Rent per month __________X 12 = ____________ =

________________ =Total for the year

Food per month __________X 12 = ____________ =

________________= Total for the year

Misc per month __________X 12 = ____________ =

________________ = Total for the year

Tuition & Fees: Spring________ + Summer_________ + Fall_________ =

________________ = Total for the year

________________ = Grand Total for year

IMPORTANT: If false information or falsified supporting documentation is included in this petition, the petition becomes

void and any resultant in-state classification action based upon this petition becomes retroactively nullified.

THE INDIVIDUAL COMPLETING THIS PETITION MUST SIGN IN THE PRESENCE OF NOTARY AND OBTAIN

THE NOTARY SIGNATURE BELOW.

I hereby swear/affirm that the answers given in this petition are accurate AND complete and that all documents, attached

hereto, are true and unaltered. If my circumstances change, affecting my tuition status, I agree to notify the Admissions and

Records Office, in writing, within 15 days of such change.

Signature of individual completing the form___________________________________________ Date_________________

State of _______________________ County of_____________________

Sworn & Subscribed to me this _______ day of____________, 20______

(SEAL)

Signature of Notary Public______________________________________

My commission expires: _______________________________________

Uccs Petition For In State Tuition - University Of Colorado Page 3