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

UCCS PETITION FOR IN-STATE TUITION

FIRST DAY OF SEMESTER

DEADLINE FOR SUBMITTING ALL MATERIALS:

PARENT(S) STATEMENT FOR STUDENTS UNDER AGE 23 CLAIMING EMANCIPATION

This section is ONLY for the parents of minors who are claiming emancipation.

(Attach copies of first page of both parents’ FEDERAL income tax returns filed since the date of emancipation)

17. I, (we), ______________________________________________________________________, the parent(s) of

______________________________________________ have entirely surrendered the right to care, custody, and

earnings of said minor as of________________________. The last time this minor was claimed by me (us) as a state or

federal income tax exemption was __________________ and she/he will not be claimed in this or any subsequent years.

The only support I (we) have provided since emancipation has been:______________________________________________

______________________________________________________________________________________________________

The emancipation referred to herein is an absolute emancipation for all purposes whatsoever, and was not done for the

purposes of tuition classification. If divorced, we certify that there is no court order in effect which requires the payment of

child support on behalf of this minor. (Each parent must sign, even though only one might have custody.)

Father’s Signature____________________________________ Mother’s Signature__________________________________

NOTARY:

State of ___________________________________)

County of __________________________________)

Sworn & Subscribed to me this _________ day of _____________, 20_______

Signature of Notary:_______________________________________________

(SEAL)

My commission expires: ___________________________________________

DO NOT WRITE BELOW THIS LINE

Additional information required:___________________________________________________________________________

______________________________________________________________________________________________________

Tuition Classification Decision:

Approved

Denied

Date:________________________

Effective:

Spring

Summer

Fall

20______

Decision by:__________________________

Notes: ________________________________________________________________________________________________

______________________________________________________________________________________________________

Revised 06/12

Uccs Petition For In State Tuition - University Of Colorado Page 4