Request For Determination Of Residency Status


Name: _______________________________________________ DMACC ID #: ___________________________
Address: _____________________________________________________________________________________
(Number & Street)
(Apt. #)
(City & State)
I hereby state that I
am not living in Iowa primarily for educational purposes; and
Have resided here for a period of not less than ninety (90) days prior to the first day of the semester in
which you will be attending; and
am providing supporting documentation proving Iowa residency (See list of acceptable documents below.)
am not classified as a non-resident by another Iowa university.
Please note that a student cannot be a resident of two states at the same time. If your home is in another state
and you are living in Iowa for the purpose of attending school, you are a resident of your home state and not
a resident of Iowa.
By submission of documented evidence of residency, I am asking to be classified as a resident of Iowa for tuition and
fee purposes.
Date of Request:
(Signature of Applicant)
(Month) (Day) (Year)
At least two dated documents are required by the Iowa Department of Education. The first document you must
provide must be from one of the items listed in 1 through 5 below. The second document you must provide may be
from 1 through 7. These documents must be submitted prior to the first day of the semester for which you are
registering. Residency status cannot be re-classified once the semester begins.
_____ 1. Iowa driver’s license
_____ 2. Iowa vehicle registration form
_____ 3. Iowa state income tax return, signed and dated
_____ 4. Iowa voter registration card
_____ 5. Proof of Iowa Homestead credit on property taxes
_____ 6. Written and notarized documentation from an employer that you are employed in Iowa
_____ 7. Other indicators of Iowa residency, such as apartment lease dated and signed by both you and the manager,
utility bills, bank statements, etc., dated and showing your Iowa address. (No two of these items can relate
to the same source, i.e., apartment lease and utility bill.)
If you are not a citizen of the United States, you will also need to:
1. Submit proof of your legal immigration status in the form of a copy of an I-94 card showing appropriate
status OR
2. Submit a copy of your U.S. Permanent Resident Card.
Send this completed form and documentation to Des Moines Area Community College, Registrar, Building 1, 2006
South Ankeny Boulevard, Ankeny, IA 50023-3993.
I have reviewed this student’s application for Iowa residency status and have taken the following action:
____Request Granted
_____Request Denied (see Comment below)
Reason for denial of request: ______________________________________________________________________
(Signature and title of Official)
(Month) (Day) (Year)
Supersedes all forms prior to 7/10


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