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Residency Reclassification Request Form
RESIDENCY RECLASSIFICATION
A student who is classified as out-of-state and wishes to request “reclassification” to in-state status must complete a Residency Reclassification
Request Form. The Reclassification Form must be submitted on or before the last day of registration/add drop of the Term/Session for which Florida
residency is sought. Refer to the “Registration Calendar” within the appropriate Term's Class Schedule for registration deadlines.
A student, or his or her parent if that student is a dependent, may become eligible for reclassification by presenting a minimum of three (3)
documents. One of the three documents must be from the First Tier. Please review page 3 or
for additional residency guidelines.
Copies of all supporting documentation must accompany this request for residency reclassification.
Living or attending school in Florida DOES NOT automatically qualify a student for Florida residency. Maintaining a legal residence in Florida requires
substantial physical presence.
Ties to another state or country WILL DISQUALIFY a student from Residency Reclassification.
STUDENT INFORMATION
Student Name_______________________ ______________________
_________________ Date of Birth____/____/____ Connections User ID__________________________
Last
First
Middle
Did you submit a Readmission Application?
Yes
No
Telephone ( ______)_______________________ E-mail ________________________________@_______________
U.S. Citizen?
Yes
No (
)
Non U.S Citizens: Legible copy of current immigration document required-resident alien card, Visa and I-94 card, etc.
complete Immigration Info
Immigration: Alien Resident?
Yes
No
Alien Number ______________________ Visa Type _______ Expiration Date________________ Other_____________________
First Term Enrolled
Fall
Spring
Summer
Year__________
Term Requesting Residency Change
Fall
Spring
Summer Year__________
Date you Established Legal Residence in Florida _______\______\_________
What is your current enrollment?
Full-time (12 credits or more)
Part-time
Less than Part-time
REQUIRED PROOF
CLAIMANT
PLEASE CHECK THE BOX THAT APPLIES TO YOUR CLAIM OF FLORIDA RESIDENCY
(See page 1 for additional information)
I am an independent person at least 24 years of age and have maintained legal
Three documents meeting the 12-month requirement.
Student
residence in Florida for at least 12 consecutive months.
At least one document MUST be from the First Tier.
I am a person under the age of 24, have maintained legal residence in Florida for at
Proof of independence status and three documents
Student
least 12 consecutive months but want to be considered as independent for tuition
meeting the 12-month requirement. At least one
purposes.
document MUST be from the First Tier.
I am a qualified beneficiary under the terms of the Florida Pre-Paid Program 1009.98.
Copy of current Florida Prepaid Card.
Student
I am a dependent person under the age of 24 and my parent or legal guardian has
Three documents meeting the 12-month requirement.
Parent or legal
maintained legal residence in Florida for at least 12 consecutive months.
At least one document MUST be from the First Tier.
guardian
I am a dependent person who has resided for five years with a legal resident adult
Documentation of relationship and three documents
Relative
relative other than my parent or legal guardian. Documentation of relationship
meeting the 12-month requirement. At least one
(proof
required-
Relative tax returns for the last five years, public school or court
document MUST be from the First Tier.
required for
documentation of relationship.
relative &
student)
I am married to a person who is a legal Florida resident. I have now established legal
Marriage license. Spouse must complete the required
Spouse
residence and intend to make FL my permanent home. Student must provide at
information section on page 3. Documentation must
(FL residency
least one document to show legal residence in FL. The document does not have to
meet the 12-month requirement. At least one
required for
document MUST be from the First Tier.
student)
satisfy the 12-month requirement. Type of document________________________
I am a full-time instructional or administrative employee of a Florida public school,
Employment verification letter/form. Dependent proof
Qualified
community college or university, or I am the employee’s spouse or dependent child.
required- current tax return and/or marriage certificate.
employee
Full-time employees of state agencies or political subdivisions of the state when the
Employer paperwork (law enforcement or corrections)
Qualified
student fees are paid by the state agency or political subdivision for the purpose of
showing fee coverage.
employee
job-related law enforcement or corrections training.
Active duty member of the Armed Services of the United States residing or stationed
Military orders (stationed in FL), DD2058 (FL home of
Active Duty
in Florida; or military personnel not stationed in Florida whose home of record or
record), or military docs showing home of record.
Member
Dependents must submit supporting military docs.
state of legal residence certificate DD Form 2058, is Florida (and spouse/dependent
children).
Active drilling members of the Florida National Guard residing or stationed in Florida.
Military orders (stationed in FL), DD2058 (FL home of
Active Duty
record), or military docs showing home of record.
Member
Active duty members of the Armed Services of the United States (and
Military orders stationed in Kings Bay, GA. Dependents
Active Duty
must submit supporting military documents.
spouse/dependent children) attending a public community college or state university
Member
within 50 miles of the military establishment where they are stationed, if such
military establishment is within a county contiguous to Florida.
Eligible Base: Naval Base Kings Bay , GA.
Active duty members of the Armed Services of the United States residing or
Military orders (stationed in FL), DD2058 (FL home of
Active Duty
stationed in this state, their spouses and dependent children, and active members of
record), or military docs showing home of record.
Member
Dependents must submit military docs and Tuition
the Florida National Guard who qualify under s. 250.10 (7) and (8) for the tuition
assistance program.
Assistance (TA) proof.
I am a permanent resident alien, legal alien or eligible non-immigrant category,
Immigration documentation and Three documents
Student
granted indefinite stay by the U.S. Citizenship and Immigration Services, and have
meeting the 12-month requirement. At least one
maintained legal residence in Florida for at least 12 months. Staff will review
document MUST be from for the First Tier
dependency status.
To Be
Other-Please explain:__________________________________________________________________________________________________
Determined
Florida State College will review and determine required proof.
Admissions Revised 9/12
Page 2 of 3
Print and Sign. Return this form to your campus Student Success Center or fax to the Welcome Center (904) 633-5955.

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