Request Form For Residence Reclassification For Degree-Seeking Students (Page 2 of 2) in pdf

PART II. DOCUMENTATION – The person claiming residency should complete and document the following sections (1-4). If an

independent person, that will be the student; if a dependent person, that will be the parent or legal guardian; if the application is

based upon the residency of a spouse, the information should be on both you and your spouse. COPIES OF ALL

DOCUMENTATION IS REQUIRED AND SUBJECT TO VERIFICATION.

1. PHYSICAL PRESENCE – DOCUMENTATION SUCH AS LEASES, DEED, DORM AGREEMENT, ETC. MUST BE PROVIDED FOR

ALL ADDRESSES WITHIN THE LAST 12 MONTHS.

(Indicate type of residence as follows: lease, own, rent room, family home, dorm.)

Current address: ____________________________________________________________________________________________________________________

How long have you resided at this address? ____________ years ____________ months (TYPE ________________________________________________)

Previous address: ___________________________________________________________________________________________________________________

How long did you reside at this address? ____________ years ____________ months (TYPE __________________________________________________)

If the above addresses do not total 12 months, please account for the other months: _________________________________________________________

ADDITIONAL VERIFICATION FOR PHYSICAL PRESENCE – documentation must be provided for the following:

BANK ACCOUNT: (Attach copies of early and late bank statements or letter from bank.)

Name and location of bank: ________________________________________ Date acc’t opened: ________________ Is it an active account? ___________

SCHOOL(S) – other than FAU:

Name/City/State

Dates attended: from/to

full-time/part-time

__________________________________________________________________________________________________________________________________

OCCUPATIONAL LICENSE: (Attach copy of license/certificate.)

Type of License:_____________________________________________________________ State ____________ Date Issued:___________________________

CLUB MEMBERSHIP: (Attach copy of Membership Card/Certificate.)

Name/type/location of club(s):__________________________________________________ Dates of membership: from ____________ to ______________

EMPLOYMENT – [Provide letter(s) on company letterhead stating dates of employment in Florida, average hours worked per week, whether full- or part-time

status.]

1) Employer’s name/address/phone: ___________________________________________________________________________________________________

Dates employed: from ____________ to ____________ full-time? ______ part-time? ______ Average hours worked per week? ____________________

2) Employer’s name/address/phone: ___________________________________________________________________________________________________

Dates employed: from ____________ to ____________ full-time? ______ part-time? ______ Average hours worked per week? ____________________

2. LEGAL RESIDENCE – IT IS EXPECTED THAT AT LEAST ONE OF THE FOLLOWING BE DATED, ISSUED OR FILED AT LEAST

12 MONTHS PRIOR TO THE FIRST DAY OF CLASSES FOR THE TERM FOR WHICH FLORIDA RESIDENT CLASSIFICATION

IS SOUGHT: (Attach copies)

Drivers License:

State _________

Date Issued __________________

Number_________________________________

Voter Registration:

State _________

Date Issued __________________

Number_________________________________

Vehicle Registration:

State _________

Date Issued __________________

Decal # _________________________________

Declaration of Domicile: Date filed __________________ Date established residence _________________ County _________________________________

3. INTENT – FLORIDA STATUTES SPECIFY THAT YOUR INTENT FOR BEING IN FLORIDA IS NOT PRIMARILY FOR

EDUCATIONAL PURPOSES. The following information is used to determine the intent of the applicant:

Have you been employed in Florida during the last 12 months? Yes ______ No ______ If so, complete the “Employment” section above and provide

documentation as outlined.

Do you own a home in Florida? Yes ______ No ______ If so, provide copy of deed, homestead exemption, etc.

PART III. AFFIDAVIT – THIS SECTION MUST BE SIGNED BY THE PERSON CLAIMING RESIDENCY

I do hereby swear and affirm that the information provided above for the purpose of obtaining Florida residency for tuition purposes is true and correct.

I UNDERSTAND THAT A FALSE STATEMENT IN THIS AFFIDAVIT WILL SUBJECT ME TO PENALTIES FOR MAKING A FALSE STATEMENT PURSUANT

TO 837.06 OF THE FLORIDA STATUTES. I ALSO UNDERSTAND THAT THE UNIVERSITY IS EMPOWERED TO REQUIRE ADDITIONAL

INFORMATION OR DOCUMENTATION IF DEEMED NECESSARY.

___________________________________________________________________________________

___________________________________________

Signature of person claiming Florida residency

Date