California Residency Reclassification Form

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City College of San Francisco
California Residency Reclassification Request
Semester:  Fall
 Spring
 Summer
Year: _______
Student Name
Last
First
Middle
Student I.D.
Address
Birth Date
Phone #
City
State
Zip
Email
Legal Status
U.S. Citizen
Permanent Resident
Number _________________
Issue Date ____________
Exp. Date ____________
* My Permanent Resident Card has expired and I will file an application for a new Permanent Resident Card.
Expired Visa
Refugee/Asylee
Date Issued ______________
Current Visa Status ____________________
Issue Date ______________
Exp. Date ______________
Physical Presence and Intent
Date California became your permanent home
_____________________________
Where were last two years’ state income tax returns filed?
and
______________________
____________________
State/Year
State/Year
If no taxes were filed, explain
_________________________________________________________________________
Do you own or rent CA property? __________________
Since what date? ____________________
If registered to vote, in what state? ________________________________________
Do you have a valid CA drivers license or ID? _______________________
Issue Date __________________
In what state is your automobile registered? ________________________
Reg. Date ___________________
Were you employed in California this past year? __________________
Employer ______________________________________ Dates of Employment ___________ to ____________
Additional proof of residency ______________________________________________________________________
_______________________________________________________________________________________________________
Military Service
Are you an active member of the U.S, armed forces? _______________
Are you a dependent or spouse of an active military member? _______________
Legal state of residence on military records ______________________________________________________
Expiration of ID card ______________________
Financial Independence For unmarried students under 24 years of age
Were you claimed as an exemption for state tax purposes by your parent(s) within the last two years?
Yes
No
What year(s) _____________ What state(s) _________________________________
Were you claimed as an exemption for state tax purposes by only one of your parents within the last two years?
Yes
No
What year(s) _____________ What state(s) _________________________________
Will your parent(s) claim you as a dependent for state tax purposes for the current calendar year?
Yes
No
What year
_____________ What state ___________________________________
I declare under penalty of perjury that the statements and documents submitted by me in connection with the determination of my residency
are true and correct and I will notify the Office of Admissions and Records if there is any change in any of the facts regarding my residency.
Signature:
Date:
________________________________________________________________________
____________________________

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