Application For Admission Page 4
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4Residency Information
Texas law requires state-supported colleges and universities to collect documentary evidence of a student’s Texas residency prior to enrollment. All applicants are
required to answer the questions below. If you have attended school or resided out-of-state, additional proof of residency may be required, and the Office of Admis-
sions and Records reserves the right to determine the validity of documents submitted. Military personnel/dependents must submit proof of military assignment in
Texas at each enrollment. Students who are not U.S. citizens must provide proof of immigration status.
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1. Are you a U.S. citizen?
Yes
No
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If not a citizen, do you hold permanent residence status for the U.S.?
Yes
No
Date permanent resident card issued: ___________________________________________ Number: _____________________________________
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2. Are you a Texas resident?
Yes
No
If yes, please complete items 3-6 and read and sign the Oath of Residency below.
If no, skip items 3-6 and read and sign the Oath of Residency below.
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3. Upon whom are you basing your claim of residence status?
Self
Parent
Legal guardian
If legal guardian, guardianship papers must be provided. (If you are 17 years or younger or a dependent of your parent or legal guardian for federal tax purposes, you
must complete item 5.)
4. If your claim of residence status is based upon self, answer the following questions:
A. How long have you resided in Texas? ________________________________ year(s) and _______________ month(s)
B. Previous state or country of residence? ________________________________________
Date moved to Texas: _________________________
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C. If you came here within the past five years, why did you move to Texas?
Education
Employment
Military
Other
5. If your claim of residence status is based upon parent or legal guardian, please answer the following questions:
A. Name of person upon whom claim is based: ___________________________________________________________________________________
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B. Relationship to you:
Parent
Legal guardian
C. How long has this person resided in Texas? ___________________________ year(s) and _______________ month(s)
D. Previous state or country of residence: _______________________________________________________________
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E. If this person came here within the past five years, why did this person move to Texas?
Education
Employment
Military
Other
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F. Is this person a U.S. citizen?
Yes
No
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If not a citizen, do they hold permanent residence status for the U.S.?
Yes
No
Date permanent resident card issued: ___________________________________ Number _____________________________________
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G. Has parent or legal guardian claimed you as a dependent for U.S. federal income tax purposes for the tax year preceding your registration?
Yes
No
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H. Will this person claim you for the current tax year?
Yes
No
6. Driver’s license information: ___________________ ________________________________ _______________ _______________________________
State
Driver’s license number
Expiration date
License plate number
Oath of Residency
I understand that information submitted herein will be relied upon by college officials to determine my status for admission and residency eligibility. I authorize
Navarro College to verify the information I have provided, to obtain my TSI scores if necessary and to request relevant information from other agencies concerning
my enrollment. I agree to notify the proper officials of the institution of any changes in the information provided. I certify that the information on this application
is complete and correct and understand that the submission of false information is grounds for rejection of my application, withdrawal of any offer of acceptance,
cancellation of enrollment, or appropriate disciplinary action. I also understand that my records may be used in compiling reports for state agencies, the federal
government, and accrediting bodies and in conducting research for program planning, management, and evaluation. My signature below indicates my consent to
the statistical use of my records.
___________________________________________________________________ ____________________________________ __________________________
Signature
Social Security Number
Date
Medical Information
My signature below indicates that I have read the information on bacterial meningitis.
_____________________________________________________________________________________ __________________________________________
Signature
Date
Code of Conduct
I understand that I will be expected to abide by the Navarro College Student Code of Conduct at all times. Failure to fulfill this commitment could result in disci-
plinary action and the possibility of being dismissed from the College.
_____________________________________________________________________________________ __________________________________________
Signature
Date
FINISHED ■
12/2014
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