Sample Application For Classification As An "In-State" Student For Fee And Admissions Purposes Page 3
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510. All colleges and universities attended (other than The University of Tennessee)
___________________________________________________________________ from
____________ to ___________
(Name)
(State)
(Dates of Attendance)
___________________________________________________________________ from
____________ to ___________
(Name)
(State)
(Dates of Attendance)
___________________________________________________________________ from
____________ to ___________
(Name)
(State)
(Dates of Attendance)
___________________________________________________________________ from
____________ to ___________
(Name)
(State)
(Dates of Attendance)
(If more, attach separate sheet)
11. Have you previously attended The University of Tennessee?
________________________
Campus
Dates of Attendance
UT at Chattanooga
from
_________ to _________
UT, Memphis
from
_________ to _________
UT, Knoxville
from
_________ to _________
UT at Martin
from
_________ to _________
12. Have you ever been classified as an in-state resident by
If so, please give details __________________________
a state-aided institution in Tennessee? Yes
No
_____________________________________________
_____________________________________________
CITIZENSHIP
13. Are you a Citizen of the U.S.? Yes
No
15. Have you filed state or federal income tax form for
previous year? Yes
No
If NO, What is your status in this country (e.g., type of
If YES, what address was given as residence?
visa)? __________________________________________
_______________________________________________
_______________________________________________
(Street & Number)
_______________________________________________
14. Are you registered to vote? Yes
No
(City)
(State)
(Zip Code)
If YES, in what state are you registered to vote?
(Documentation: photocopy of address section of form(s).)
_______________________________________________
(Documentation: photocopy of voter registration card.)
EMPLOYMENT
Dates of employment ______________________________
(Documentation: Letter from employer which verifies the
below information.)
Job Title ________________________________________
16. Are you presently employed? Yes
No
If appropriate, what percentage of your on-the-job time is
If YES, employer’s name ___________________________
spent out-of-state? ________________________________
_______________________________________________
_______________________________________________
Employer’s address _______________________________
Hours worked per week ____________________________
FINANCIAL SUPPORT
17. List every source from which you received more than
_______________________________________________
approximately ten percent (10%) of your support or income
_______________________________________________
during the past twelve months _______________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
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