Sample Application For Classification As An "In-State" Student For Fee And Admissions Purposes Page 4
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5MARITAL
18. Are you Married
Single
For what reasons did spouse come to Tennessee to
establish most recent domicile _______________________
If married, spouse’s name
_______________________________________________
_______________________________________________
(Last Name)
(First Name)
(Middle Name)
20. Is spouse employed full-time? Yes
No
19. Has spouse been domiciled in Tennessee continuously
21. How long has he/she been in present position? ______
since birth? Yes
No
22. His/her employer in Tennessee ___________________
If NO, when did spouse begin his or her most recent domicile
in Tennessee?
_______________________________________________
_______________________________________________
(Month)
(Year)
_______________________________________________
PARENTAL INFORMATION
23. Father’s name ____________________________________________________________________________________
(Last Name)
(First Name)
(Middle Name)
24. Father’s address __________________________________________________________________________________
(Street & Number)
(City)
(State)
25. Mother’s name ____________________________________________________________________________________
(Last Name)
(First Name)
(Middle Name)
26. Mother’s address __________________________________________________________________________________
(Street & Number)
(City)
(State)
27. Do you have a legally appointed guardian? Yes
No
If YES, guardian’s name ________________________________________________________________________________
(Last Name)
(First Name)
(Middle Name)
28. Guardian’s address ________________________________________________________________________________
(Street & Number)
(City)
(State)
29. If your parent or guardian is not presently domiciled
30. If parent or guardian is not presently domiciled in
in Tennessee, has he/she previously been domiciled in
Tennessee, but was domiciled here in the past, state reason
for leaving _______________________________________
Tennessee? Yes
No
If YES, Give previous Tennessee address
_______________________________________________
_______________________________________________
31. Did either parent or your guardian claim you as a
(Street & Number)
dependent on his/her most recent income tax return?
Yes
No
_______________________________________________
(City)
(State)
(Documentation: photocopy of address & dependent sections
Dates of previous domicile in Tennessee:
of tax form )
from ____________________ to _____________________
MILITARY
32. Have you served in active military service?
State in which you were discharged ___________________
Yes
No
Home of Record as listed on D.D. Form 214 ____________
If YES, from what state did you enter service? __________
_______________________________________________
(Documentation: photocopy of D.D. Form 214)
_______________________________________________
Date of discharge _________________________________
Date of entry into service ___________________________
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