Sample Application For Classification As An "In-State" Student For Fee And Admissions Purposes (Page 5 of 5) in pdf

AUTOMOBILE

33. Do you have a driver’s license? Yes

34. Do you own an automobile? Yes

If YES, what state issued the license? _________________

If YES, in what state is your automobile registered?

(Documentation: photocopy of license.)

_______________________________________________

(Documentation: photocopy of auto registration.)

Driver’s License Number ___________________________

Automobile License Number ________________________

REAL ESTATE

35. Do you own the dwelling in which you live? Yes

(Documentation: photocopy of bill of sale, or mortgage papers, or other

If YES, date of purchase ____________________________

public record)

OTHER IN-STATE CLASSIFICATION

36. Have you been classified for tuition or fee purposes as

If YES, date classification was made and by whom

an in-state resident of any other state? Yes

_______________________________________________

OTHER INFORMATION

37. Provide any further information which you wish to offer

in support of your application ________________________

_______________________________________________

TO BE COMPLETED BY ALL APPLICANTS

My signature below is to certify to the correctness and com-

and that I further understand that any false information pro-

pleteness of the information supplied. It further indicates

vided in the foregoing statements will disqualify me from

that I understand that The University of Tennessee may

being considered an in-state student for fee and admission

contact any of the persons referred to above for the pur-

purposes and I may be required to withdraw from The Uni-

pose of obtaining additional pertinent information,

versity of Tennessee.

Date _______________________________ Signature of Applicant ______________________________________________

State of __________ County of _____________ Subscribed and sworn to before me this _____ day of __________ , 19 ___

Notary Public ________________________________________ My Commission Expires ____________________________

____________________________________________

Please do not write below this line

Special Conditions: ________________________________

Determination:

Resident

Non-Resident

_______________________________________________

By: _____________________________________________

_______________________________________________

Date: ___________________________________________

_______________________________________________

Sample Application For Classification As An "In-State" Student For Fee And Admissions Purposes Page 5

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