Microsoft Word 014 07 Residency Declaration

Yüklə 39,69 Kb.

ölçüsü39,69 Kb.




A Florida “resident for tuition purposes” is a person who has, or a dependent person whose parent or legal 

guardian has, established and maintained legal residency in Florida for at least twelve (12) consecutive months 

preceding the first day of classes of the term for which Florida residency is sought. 


Residence in Florida must be a bona fide domicile rather than for the purpose of maintaining a 

residence incident to enrollment at an institution of higher education. 


To qualify as a Florida resident for tuition purposes, you must be a U.S. citizen, a foreign national in a 

nonimmigrant visa classification that grants you the legal ability to establish a bona fide domicile in the 

United States, a permanent resident alien, or legal alien granted indefinite stay by the U.S. Citizenship 

and Immigration Services.  Other persons not meeting the twelve-month legal residence requirements 

may be classified as Florida residents for tuition purposes only if they fall within one of the limited 

special categories authorized by the Florida Legislature pursuant to section 1009.21, Florida Statutes.  

All other persons are ineligible for classification as a Florida “resident for tuition purposes.” 


Living in or attending school in Florida will not, in itself, establish legal residence.  Students who depend 

upon out-of-state parents for support are presumed to be legal residents of the same state as their 



Residency for tuition purposes requires the establishment of legal ties to the state of Florida.  Students 

must verify that they have broken ties to other states if the student or, in the case for dependent 

students, his or her parent has moved from another state. 


Please print if submitting hard copy. 

Name of Student:  ____________________________________ Date of Birth: _____________ 

Student is a:       [  ] U.S. Citizen      [  ] Non-U.S. Citizen     [   ] Permanent Resident      [   ] Other 

Alien Registration Number:  _____________________________   Issue Date: _________________________ 

All non-U.S. citizen students are required to submit documentation of their legal status in the United States as 

issued by the United States Citizenship and Immigration Services office.   




I do not qualify as a Florida resident for tuition purposes for the term for which this application is submitted.  I 

understand that should I qualify for a future term, it will be necessary for me to submit an updated Residency 

Declaration while providing prescribed, supporting documentation to substantiate as “reclassification” of my 

status.  Submission of this required document must occur prior to the beginning of the term for which residency 

is sought.  I do not have to complete any further portion of this form except for the signing below.  


Student Name:  ____________________________________________________  


Signature of Student: (Electronic or ink):_________________________________Date:  __________________ 




[   ]  I qualify as a resident for tuition purposes, as defined by s. 1009.21, Florida Statutes, for the term for which 

this application is submitted .  I understand that it will be necessary for me to provide copies of the required 

documentation upon admission, in order to be considered as a Florida resident for tuition purposes.  I have read 

the residency information on qualifying as a dependent or independent student, and declare that:  (select one of 

the options below): 



[   ]  I am a dependent student, as defined by s. 1009.21(1)(a), Florida Statutes, in that I am eligible to 

be claimed as a dependent under the federal income tax code by the claimant below.  The claimant is my 

“parent” as defined by s. 1009.21(1)(f), Florida Statutes, (i.e., either or both parents of the student, any guardian 

of a student, or any person in a parental relationship to the student).  My parent has maintained legal residence 

in Florida for at least the past 12 consecutive months.  As defined by section 1009.21(1)(d), Florida Statutes, 

“’legal resident’ or ‘resident’ means a person who has maintained his or her residence in this state for the 

preceding year, has purchased a home which is occupied by him or her as his or her residence, or has 

established a domicile in this state pursuant to s. 222.17.” A copy of your parent’s tax return may be requested 

to establish dependence.   


[   ]  I am an independent person who has maintained legal residence in Florida for at least the past 12 

consecutive months.  I provide 51% or more of my own support.  An independent student generally includes a 

person who is at least 24 years old, married, a graduate or professional student, a veteran, a member of the 

armed forces, a ward of the court, or someone with legal dependents other than a spouse, pursuant to the 

United States Department of Education for the purposes of federal financial aid eligibility.  There may be limited 

cases where a person under the age of 24 years old may qualify as an independent student.  Such students will 

be required to verify independence (including financial independence.)  A copy your tax return may be 

requested to establish independence. 


: (check one):     [   ] FALL  [   ]SPRING     [   ]SUMMER 

YEAR:  20 ______ 




Note:  If the student is a dependent, the parent is the claimant and will complete this section and provide 

supporting documentation.  If the student is independent, the student is the claimant and will complete this 

section and provide supporting documentation.   No single document shall be conclusive in establishing 

residency.  Additional documentation, other than what is prescribed, may be requested in some cases.  

All documentation provided is subject to verification.  Evidence of ties to another state may result in 

denial of Florida residency for tuition purposes. 

Claimant/Name of Person Claiming FL Residency:  ___________________________________________ 

Claimant’s Relationship to Student:  _______________________________________________________  

Claimant’s Address:  ___________________________________________________________________ 

____________________________________________  Telephone Number:  ______________________ 

Date Claimant began establishing legal FL residence: _________________________________________ 



Per s. 1009.21(3)(c), Florida Statutes, the residency determination must be documented by the 

submission of written or electronic verification that includes two or more of the documents identified 

below.  No single piece of evidence shall be conclusive. 


Claimant must provide at least one of the following of his/her personal documentation: 

[   ]  Florida voter's registration card


Number:____________________ Issue Date:_____/_____/_____  

[   ]  Florida driver's license. 

Number:_________________________________ Original Issue Date:______/______/______ 

Current Issue Date:  ____/_____/_____


[   ]  State of Florida identification card.   

 Number:___________________ Original Issue Date:______/______/______  

Current Issue Date:  ____/_____/_____ 

[   ]  Florida vehicle registration. 

Number:_______________ Original Issue Date:______/______/_______ 


Current Issue Date:  ______/_______/_______


[   ]  Proof of permanent home in Florida occupied as primary residence for 12 consecutive months  


prior to the student’s enrollment.  (Required:  document such as a deed or other evidence of title to 

property used as primary residence, a homeowner’s policy, a title insurance policy, evidence of a 

property tax payment on the primary residence, or a lease of multiple years’ duration.) 


[   ]  Proof of a homestead exemption in Florida.  (Required:  document from the county tax collector 

demonstrating the application of a homestead exemption to the claimant’s primary residence.) 

[   ]  Official transcripts from a Florida high school for multiple years (2 or more years), if the Florida 

high school diploma or GED® was earned within the last 12 months.  

(Dates of Attendance:_____________________    Graduation Date:  ______/______/_______). (Required: transcript) 

[   ]  Proof of permanent full-time employment in Florida for at least 30 hours per week for a 12- 


month period.  (Required: pay stubs or W-2 form for past 12 consecutive months)




Claimant may provide one or more documents from the following categories to demonstrate 

residency in Florida (to be used in conjunction with one document from above)

[   ]   Declaration of domicile in Florida.



[   ]   Florida professional or occupational license.



[   ]   Florida incorporation.  

[   ]   Document evidencing family ties in Florida   

[   ]   Proof of membership in a Florida-based charitable or professional organization.  


       [   ]   Any other documentation that supports your request for resident status, including, but not  


limited to, utility bills and proof of 12 consecutive months of payments; a lease agreement and  


proof of 12 consecutive months of payments; or an official state, federal, or court document  


evidencing legal ties to Florida.   


QUALIFICATION BY EXCEPTION (to be completed by the student)  


As provided in s. 1009.21, Florida Statutes, I qualify for residency based on the 

following permitted exception (documentation required):  


[   ]  I am a qualified beneficiary under the terms of the Florida Prepaid College Program (s. 1009.98, Florida 

Statutes.)  (Required:  Copy of Florida Prepaid Recipient card.) 

[   ]  I am married to a person who has maintained legal residence in Florida for at least the past 12 consecutive 

months.  I now have established legal residence and intend to make Florida my permanent home.  (Required:  

copy of marriage certificate and/or other documents required to establish residency.) 

[   ]  I was previously enrolled at a Florida state postsecondary institution and classified as a Florida resident for 

tuition purposes.  I am transferring to another Florida state postsecondary institution within 12 months of the 

previous enrollment.   

[   ]  I was previously enrolled at a Florida state postsecondary institution and classified as a Florida resident for 

tuition purposes.  I abandoned my Florida domicile less than 12 months ago and am now re-establishing Florida 

legal residence. 

[   ]  Active duty members of the Armed Services of the United States residing in this state and their spouses 

and dependent children, and active drilling members of the Florida National  Guard.  (Required:  Copy of military 

orders or DD2058 showing home of record.) 

[   ]  Active duty members of the Armed Services of the United States and their spouses and dependents 

attending a Florida College System institution or state university within 50 miles of the military establishment 

where they are stationed, if such military establishment is within a county contiguous to Florida.  (Required:  

Copy of military orders.) 

[   ]  United States citizens living on the Isthmus of Panama, who have completed 12 consecutive months of 

college work at the Florida State University Panama Canal Branch, and their spouses and dependent children.  

(Required:  Copy of marriage certificate or proof of dependency.) 

[   ]  Full-time instructional and administrative personnel employed by state public schools and institutions of 

higher education and their spouses and dependent children.   

[   ]  Students from Latin America and the Caribbean who receive scholarships from the federal or state 

government.  Any student classified pursuant to this paragraph shall attend, on a full-time basis, a Florida 

institution of higher education.  (Required:  proof of scholarship and Latin America or Caribbean residency.) 

[   ]  Southern Regional Education Board’s Academic Common Market graduate students attending Florida’s 

state universities.  (Required:  Certification letter from State Academic Common Market Coordinator.) 

[   ] Full-time employees of state agencies or political subdivisions of the state when the student fees are paid by 

the state agency or political subdivision for the purpose of job-related law enforcement or corrections training. 

[   ]  McKnight Doctoral Fellows and Finalists who are United States citizens.  (Required:  Verification from 

graduate studies.) 


[   ]  United States citizens living outside the United States who are teaching at a Department of Defense 

Dependent School or in an American International School and who enroll in a graduate level education program 

which leads to a Florida teaching certificate.   

[   ]  Active duty members of the Canadian military residing or stationed in this state under the North American 

Air Defense (NORAD) agreement, and their spouses and dependent children, attending a Florida College 

System institution or state university within 50 miles of the military establishment where they are stationed.  

(Required:  proof of active duty membership for specified purpose.) 

[   ]  Active duty members of a foreign nation’s military who are serving as liaison officers and are residing or 

stationed in this state, and their spouses and dependent children, attending a Florida College System or state 

university within 50 miles of the military establishment where the foreign liaison officer is stationed.  (Required:  

proof of active duty membership for specified purpose.) 





I, the undersigned, hereby declare that I have read the foregoing document and that the facts stated in it are 

true and further affirm the authenticity of the information provided on all pages of this Residency Declaration. I 

understand that any false or misleading information on this Residency Declaration, or provided in support of this 

Residency Declaration, will subject me to penalties pursuant to section 837.06, Florida Statutes, for making a 

false statement.  I give permission for the institution to review or examine any and all documents and records, 

including those accessible electronically, which may assist in support of my status as a Florida resident for 

tuition purposes


Student Name (Please Print):  _____________________________________________________________      


Claimant Name (if not the Student):_________________________________________________________ 


Signature of Claimant (Electronic or ink): ___________________________________ Date:  _____________ 




Dostları ilə paylaş:

Verilənlər bazası müəlliflik hüququ ilə müdafiə olunur © 2017
rəhbərliyinə müraciət

    Ana səhifə