Affidavit And Application For Certificate Of Residence Form printable pdf download

AFFIDAVIT AND APPLICATION FOR CERTIFICATE OF RESIDENCE

Pursuant to Section 6305 of the Education Law*For Attendance At A Community College

APPLICATIONS ARE ACCEPTED BY MAIL ONLY

PRINT ALL INFORMATION

PROOF OF ADDRESS MUST BE SUMITTED WITH APPLICATION

INCOMPLETE APPLICATIONS WIll BE RETURNED

U.S. CITIZENSHIP STATUS: Please Check Box

STATE OF NEW YORK

COUNTY OF WESTCHESTER

Citizen ___ Resident Alien* ___ Other-Visa*____

* Attach Copy of Permanent Resident Card Or Visa

Social Security Number _____________________

I ___________________________ hereby swear that I reside at ______________________________________________

FULL NAME

STREET ADDRESS

in the City, Village, Town of _________________________________________, County of Westchester, State of New York.

NAME OF TOWN/ZIP CODE

That I now am, and have been for a period of at least one year immediately prior to the date of this affidavit and

application, been a resident of the State of new York, that I am now, and have been for a period of at least six months

immediately prior to the date of this affidavit and application been, a resident of the County of Westchester, and that I

have lived at the above address(s) during the year immediately prior to the date of this affidavit and application.

If less than one year at the above address complete the following

Address

From/To

_____________________________________________________

_________________________________

____________________________________________________

________________________________

I plan to enroll in _________________________________for the Semester beginning __________________________

SCHOOL NAME

DATE

And that this affidavit and application is made for the purpose of securing from the Chief Fiscal Officer of the County of

Westchester a Certificate that the applicant has met the residency requirement of Article 126 of the Education Law.

Sworn to before me this

___________________________________

_____ day of ________________________ ______

Signature of Applicant

______________________________

Notary Public

*Education Law, Section 6305, provides: “The chief fiscal officer of each county, as defined in Section 2.00 of the Local Finance Law, shall, upon

application and submission to him/her of satisfactory evidence, issue to any person desiring to enroll in a community college as a non-resident student, a

certificate of residence showing that said person is a resident of said county …Such person shall, upon his registration for each college year, file with the

college a certificate issued not earlier than two months prior thereto, and such certificate of residence shall be valid for a period of one year from the date

of issuance. Education Law, Section 6301, Paragraph 4 defines: Resident – person who has resident in the State for a period of at least one year and in

the county, city, town, intermediate school district or school district, as the case may be, for a period of at least 6 months, both immediately preceding the

date of such registration in a community college.

This Space For use of the Chief Fiscal Officer of County

Certificate Issued

____________________________

By ___________________________________________________

Revised June 2014