Military Residency Verification Form (Page 2 of 2) in pdf

Military Residency Verification Form

Certification Documentation

The bulleted documentation must be presented in person, by the student, to the Registrar’s

office located in the Alexander Student Center. All documentation must be presented

on/before the first day of classes for the semester in which enrollment occurs.



Proof (e.g., military orders) of active duty status/permanent duty assignment in Missouri



Verification of military member and dependent’s residence in Missouri (e.g., driver’s license, or any

number of ways of demonstrating residency in Missouri, such as a copy of a utility bill, a lease, etc.), and



Military ID card



DD2058 change of legal residence (if applicable)

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Certification of Dependent/Spouse Relationship

Please complete this section if in‐state status is requested for your spouse or dependent.

I, _______________________, certify that the above named student is my dependent for

Federal Income Tax purposes or is my spouse.

Certification of Eligibility:

I, _______________________, certify that I am a member of the Armed Forces of the United

States presently stationed at _____________________. I anticipate no change in my military

status or duty station prior to the first day of classes for the semester which this application is

filed. I request in‐state status for:

_____Self

_____Spouse _____Dependent

FOR

_____Year

Indicate Semester: _____Fall

_____Spring _____Summer

_______________________________________

_________________________

Signature of Military Member

Date

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Certification of Commanding Officer or Designee

I certify that the above information concerning military status, duty station and relationship is,

to the best of my knowledge and believe, true and correct.

_______________________________________

_________________________

Signature of Commanding Officer/Designee

Date

Page 2 of 2

Please return to Registrar’s Office, Alexander Student Center

Military Residency Verification Form Page 2