Florida Residency Reclassification For Tuition Purposes Form (Page 2 of 2) in pdf

SANTA FE COLLEGE

3000 NW 83

Gainesville, FL 32606

Telephone: (352) 395-5000

Florida Residency Reclassification for Tuition Purposes

PLEASE PRINT

Term Requested:

________________

Student’s Name:

Student ID:

Name of Claimant

Relationship to Student

(The CLAIMANT is the person who is claiming Florida residency, e.g., the applicant ( if independent), parent, spouse or leg al guardian. All of the questions below pertain to the claimant.)

Permanent Address

City

State

Zip

Telephone _______________

Definitions:

Dependent:

A person, whether or not living with his or her

parent, who is eligible to be claimed by his or her

parent as a dependent under the federal income tax

code.

Independent

A person who provides more than 50 percent of

his/her support, as determined by the state of

Florida

Did your parent (s) claim you on their most recent income tax return? Yes No

(

Students under the age of 24 must provide a copy of their parents’ and their most recent IRS tax transcript)

Date Claimant Began Establishing Legal Residence in the state

mm/dd/yy

All documentation must be dated at least one year prior to the first day of the term (Note* A minimum of 3 documents

required for reclassification - one must be a tier one document) FS1009.21.

Additional information on residency can be found at:

Claimant’s Voter Registration:

State:

County:

Number:

Registration date

mm/dd/yy

Claimant’s Driver’s License:

State

Number:

Issue date

mm/dd/yy

Claimant’s Vehicle Registration: State

Tag Number:

Issue date

mm/dd/yy

Citizenship:

U.S. Citizen

Permanent Resident Alien

Asylee or Refugee Alien

Other

Resident Alien Number

Date Card Issued

(Copy of both sides of card required)

Do you own a home in Florida?

Yes

(If Yes, provide proof of Homestead Exemption)

ADDITIONAL DOCUMENTATION MAY BE REQUESTED BY THE INSTITUTION

I do hereby swear or affirm that the above-named applicant meets all requirements indicated in the category checked above for classification as a Florida “resident for

tuition purposes.” I understand that a false statement in this affidavit will subject me to penalties for making a false statement pursuant to 837.06, Florida Statutes, and

that a false statement in this affidavit may subject the above-named student to the penalties for making a false or fraudulent statement.

_______________________________________

___________________________________

__________________

Signature of Student in ink

Claimant signature

Date

Denied

______Approved

FOR OFFICE USE ONLY

Authorization:

Date: