Residency Questionnaire Template (Page 3 of 4) in pdf

___ c. Has held a state or local license to conduct a business or practice a profession in Texas for all of the 12 months prior to the term of this

questionnaire.

Date acquired (mm/yyyy) ____ ____ / ____ ____ ____ ____

___ d. Has been gainfully employed in Texas for at least 12 months prior to the term of this questionnaire.

___ e. Has received services from a social service agency in Texas for at least 12 months prior to the term of this questionnaire.

9. Is your parent or legal guardian married to a person who could answer Yes to any part of question 8?

If Yes, which part: ____a ____b ____c ____d ____e

a. ___ Yes

b. ___ No

c. How long has your parent or guardian been married to the Texas resident? ______ Months

______ Years

PART G: Questions for Independent Students

If you answered Yes, skip to question 4.

1. Are you a United States citizen?

____ Yes

____ No

If you answered No, continue.

2. I am a citizen of

Country

3. ___ a. I am a Permanent Resident with I-551 (Front and back of I-551 must be submitted.)

___ b. I am in the United States as a Refugee, Asylee, Parolee, or under Temporary Protective Status.

(I-94 must be submitted.)

___ c. I am a noncitizen whose application for Permanent Resident Status has been preliminarily reviewed.

(USCIS Notice of Action [I-797] must be submitted showing I-485 has been accepted for processing.)

___ d. I hold a current visa. (STOP HERE: You must complete an International Application. See or

contact the TCC International Admissions Office for assistance.)

___ e. None of the above. (Continue, but provide additional information in Part H: General Comments.)

4. Do you currently live in Texas? ____Yes ___No (If you answered No, but are out of the state due to a temporary assignment, provide additional

information in Part H: General Comments.)

5. How long have you lived in Texas? ______Years ______Months

State or country of residence prior to Texas

6. If you have lived in Texas for fewer than five years, what was your main reason for coming to Texas?

___Work assignment

___To establish a home in Texas

___To go to school

(If none of these apply, please provide additional information in Part H: General Comments.)

7. Are you a member of the U.S. military?

If Yes, answer questions 7a and 7b, then continue to question 8.

___ Yes

If No, skip questions 7a and 7b, then continue to question 8.

___ No

___ a.

Texas is my Home of Record. (Copy of DD 214 required.)

___ b.

Texas is listed as my legal residence for tax purposes on my Leave and Earnings Statement.

(Copy of Leave and Earnings Statement required.)

If neither applies, indicate state listed on either form

State

8. Check all of the following that apply:

___ a. I have held the title to real property (home or land) in Texas for all of the 12 months prior to the term of this questionnaire.

Date acquired (mm/yyyy) ____ ____ / ____ ____ ____ ____

___ b. I have owned a business in Texas for all of the 12 months prior to the term of this questionnaire.

Date acquired (mm/yyyy) ____ ____ / ____ ____ ____ ____

___ c. I have held a state or local license to conduct a business or practice a profession in Texas for all of the 12 months prior to

the term of this questionnaire.

Date acquired (mm/yyyy) ____ ____ / ____ ____ ____ ____

___ d. I have been gainfully employed in Texas for at least 12 months prior to the term of this questionnaire.

(Gainful employment requires an average employment of at least 20 hours per week for one year or earnings equal to at least half of tuition and living expenses

for one 9-month academic year. Employment conditioned on student status such as work-study, the receipt of stipends, fellowships or research or teaching

assistantships does not constitute gainful employment.)

___ e. I have received services from a social service agency in Texas for at least 12 months prior to the term of this questionnaire.

9. Are you married to a person who could answer Yes to any part of question 8?

If Yes, which part: ____a ____b ____c ____d ____e

a. ___ Yes

b. ___ No

Date of marriage (mm/yyyy) ____ ____ / ____ ____ ____ ____

See reverse side for Part H and Part I.