Residency Questionnaire Template Page 4
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4PART H: General Comments
Is there any additional information you believe Tarrant County College should know in evaluating
your eligibility to be classified as a resident? If so, please provide it below.
PART I: Certification of Residency
All students must complete this section.
I understand TCC officials will use the information submitted on this form to determine my status for residency eligibility. I authorize TCC to verify
the information I have provided. I agree to notify the proper officials of the institution of any changes in the information provided. I certify the
information on this questionnaire is complete and correct, and I understand the submission of false information is grounds for rejection of my
questionnaire, withdrawal of any offer of acceptance of my application, cancellation of enrollment, and/or appropriate disciplinary action.
Signature _______________________________________________________________________ Date ____________________________________
OFFICE USE ONLY
Residency Code ____________________
Documents Reviewed: (as needed)
_____ Lease: Dates Covered
_____ Payroll Stub: Dates Covered _________________________________
_____ Texas Voter Registration
_____ Texas Driver’s License
_____ Bank Statements: Dates Covered _____________________________
_____ Other
Documents Attached: (as needed)
_____ Immigration Documents (I-551, I-94, Visa, etc.)
_____ Military Documents
_____ Legal Guardianship Papers
Staff Signature ___________________________________________________________________ Date ____________________________________
Campus ____SO
____ NE ____NW ____SE
____TR ____District
An Equal Opportunity Institution/Equal Access to persons with disabilities.
SC:DTAR.432.01.14
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