Florida Resident Access Grant Application Form Page 2
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2Florida Residency Affidavit
If you checked any of the boxes on page 1 of this form, this section must be completed.
Dependent -*
If you’re under 24, you’re dependent – dependent means any person, whether or not living with his or her parent, who is eligible to
*If you are a dependent student then your parent or legal
be claimed by his or her parent as a dependent under the federal income tax code.
guardian is the claimant.
Independent -
*If you are over 24, you are independent. You may also be considered independent if you are married, you have a child or other
dependent as defined by the federal tax code, your parents are deceased and you are or were until age 18 a ward of the court, or you are considered
independent for financial aid purposes. Documentation of any of these situations is required.
Step 1 - Student General Information
Student Stetson ID: 800- __ __ __ __ __ __
Name of Student:
____
SS#: _________________________________
First
Middle
Last
City _______________________________ State _______ Zip ____________
Contact number: (_______) _________-_____________
Step 2 - Initial Eligibility Requirement to Receive Funding:
I certify the following (place a check mark by each statement that applies):
_____I am a U. S. Citizen
OR
_____I am an eligible non-citizen. Please attach a copy of your alien registration card or Visa.
AND
_____I am not in default on any educational loan and do not owe a repayment on a state or federal grant.
_____I have not previously earned a bachelor’s degree.
Selective Service Status:
_____I am registered with the Selective Service.
OR
_____I am not required to be registered with Selective Service because (check one):
_____I am female.
_____I am in the armed services on active duty.
_____Other: ________________________
Step 3 - Residency Claimant Information
Name:
_______ ___ _
Relationship to Student: _________________________
First
Middle
Last
Permanent Florida Residence:
_________________________
____________________
City _______________________ State ______ Zip ____________ Contact number: (_____) _____-____________
Telephone Number: (Home)
________
(Work)
________________
Date that you established Florida Residency:
________________________________ _______
If you move from Florida before the start of classes you MUST notify the Financial Aid Office.
* Don’t forget to enclose copies of the appropriate documents listed on the application. Documents supporting the
establishment of legal residence must be dated, issued or filed 12 months prior to matriculation at Stetson University.
I do hereby swear or affirm that the above named student meets all the requirements indicated in the checked category on
page 1 for classification as a Florida resident for Florida financial assistance. I understand that a false statement in the
affidavit will subject me to penalties for making a false statement pursuant to 837.06 FS and BOR rule 6C-6.00 (6) F.A.C.
Student’s Signature
Date
Claimant’s Signature
________________
Date
Return to: Stetson University
421 N. Woodland Blvd., Unit 8379, Deland FL 32723
Phone: 386-822-7120 or 800-688-7120 / Fax: 386-822-7126
Email: finaid@stetson.edu / Website:
Page 2
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