Appendix III, Revised Chart II

Core Residency Questions

Texas Higher Education Coordinating Board rule 21.731 requires each student applying to enroll at an institution to respond to a set of core residency questions for the purpose of determining the student's eligibility for classification as a resident.

Part A. Student Basic Information. All Students must complete this section.

Name: ______________________________________

Student ID Number: ______________________________________

Date of Birth: ______________________________________

Part B. Previous Enrollment. For all students.

1. During the 12 months prior to the term for which you are applying, did you attend a public college or university in Texas in a fall or spring term?

Yes       No

If you answered "no", please continue to Part C.

If you answered "yes", complete questions 2-5:

2. What Texas public institution did you last attend?

3. In which terms were you last enrolled? (check all that apply)

___ fall, 200_       ___ spring, 200_

4. During your last semester at a Texas public institution, did you pay resident (in-state) or nonresident (out-of-state)?

___ resident (in-state)       ___ nonresident (out-of-state)       ___ unknown

5. If you paid in-state tuition at your last institution, was it because you were classified as a resident, or because you were a nonresident who received a waiver?

___ resident (in-state)       ___ nonresident with a waiver      ___ unknown

IMPORTANT: If you were enrolled at a Texas public institution during a fall or spring semester within the previous 12 months and were classified as a Texas resident, skip to Part I, sign and date this form and submit it to your institution. If you were not enrolled, or if you were enrolled but classified as a nonresident, proceed to Part C.

Part C. Residency Claim

Are you a resident of Texas?       Yes       No

If you answered "yes", continue to Part D.

If you answered "no", complete the following question and continue to Part I.

Of what state or country are you a resident? ______________________________________

If you are uncertain, continue to Part D.

Part D. Acquisition of High School Diploma or GED.

Instructions to Part D:

If you answered "no" to question 1a or 2 or 3, continue to Part E.

If you answered "yes" to all four questions, skip to Part I.

If you answered "yes" to questions 1, 2 and 3, but "no" to question 4, complete a copy of the Affidavit in Chart III, provided as an Attachment to this form, skip to Part I of this form, and submit both forms and the affidavit to your institution.

Part E. Basis of Claim to Residency. TO BE COMPLETED BY EVERYONE WHO DID NOT ANSWER "YES" TO QUESTIONS 1a, 2 AND 3 OF PART D.

1. Do you file your own federal income tax as an independent tax payer?

Yes       No

2. Are you claimed as a dependent or are you eligible to be claimed as a dependent by a parent or court-appointed legal guardian?

Yes       No

(To be eligible to be claimed as a dependent, your parent or legal guardian must provide at least one half of your support. A step-parent does not qualify as a parent if he/she has not adopted the student.)

3. Of you answered "no" to both questions above, who provides the majority of your support?

Self ___       Parent or guardian ___       Other (list below) ___

Instructions to Part E:

If you answered "yes" to question 1, continue to Part F.

If you answered "yes" to question 2, skip to Part G.

If you answered "no" to 1 and 2 and "self" to question 3, continue to Part F.

If you answered "no" to 1 and 2 and "parent or guardian" to question 3, skip to Part G.

If you answered "no" to 1 and 2 and "other" to question 3, skip to Part H and provide an explanation, and complete Part I.

Part F. Questions for Students who answered "Yes" to Question 1 or "Self" to Question 3 of PART E.

Part G. Questions for students who answered "Parent" or "Legal Guardian" to Question 3 of PART E.

Part H. General Comments. Is there any additional information that you believe your 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 that officials of my college/university will use the information submitted on this form to determine my status for residency eligibility. I authorize the college/ university 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 that the information on this application is complete and correct and I understand that the submission of false information is grounds for rejection of my application, withdrawal of any offer of acceptance, cancellation of enrollment and/or appropriate disciplinary action.

Signature: ___________________________________ Date: _________________________