Residency Questionnaire

This residency questionnaire should only be used by undergraduate students. Graduate students should contact the College of Graduate Studies at graduate.studies@angelo.edu for instructions regarding residency issues.

First Name

Last Name

ASU Student ID Number (CID)

Date of Birth

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?

YesNo

Previous Enrollment

What Texas public institution did you last attend?

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

Resident (In-state)

Non-resident (Out-of-state)

Unknown

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

Non-resident with a waiver

Unknown

ADDITIONAL QUESTIONS

Residency Claim

Are you a resident of Texas?

YesNoUncertain

Of what state or country are you a resident?

Resident Questions

Acquisition of High School Diploma or GED

Did you graduate or will you graduate from high school or complete a GED in TX prior to the term for which you are applying?

YesNo

What was the name of the school?

What city was the high school located in?

Did you live or will you have lived in TX the 36 months leading up to high school graduation or completion of the GED?

YesNo

When you begin the semester for which you are applying, will you have lived in TX for the previous 12 months?

YesNo

Are you a U.S. Citizen or Permanent Resident?

YesNo

Basis of Claim to Residency

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

YesNoAn independent tax payer should not be claimed as a dependent for tax purposes by another person. If you file a joint return with your spouse, answer “yes.”

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

YesNoTo 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.

Who provides the majority of your support?

SelfParent or GuardianOther

Who provides your support?

Please provide an explanation of the support you receive:

Self-Claimed Questions

Are you a US Citizen?

YesNo

Are you a Permanent Resident of the U.S.?

YesNo

Are you a foreign national whose application for Permanent Resident Status has been preliminarily reviewed?

YesNoYou should have received a fee/filing receipt or Notice of Action (I-797) from USCIS showing your I-485 has been reviewed and has not been rejected.

Which of the following apply to you? I am:

a Foreign National here with a Visaa Refugeean Asyleea ParoleeHere under Temporary Protective StatusNone of the above

Do you currently live in Texas?

YesNoIf you are out of state due to a temporary assignment by your employer or another temporary purpose, please check “no” and explain in the general comments section at the bottom of this form.

How long have you been living here? (Example 3 years and 2 months)

What is your main purpose for being in the state?

Go to collegeEstablish/maintain a homeWork assignmentOther

Please explain your reason for being in the state:

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

YesNo

Is Texas your Home of Record?

YesNo

What state will have been listed as his or her military legal residence for tax purposes on his or her Leave and Earnings Statement for the 12 months prior to enrollment?

Do you hold the title (Warranty Deed, Deed of Trust, or other similar instrument that is effective to hold title) to residential real property in Texas?

YesNo

Date acquired:

Do you have ownership interest and customarily manage a business in Texas without the intention of liquidation in the foreseeable future?

YesNo

Date acquired:

While living in Texas, have you been gainfully employed for a period of at least 12 consecutive months?

YesNoGainful 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 assistanceships does not constitute gainful employment.

While living in Texas, have you received primary support through services from a social service agency for a period of at least 12 consecutive months?

YesNo

Are you currently married?

YesNo

Marriage Questions

How long will you have been married to the Texas resident prior to enrollment? (Example : 3 years, 2 months)

Are you married to a person who holds the title (Warranty Deed, Deed of Trust, or other similar instrument that is effective to hold title) to residential real property in Texas?

YesNo

Are you married to a person who has ownership interest and customarily manage a business in Texas without the intention of liquidation in the foreseeable future?

YesNo

Are you married to a person who, while living in Texas, has been gainfully employed for a period of at least 12 consecutive months?

Are you married to a person who, while living in Texas, has received primary support through services from a social service agency for a period of at least 12 consecutive months?

YesNo

Parent/Guardian Information

Is the parent or legal guardian upon whom you base your claim of residency a U.S. citizen?

YesNo

Is the parent or legal guardian upon whom you base your claim of residency a Permanent Resident?

YesNo

Is this parent or legal guardian a foreign national whose application for Permanent Resident Status has been preliminarily reviewed?

YesNoHe or she should have received a fee/filing receipt or Notice of Action (I-797) from the USCIS showing his or her I-485 has been reviewed and has not been rejected.

Which of the following applies to your parent? My parent/guardian is:

a Foreign National here with a Visaa Refugeean Asyleea ParoleeHere under Temporary Protective StatusNone of the above

Does this parent or guardian currently live in Texas?

YesNoIfheorsheisoutofstateduetoa temporary assignment by his or her employer or another temporary purpose, please check “no” and explain in the general comments section at the bottom of this form.

How long has he or she been living here? (Example: 3 year, 2 months)

What is your parent's main purpose for being in the state?

Go to collegeEstablish/maintain a homeWork assignmentOther

What is your parent/guardian's purpose for being in the state?

Is your parent a member of the U.S. military?

YesNo

Is Texas their Home of Record?

YesNo

What state will have been listed as your military legal residency for tax purposes on your Leave and Earnings Statement for the 12 months prior to enrollment?

Does your parent hold the title (Warranty Deed, Deed of Trust, or other similar instrument that is effective to hold title) to residential real property in Texas?

YesNo

Date acquired:

Does your parent have ownership interest and customarily manage a business in Texas without the intention of liquidation in the foreseeable future?

YesNo

Date acquired:

While living in Texas, has your parent been been gainfully employed for a period of at least 12 consecutive months?

While living in Texas, has your parent received primary support through services from a social service agency for a period of at least 12 consecutive months?

YesNoNote: the dollar value of social services received may be combined with earnings to total at least one-half of tuition and living expenses for one 9-month academic year.

Is your parent/guardian married?

YesNo

Parent/Guardian Spouse Information

Is your parent/guardian married to a person who is classified as a Texas resident?

YesNo

Does your parent/guardian's spouse hold the title (Warranty Deed, Deed of Trust, or other similar instrument that is effective to hold title) to residential real property in Texas?

YesNo

Does your parent/guardian's spouse have ownership interest and customarily manage a business in Texas without the intention of liquidation in the foreseeable future?

YesNo

While living in Texas, has your parent/guardian's spouse been been gainfully employed for a period of at least 12 consecutive months?

While living in Texas, has your parent/guardian's spouse received primary support through services from a social service agency for a period of at least 12 consecutive months?

YesNoNote: the dollar value of social services received may be combined with earnings to total at least one-half of tuition and living expenses for one 9-month academic year.

General Comments. Is there any additional information that you believe your college/university should know in evaluating your eligibility to be classified as a resident? If so, please provide it below:

Residency Affidavit

Based on the way I answered these questions, I understand that I must submit also submit a copy of the Residency Affidavit.

Certification of Residency:

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.

Electronic Signature: By typing my name below, I confirm that I am the person who has filled out this document.