Chart I - AFFIDAVIT
STATE OF TEXAS - COUNTY OF
____________________ ยง
Before me, the undersigned
Notary Public, on this day personally appeared
___________________________________________________, known to me, who being by
me duly sworn upon his/her oath, deposed and said: 1. My name is
________________________________________________________. I am ___ years of
age. I have personal knowledge of the facts stated herein and they are all true
and correct. 2. I graduated or will graduate from a Texas high school or
received my GED certificate in Texas. 3. I resided in Texas for three years
leading up to graduation from high school or receiving my GED certificate. 4. I
have resided or will have resided in Texas for the 12 months immediately
preceding the census date of the semester in which I will enroll in
__________________________________________________ (college/university). 5. I
have filed or will file an application to become a permanent resident of the
United States as soon as I am eligible to do so. In witness whereof, this
____________day of _______________________, _________.
___________________________________
(Signature)
___________________________________
(Printed Name)
___________________________________
(Student I.D.#)
___________________________________
(Student Date of Birth)
SUBCRIBED TO AND SWORN TO
BEFORE ME, on the ___________________ day of
________________________________________,
___________________________, to certify which witness my hand and official
seal.
__________________________________
Notary Public in and for the State of Texas