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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? (Give full name, not just initials)

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.

	YES	NO
1. a. Did you graduate from high school or complete a GED in Texas?
1. b. If you graduated from high school, what was the name and city of the school?
2. Did you live in Texas the 36 months leading up to high school graduation or completion of the GED?
3. When you begin the semester for which you are applying, will you have lived in Texas for the previous 12 months?
4. Are you a U.S. Citizen or Permanent Resident?

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.

	YES	NO	Mo.	YEARS	VISA/STATUS
1. Are you a U.S. Citizen?
2. Are you a Permanent Resident of the U.S.?
3. Are you a foreign national whose application for Permanent Resident Status has been preliminarily reviewed? (You 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.)
4. Are you a foreign national here with a visa or are you a Refugee, Asylee, Parolee or here under Temporary Protective Status? If so, indicate which.
5. Do you currently live in Texas? If you are out of state due to a temporary assignment by your employer or other temporary purpose, please explain in Part H.
6. a. If you currently live in Texas, how long have you been living here?
6. b. What is your main purpose for being in the state? If for reasons other than those listed, give an explanation in Section H.	Go to college [ ]		Establish / maintain a home [ ]		Work assigment [ ]
7. If you are a member of the U.S. military, is Texas your Home of Record?
What state is listed as your military legal residence for tax purposes on your Leave and Earnings Statement?	State:
				YES	NO
8. Do any of the following apply to you? (Check all that apply)
a. Hold the title to real property (home, land) in Texas? If yes, date acquired: _____________
b. Own a business in Texas? If yes, date acquired: _____________
c. Hold a state or local license to conduct a business or practice a profession in Texas? If yes, date acquired: _____________
9. For the past 12 months, have you: (Check all that apply)
a. been gainfully employed in Texas?
b. received services from a social service agency that provides services to homeless persons?
10. Are you married to a person who could answer "yes" to any part of questions 8 or 9?
a. If "yes", indicate which questions could be answered by your spouse: ___
b. How long have you been married to the Texas resident?				Months [ ]	Years [ ]
SKIP PART G. AND CONTINUE TO PART H.

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

	YES	NO	Mo.	YEARS	VISA/STATUS
1. Is the parent or legal guardian upon whom you base your claim of U.S. residency a U.S. Citizen?
2. Is the parent or legal guardian upon whom you base your claim of U.S. residency a Permanent Resident of the U.S.?
3. Is this parent or legal guardian a foreign national whose application for Permanent Resident Status has been preliminarily reviewed? (He or she should have received a fee/filing receipt or Notice of Action (I-797) from USCIS showing his or her I-485 has been reviewed and has not been rejected.)
4. Is this parent or legal guardian a foreign national here with a visa or are you a Refugee, Asylee, Parolee or here under Temporary Protective Status? If so, indicate which.
5. Does this parent or legal guardian currently live in Texas? If he or she is out of state due to a temporary assignment by your employer or other temporary purpose, please explain in Part H.
6. a. If he or she is currently living in Texas, how long has he or she been living here?
6. b. What is your parent's or legal guardian's main purpose for being in the state? If for reasons other than those listed, give an explanation in Section H.	Go to college [ ]		Establish / maintain a home [ ]		Work assigment [ ]
7. If he or she is a member of the U.S. military, is Texas your Home of Record?
What state is listed as his or her military legal residence for tax purposes on your Leave and Earnings Statement?	State:
				YES	NO
8. Do any of the following apply to your parent or guardian? (Check all that apply)
a. Hold the title to real property (home, land) in Texas? If yes, date acquired: _____________
b. Own a business in Texas? If yes, date acquired: _____________
c. Hold a state or local license to conduct a business or practice a profession in Texas? If yes, date acquired: _____________
9. For the past 12 months, has your parent or guardian: (Check all that apply)
a. been gainfully employed in Texas?
b. received services from a social service agency that provides services to homeless persons?
10. Is you parent or legal guardian married to a person who could answer "yes" to any part of questions 8 or 9?
a. If "yes", indicate which questions could be answered by your parent or guardian's spouse: ___
b. How long have your parent or guardian been married to the Texas resident?				Months [ ]	Years [ ]

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: _____________

The University of Texas at Dallas 2006-2008 Undergraduate Catalog
Volume 31, Number 1
Copyright © The University of Texas at Dallas

This catalog is a general information publication only. It is not intended to nor does it contain all regulations that relate to students. The provisions of this catalog do not constitute a contract, express or implied, between any applicant, student or faculty member and The University of Texas at Dallas or The University of Texas System. The University of Texas at Dallas reserves the right to withdraw courses at any time, to change fees or tuition, calendar, curriculum, degree requirements, graduation procedures, and any other requirements affecting students. Changes will become effective whenever the proper authorities so determine and will apply to both prospective students and those already enrolled.

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