Appendix III

Chart III

Affidavit

State of Texas ___________________ §

County of _______________________ §

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 and 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 prior to 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 at the earliest opportunity that I am eligible to do so.

In witness whereof, this __________ day of _________________, _______________ .

_______________________________________
(Signature)

_______________________________________
(Printed Name)

_______________________________________
(Student I.D. #)

SUBSCRIBED 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

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.

Statement on Equal Educational Opportunity
The University of Texas at Dallas is committed to an educational and working environment that provides equal opportunity to all members of the University community. In accordance with federal and state law, the University prohibits unlawful discrimination on the basis of race, color, religion, national origin, gender, age, disability, and veteran status. Discrimination on the basis of sexual orientation is also prohibited pursuant to University policy.