NON-DEGREE

RESIDENCY CLASSIFICATION
OFFICE OF THE REGISTRAR 777 Cudes Roud - ocu Ruton, lordu 3343l-099l - 1eephone: 56l.297.3050 - e-mu: registrar@fau.edu
luure to unswer these questons w deuy processng ol your uppcuton. ll you unswer yes to uny ol the loowng, you must submt
u lu stutement ol reevunt lucts on u sepurute sheet uttuched to ths lorm. You muy be requred to lurnsh the Lnversty wth copes ol
olcu documentuton expunng the nu dsposton ol the proceedngs. ll uny box s checked YLS, uddtonu documentuton und/
or lurther consderuton by the Admssons Revew ourd muy be requred.
A. U Yes U No Are you currenty or huve you ever been churged wth or subect to dscpnury ucton lor schoustc or uny other type ol msconduct
ut uny educutonu nsttuton:
B. U Yes U No Huve you ever been churged wth u vouton ol the uw thut resuted n, or, l st pendng, coud resut n probuton, communty
servce, u u sentence, the revocuton or suspenson ol your drver's cense (ncudng trulc voutons thut resuted n u ne ol S200 or
more):
- l certly thut the ubove nlormuton s correct und compete und understund thut luslyng or wthhodng nlormuton muy resut n dscpnury ucton
und wthdruwu lrom the Lnversty. l ugree to ubde by the poces ol the lordu ourd ol Lducuton und the rues und reguutons ol ths Lnversty.
tudents signature: ___________________________________________________________________ ________________________________
This form is used to establish residency status for tuition purposes for non-degree seeking students at Florida Atlantic University. All New non-degree
students, or those who have not attended FAU within the last year, must complete this form. This form should be submitted by mail with your non-
degree enrollment application. If you are a transient Student from another State University in Florida, a State University SystemTransient Student
form can be used in lieu of this form.
_______________________________________________________________________ ________________________________
erm applying for: _________________________________________________ Daytime phone: ( ______ ) ________________________________________
egal permanent home address:______________________________________________________________________________________________________
____________________________________________________________________________
__________________________________________________________________________________________________________________________________
Note: if you are a non-U.S. citizen, please see important information in Section a. and Part 1-#6 below.
A lordu resdent lor tuton purpose s u person who (or u dependent person whose purent or egu guurdun) hus estubshed und muntuned egu resdence
n lordu lor ut eust l2 months mmedutey precedng the rst duy ol cuss lor the term you wsh to puy n-stute lees. Cther persons not meetng the l2-month
egu resdence requrement muy be cussed us lordu resdents or temporury resdents lor tuton purposes ony l they lu wthn one ol the mted specu
cutegores sted beow us uuthorzed by the lordu Legsuture und lordu ourd ol Covernors Resouton duted Apr 2l, 2005 (udoptng lordu Depurtment
ol Lducuton Rue 6A-l0.044). All other persons are ineligible for classication as a p g Florida resident for tuition purposes. p p
IMPORTANT: B TT E AW AA ARE WW THAT THIS FORM IS SUBJ JECT TO REVIEW & THE RESIDENCY DETERMINATION MADE MAY BE CHANGE. IF YOUR
RESIDENCY IS CHANGE,, YOU WILL BE NOTIFIED BY MAIL!
u. 1o quuly us u lordu resdent lor tuton purposes, you must be u L.S. ctzen, permunent resdent uen or egu uen grunted ndente stuy by L.S.
ureuu ol Ctzenshp und lmmgruton Servces (.C.l.S) or one ol the loowng vsu cutegores vsu cutegores whch huve been upproved by the
Stute ol lordu lor egbty (u other resdency requrements uso uppy): A, L, C, H-l, H-4, l, K, L, N, C-l, C-3, R, NA1C l-7.
b. Lvng or uttendng schoo n lordu w not, n tsel, estubsh egu resdence.
c. Students who depend on out-ol-stute purents lor support ure presumed under uw to be egu resdents ol the sume stute us ther purents.
d. Resdence n lordu must be lor the purpose ol estubshng u permunent home und not merey lor enroment ut un nsttuton ol hgher educuton.
e. Documents supportng the estubshment ol egu resdence must be ssued or ed l2 months belore the rst duy ol cusses ol the term lor whch u
lordu resdent cusscuton s sought.
(Copy of most recent tax return or other documentation may be requested to establish dependence/independence status.)
_____ l. l um un ndependent person (l provde more thun 50% ol my own support) und huve muntuned egu resdence n lordu lor ut eust l2 months. ll under the uge ol
25, u copy ol your purent's most recent tux return must be provded n uddton to u other documents.
_____ 2. l um u dependent person (50% or more ol my support s provded by unother us dened by the lRS) und my purent or egu guurdun hus muntuned egu resdence
n lordu lor ut eust l2 months. (Copy ol most recent tux returns on whch you were cumed us dependent or other prool ol resdency requred.)
_____ 3. l um u dependent person who hus resded lor ve yeurs wth un udut reutve other thun my purent or egu guurdun und my reutve hus muntuned egu resdence
n lordu lor ut eust l2 months not prmury to uttend un nsttuton ol hgher educuton. (Copy ol most recent tux returns on whch you were cumed us dependent
or other prool ol resdency requred.)
_____ 4. l um murred to u person who hus muntuned egu resdence n lordu lor ut eust l2 months. l huve estubshed egu resdence und ntend to muke lordu my
permunent home. ll spouse s un lAL student, peuse provde ther nume und socu securty number ____ (copy ol murruge certcute requred.)
_____ 5. l wus prevousy enroed ut u lordu stute nsttuton und cussed us u lordu resdent lor tuton purposes. l ubundoned my lordu domce ess thun l2 months
ugo, und um now re-estubshng lordu egu resdence. (Prool ol pror cusscuton requred.)
_____ 6. Accordng to the L.S. ureuu ol Ctzenshp und lmmgruton (.C.l.S), l um u permunent resdent uen or other egu uen grunted ndente stuy. l huve muntuned
domce n lordu lor ut eust l2 months. (.C.l.S. documentuton requred.) My Aen Number s: _______________ (Vud copy ol Resdent Aen Curd requred.)
_____ 7. l um u member ol the urmed servces ol the Lnted Stutes und um stutoned n lordu on uctve mtury duty pursuunt to mtury orders, or whose home ol record s
lordu or l um the member's spouse or dependent chd. (Copy ol mtury orders or mtury document showng home ol record requred.) - (DD 2l4/ DD 2058)
_____ 8. l um u lu-tme nstructonu or udmnstrutve empoyee empoyed by u lordu pubc schoo, communty coege or nsttuton ol hgher educuton or l um the
empoyee's spouse or dependent chd. (Copy ol empoyment vercuton requred.)
_____ 9. l um purt ol the Lutn Amercu/Curbbeun schourshp progrum. (Copy ol schourshp pupers requred.)
_____ l0. l um u lu-tme empoyee ol u stute or ocu ugency tukng ob-reuted uw enlorcement or correctons trunng pud lor by my empoyer. (Copy ol empoyment
vercuton requred.)
_____ ll. l um u quued benecury under the terms ol lordu Pre-Pud Postsecondury Lxpense Progrum (S. l009.988(2), l.S.) (Prool ol pun requred.) PP
_____ l2. l um u Southern Regonu Lducuton ourd Acudemc Common Murket gruduute student. (Prool ol schourshp requred.)
2.4 Exceptions/Qualications
Stututory Lxceptons. Secton l009.2l, lordu Stututes, permts certun uppcunts who do not meet the l2-month egu resdence requrement to be cussed us lordu
resdents or temporury resdents lor tuton purposes. 1he nsttuton w requre documentuton n support ol the ubove exceptons, however, the student does not huve to
show l2 months ol resdence n lordu pror to quulyng. 1hese exceptonu cutegores ure us loows:
l. Lnted Stutes ctzens vng on the lsthmus ol Punumu, who huve competed l2 consecutve months ol coege work ut the lordu Stute Lnversty Punumu Cunu runch,
und ther spouses und dependent chdren.
2. Lnted Stutes ctzens vng outsde the Lnted Stutes who ure teuchng ut u Depurtment ol Delense Dependent Schoo or n un Amercun lnternutonu Schoo und who
enro n u gruduute eve educuton progrum whch euds to u lordu teuchng certcute.
3. Actve duty members ol the Cunudun mtury resdng or stutoned n ths stute under the North Amercun Ar Delense (NCRAD) ugreement, und ther spouses und
dependent chdren, uttendng u pubc communty coege or unversty wthn 50 mes ol the mtury estubshment where they ure stutoned.
4. Actve duty members ol u loregn nuton's mtury who ure servng us uson olcers und ure resdng or stutoned n ths stute, und ther spouses und dependent chdren,
uttendng u communty coege or stute unversty wthn 50 mes ol the mtury estubshment where the loregn uson olcer s stutoned.
5. Lnkuge lnsttute purtcpunts recevng purtu or lu exemptons lrom S. l009.2l, lS, bused on crteru upproved by the lordu Depurtment ol Lducuton per S. 288.8l75,
lS, whch estubshes nkuge nsttutes between postsecondury nsttutons n ths stute und loregn countres. See Secton 7.0, lmmgruton und lnternutonu Student
lssues, lor more nlormuton on Lnkuge lnsttutes.
OVER BOTH SIDES OF THIS FORM MUST BE COMPLETED!
ClllCL LSL CNLY
Residency Code _________ Approved _________ Denied _________ Date_________ Init.__________ Letter sent __________
Important. You must read and sign the following section in order to complete your application to Florida Atlantic University.
Student ID #: _ Students signature:
Student ID #: _ Student Name:
Daytime phone: Term applying for: TT
Legal permanent home address:_
Students address and if under 25, parents name and address:
PART PP I. DEFINITIONS
(At least one must be checked. Please check all that apply.)
PAR1 ll. DCCLMLN1A1lCN 1he person cumng resdency shoud compete und document the loowng sectons p g y p g
(l-4). ll un ndependent person, thut w be the student, l u dependent person, thut w be the purent or egu guurdun, ( ) p p , , p p , p g g ,
l the uppcuton s bused upon the resdency ol u spouse, the nlormuton shoud be on both you und your spouse. pp p y p , y y p
1. DOCUMENTATION SUCH AS LEASES, DEED, DORM AGREEMENT, TT ETC. MUST BE
PROVIDED FOR ALL ADDRESSES WITHINTHE LAST 12 MONTHS. (Indicate type of residence as follows: lease,
own, rent room, family home, dorm.)
Current uddress: ________________________________________________________________________________________________________
How ong huve you resded ut ths uddress: ____________ yeurs ____________ months (1YPL _____________________________________)
Prevous uddress: _______________________________________________________________________________________________________
How ong dd you resde ut ths uddress: ____________ yeurs ____________ months (1YPL _______________________________________)
ll the ubove uddresses do not totu l2 months, peuse uccount lor the other months:
documentation must be provided for the following: p g
ANK ACCCLN1: (Attuch copes ol eury und ute bunk stutements or etter lrom bunk.)
Nume und ocuton ol bunk: ___________________________________ Dute ucc't opened: __________ ls t un uctve uccount: __________
other thun lAL:
Nume/Cty/Stute Dutes uttended: lrom/to lu-tme/purt-tme
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
(Attuch copy ol cense/certcute.)
1ype ol Lcense:______________________________________________________________ Stute ____________ Dute lssued: _____________
(Attuch copy ol Membershp Curd/Certcute.)
Nume/type/ocuton ol cub(s):______________________________________________ Dutes ol membershp: lrom __________ to _________
Provde etter(s) on company letterhead stutng dates of employment in Florida, uveruge hours worked per week, whether
full- or part-time status.
l) Lmpoyer's nume/uddress/phone: _______________________________________________________________________________________
Dutes empoyed: lrom ____________ to ____________ lu-tme: ______ purt-tme: ______ Averuge hours worked per week: _________
2) Lmpoyer's nume/uddress/phone: _______________________________________________________________________________________
Dutes empoyed: lrom ____________ to ____________ lu-tme: ______ purt-tme: ______ Averuge hours worked per week: _________
2. IT IS EXPECTED THAT AT LEAST (2) TWO OF THE FOLLOWING BE DATED, ISSUED OR
FILED AT LEAST 12 MONTHS PRIOR TO THE FIRST DAY OF CLASSES FOR THE TERM FOR WHICH FLORIDA
RESIDENT CLASSIFICATION IS SOUGHT: TT (Attuch copes)
Drvers Lcense: Stute _________ Dute lssued __________________ Number _________________________
Voter Regstruton: Stute _________ Dute lssued __________________ Number _________________________
Vehce Regstruton: Stute _________ Dute lssued __________________ Decu r __________________________
Decuruton ol Domce: Dute ed ____________ Dute estubshed resdence ________________ County __________________________
3. FLORIDA STATUTES SPECIFYTHATYOUR INTENT FOR BEING IN FLORIDA IS NOT PRIMARILY FOR
EDUCATIONAL PURPOSES. The following information is used to determine the intent of the applicant:
Huve you been empoyed n lordu durng the ust l2 months: Yes ______ No ______ ll so, compete the Lmpoyment secton ubove und
provde documentuton us outned.
Do you own u home n lordu: Yes ______ No ______ ll so, provde copy ol deed, homesteud exempton, etc.
PART PP III. AFFIDAV AA IT THIS SECTION MUST BE SIGNED BY THE PERSON CLAIMING RESIDENCY
l do hereby sweur und ulrm thut the nlormuton provded ubove lor the purpose ol obtunng lordu resdency lor tuton purposes s true
und correct. I UNDERSTANDTHAT A FALSE STATEMENT INTHIS AFFIDAV AA IT WILL SUBJECT ME TO PENALTIES FOR MAKINGA FALSE
STATEMENT PURSUANT TO 837.06 OF THE FLORIDA STATUTES. I ALSO UNDERSTANDTHAT THE UNIVERSITY IS EMPOWEREDTO
REQU Q IRE ADDITIONAL INFORMATION OR DOCUMENTATION IF DEEMED NECESSARY. YY
___________________________________________________________________________________ ____________________________

NON-FLORIDA RESIDENTS ONLY
l understund thut l do not quuly us u lordu resdent lor tuton purposes ut ths tme und thut l l shoud quuly lor some luture term t w be necessury
lor me to e the requred documentuton pror to the deudne lor the term l um requestng consderuton lor lordu resdent cusscuton.
_______________________________________________________________________________________ _____________________________
Sgnuture ol person cumng lordu resdency Dute
09l0l4
COPIES OF ALL AND SUBJJECT
SCHCCL(S)
CCCLPA1lCNAL LlCLNSL:
CLL MLMLRSHlP:
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Sgnuture ol person cumng lordu resdency Dute
ADDITIONAL VERI
ATIO DOCUMENTA ON IS REQU Q IRED O ATIO T TO VERIFICA ON.
AL PHYSICA PRESENCE
ATIO AL IFICA ON FOR PHYSICA PRESENCE
LEGAL RESIDENCE
IINTENT