Application for
Review of Residency Classification
PO BOX 261966 . CONWAY, SC . 29528
FAX 843-349-7588
email: residency@hgtc.edu
WEBSITE www.hgtc.edu
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PLEASE PRINT CLEARLY (IN BLACK INK)
Regulations regarding the establishment of legal residency in South Carolina for tuition and fees at Horry-Georgetown Technical College are governed by the
Code of Laws of South Carolina, Sections 59 - 112 to 59 - 112 - 100 and are not governed by the College. Regulations regarding the establishment of in-county
(Horry or Georgetown county) residency for tuition and fees are governed by college policy and procedures.
Failure to complete all required parts of this application or to submit required documentation with the application will stop the review of your residency status. After
submission of the Application for Review of Residency Classification to the Admissions Office, an applicant will be notified of the decision regarding his/her residency
classification within two business weeks. The deadline for submission of this application is the last day of late registration for the term for which
residency reclassification is requested. There is no provision for retroactive-non-resident fee adjustment except in instances of error by the College. An
applicant may appeal a residency decision to the Associate Vice President for Student Affairs.
Instructions: 
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Complete section below
Choose ONE basis for reclassification (Part 1) and complete it as requested
Provide supporting documentation as required. (See residency checklist)
Sign and date this form at Part 9
Return the form to the Residency Coordinator
NOTE: You are a dependent student if your predominant source of income or support is from a parent, spouse, or guardian and you qualify for and are claimed
as a dependent or exemption for income tax purposes. You are an independent student if you are 18 years or older and have provided more than half of
your support during the 12 months prior to the date that classes begin of the term for which residency is requested. You CANNOT be claimed as a dependent
by anyone for income tax purposes.
 Applicant's Social Security Number ______________ — _________ — ______________ "H" Number _____________________________________________
 Legal last name _________________________________ Legal first name ___________________________ Legal middle name ______________________ Suffix _____
(Jr., II, III, etc.)
 Preferred name/nickname ________________________________ Any other name on record ______________________________________________________________
Marital status __________________ If married, date of marriage ____________ ____________ ____________
month
day
year
 Permanent mailing address___________________________________________________ City___________________ State_____ Zip_________ County _____________
county within SC
(all mail will be sent to this address)
 Present address____________________________________________________________ City___________________ State_____ Zip_________
(if different)
 Permanent phone ( ______ ) _________________________________ Present daytime/work phone ( _____ ) ______________________________________________
 E-mail address _______________________________________________________________________________________________________________________________
 Applicant's birthdate _________________ _________________ _________________  male  female
month
day
year
 What is your present residency classification?  Out-of-State In-State/Out-of-County
 To what are you requesting that your residency classification be changed?  In-State/In-County (Horry or Georgetown County)  In-State/Out-of-County
 For which semester are you requesting in-state or in-county residency classification to begin? _______________________________________________
 PART 1. PURPOSE FOR REQUESTING RESIDENCY REVIEW
(Fill in box of one.) Note: If one of the following (A - K) does not apply to your situation, please contact the Admissions Office before
completing this application. For detailed information on requirements to establish residency for tuition and fees at HGTC, please
see "Residency Classification for Tuition and Fee Purposes" brochure.
 (A) I am requesting residency classification on the basis that I am an independent person who has physically resided and established a permanent home
in South Carolina/Horry County/Georgetown County for at least 12 consecutive months immediately preceding the term for which I am requesting instate or in-county residency classification. Note: the 12-month residency period does not start until the independent person begins to take
steps which indicate that the person intends to establish a permanent home in South Carolina. Complete Parts 2, 3, 4, 5, and 9.
 (B) I am requesting in-state or in-county residency classification on the basis that I am a dependent (or exemption) of a person who has physically resided
and established a permanent home in South Carolina/Horry County/Georgetown County for at least 12 consecutive months immediately preceeding
the term for which I am requesting in-state or in-county residency classifications. Note: The 12-month residency period does not start until the
person begins to take steps which indicate that the person intends to establish a permanent home in South Carolina. Name of person
upon whom you are dependent.
___________________________________________ Relationship to you ___________________________ Complete Parts 3, 5, 6, 7, and 9.
 (C) I am requesting in-state or in-county residency classification on the basis that I am an independent person who is employed full-time in South Carolina/
Horry County/Georgetown County and have been domiciled in the state/county for less than 12 consecutive months. Complete parts 2, 3, 4, 5, and 9.
 (D) I am requesting in-state or in-county residency classification on the basis that I am a dependent (or exemption) of an employee in South Carolina/Horry
County/Georgetown County who has been domiciled in the state/county for less that 12-months. Complete Parts 3, 5, 6, 7, and 9.
 (E) I am requesting in-state or in-county residency classification on the basis that (circle one) I/my spouse/my parent is on active military duty in South Carolina.
Complete Parts 3, 8, and 9.
 (F) I am requesting in-state or in-county residency classification on the basis that I am a full-time faculty or administrative employee of a South Carolina statesupported college or university. Complete Parts 2, 3, 4 and 9 and include a letter from your employer certifying full-time employment.
 (G) I am requesting in-state or in-county residency classification on the basis that I am a dependent of a full-time faculty or administrative employee of a South
Carolina state-supported college or university. Complete Parts 3, 6, 7 and 9 and include a letter from their employer certifying full-time employment
of the person upon whom you are dependent.
 (H) I am requesting in-state or in-county residency classification on the basis that I am a retired person receiving a pension or annuity who has been domiciled
in South Carolina/Horry County/Georgetown County for less than 12 months. Complete parts 2, 3, 4, 5 and 9 and attach documentation verifying
retirement status and receipt of pension or annuity.
 (I) I am requesting in-state or in-county residency classification on the basis that I am a dependent (or exemption) of a retired person receiving a pension or
annuity who has been domiciled in South Carolina/Horry County/Georgetown County for less than 12 months. Complete Parts 3, 5, 6, 7 and 9 and attach
documentation verifying retirement status and receipt of pension or annuity of the person upon whom you are dependent.
NOTE: The following two categories are applicable only for a South Carolina resident or a dependent of a South Carolina resident whose
current residency classification is in-state/out-of-county and who is requesting a reclassification to in-state/in-county:
 (J) I am an independent person who is a legal resident of South Carolina, and I am requesting in-county residency classification on the basis that I have owned
property in Horry or Georgetown county for at least 12 months prior to the first day of classes for the term for which in-county residency classification is requested.
Complete Parts 2, 3, 4, 5 & 9. Also attach a photocopy of your most recent paid property tax receipt for Horry or Georgetown County.
 (K) I am a dependent (or exemption) of a legal resident of South Carolina, and I am requesting in-county residency classification on the basis that the person
upon whom I am legally dependent has owned property in Horry or Georgetown county for at least 12 months prior to the first day of classes for the term
for which in-county residency classification is requested. Complete Parts 3, 6, 7, and 9. Also attach a photocopy of the most recent paid property
tax receipt for Horry or Georgetown County.
 PART 2. LEGAL RESIDENCY INFORMATION
(A) Addresses where you have lived for more than 30 days during the past 24 months. Begin with your current address: (Do not use P.O. Boxes.)
Dates: From
To
Address
County
City/State/Zip Code
(B) Do you own or rent your current residence?  yes  no If you own it, when did you purchase it?____________ __________ ___________
month
day
year
(C) Are you a U.S. citizen?  yes  no If not, what type of visa do you have? _____________________________________________________
Note: a holder of one of the following visa classifications is eligible for consideration for S.C. In-state / Out-of-County Residency
classification if all other residency requirements/criteria are met: A-1, A-2, G-1, G-2, G-3, G-4, H-1B, H-2A, H-2B, H-3, H-4, K-1, K-2, L-1, L-2,
N-8, N-9. Holders of other visa classifications are ineligible for S.C. in-state residency classification.
(D) Are all, or substantially all, of your posessions in South Carolina/Horry County/Georgetown County?  yes  no
If not, in what state/county are most of your possessions? _______________________________________________________________________
(E) Do you have a valid driver's license or state-issued South Carolina ID card?  yes  no If yes, date of issue?_________ ________ __________
Do you have a valid driver's license from another state?  yes  no If yes, in what state? _____
month
day
year
Note: If you have a S. C. driver's license, attach photocopy. If not, you must submit a copy of your S.C. identification card.
(F) Is the vehicle which you use registered in your name?  yes  no If yes, in what state is it registered? _________________________________
What is the date of current registration certificate?_________ __________ __________
month
day
year
Note: If vehicle is registered in S.C., attach a photocopy of current vehicle registration certificate.
(G) Did you file state income tax returns in any state during the past 24 months?  yes  no
If yes, please answer the following:
State_____________________________ Year____________________________ Date filed_________________________________________
State_____________________________ Year____________________________ Date filed_________________________________________
Note: If you filed a S.C. tax return for the previous year, attach a signed photocopy of your tax return.
(H) Will you file a state income tax return for the current year?  yes  no If yes, in which state will you file? ________________________________

PART 3. FINANCIAL INFORMATION
(A) Sources and percentages of your support for the 12 months immediately preceeding the term for which you are requesting in-state or in-county residency
classification:
parents
______________ %
student financial aid
______________ %
your job
______________ %
other sources (specify)
______________ %
VA benefits
______________ %
___________________
______________ %
social security
______________ %
___________________
______________ %
(B) Person who last claimed you as a dependent (or exemption) on a federal income tax return (do not list yourself).
Name ________________________________________________________ Relationship ____________________________________________
City/State of residence of person _______________________ Tax year person last claimed you as a dependent or exemption _________________
Note: if applicable, attach photocopy of person's federal tax return showing your dependent (exemption) status.
Income information may be blacked out.
(C) Will you be claimed as a dependent (or exemption) on someone's federal tax return for the current year?  yes  no
If so, what is the name and address of the person who will claim you?
Name _____________________________________________________ Relationship________________________________________________
Address______________________________________________________________________________________________________________
(D) Did you file a federal income tax return for the previous year?  yes  no
Note: if yes, attach photocopy of return. Income information may be blacked out.

PART 4. EMPLOYMENT INFORMATION
(A) List all employment for the previous 24 months. Begin with the most recent employment.
Dates: From
To
Employer
Full or Part time
City
State Number of hours per week
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
Note: if you are requesting in-state or in-county residency classification based on your full-time employment, attach a letter (on company
letterhead stationary or notarized) which states the following:
(a) that person is employed full-time in South Carolina/Horry County/Georgetown County;
(b) the effective date of employment in South Carolina/Horry County/Georgetown County;
(c) the number of hours person works a week must be at least 37.5 hours, or be entitled to receive full-time employee benefits;
(d) A person who is self-employed should provide a notarized statement certifying the foregoing information and submit a copy
of his/her South Carolina business license.
(B) If you are currently employed full time in South Carolina/Horry County/Georgetown County, do you expect any change in your full time employment
status within the next six months?  yes  no If yes, explain. _______________________________________________________________
___________________________________________________________________________________________________________________
(C) If you are retired and receiving a pension or annuity, what was the effective date of your retirement? ____________ ____________ ____________
Provide a copy of documentation confirming retirement and receipt of pension or annuity.
month
day
year
 PART 5. EDUCATIONAL INFORMATION
(A) List high schools attended
___________________________________________________________________________________________________________________
to - from dates
name of high school
city/state
___________________________________________________________________________________________________________________
to - from dates
name of high school
city/state
(B) List all colleges/universities attended. (Include attendance at HGTC.)
___________________________________________________________________________________________________________________
to - from dates
name of institution
city/state
resident or non-resident status
to - from dates
name of institution
city/state
resident or non-resident status
___________________________________________________________________________________________________________________
 PART 6. DOMICILE AND RELATED INFORMATION OF PERSON (NOT APPLICANT) UPON WHOM IN-STATE OR IN-COUNTY RESIDENCY
CLASSIFICATION IS TO BE BASED
Name _______________________________________________________________________________ Relationship _____________________
18
Address _____________________________________________________________________________________________________________
(A) How long has this person been a legal resident of South Carolina/Horry County/Georgetown County? _____________________________________
(B) Is this person a U. S. citizen?  yes
 no If not, what type of visa does this person have? __________________________________________
Note: a holder of one of the following visa classifications is eligible for consideration for S. C. In-state Residency classification
if all other residency requirements/criteria are met: A-1, A-2, G-1, G-2, G-3, G-4, H-1B, H-2A, H-2B, H-3, H-4, K-1, K-2, L-1, L-2, N-8,
N-9. Holders of their visa classifications are ineligible for S.C. In-state Residency classification.
(C) Has this person ever claimed you as a dependent (or exemption) for federal income tax purposes?  yes  no
If so, what is the last tax year in which this person claimed you? ________________
Will this person claim you as a dependent (exemption) on the current year's federal return?  yes  no
Note: if applicable, attach photocopy of person's previous year's federal tax return showing your dependent (or exemption) status.
Income information may be blacked out.
(D) Does this person have a driver's license?  yes  no If so, from what state? ___________ Date of issue?__________ _________ _________
month
day
year
Note: If this person has a S.C. driver's license, attach a photocopy of their driver's license. If this person does not have a driver's
license, he/she must submit a copy of his/her South Carolina identification card.
(E) Does this person own a car?  yes  no If so, in what state is the car registered? _______ Date of current registration? _______ _____ ______
Note: If vehicle is registered in S.C., attach photocopy of current vehicle registration certificate.
month
day
year
(F) Did this person file a S.C. income tax return for the previous year?  yes  no If so, date filed? __________ __________ __________
month
day
year
Will the person file a S.C. income tax return for the current tax year?  yes  no
Note: If person filed a S.C. tax return for the previous year, attach a photocopy of return.
PART 7. EMPLOYMENT OF PERSON (NOT APPLICANT) UPON WHOM IN-STATE OR IN-COUNTY RESIDENCY CLASSIFICATION IS TO BE
BASED.
(A) List employment of person for the past 24 months (Begin with most recent employment.)
Dates: From
To
Employer
Full or Part time
City
State Number of hours per week
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
Note: if you are requesting in-state or in-county residency classification based on your full-time employment, attach a letter (on company
letterhead stationary or notarized) which states the following:
(a) that person is employed full-time in South Carolina/Horry County/Georgetown County;
(b) the effective date of employment in South Carolina/Horry County/Georgetown County;
(c) the number of hours person works a week must be at least 37.5 hours, or be entitled to receive full-time employee benefits;
(d) A person who is self-employed should provide a notarized statement certifying the foregoing information and submit a copy of his/
her South Carolina business license.

(B) If the person who claims you as a dependent or exemption is retired or receiving a pension or annuity, what was the date of
retirement? __________ __________ __________
month
day
year
Note: Provide a copy of documentation confirming retirement and receipt of pension or annuity.
(C) If the person is employed full-time in South Carolina/Horry County/Georgetown County, does the person expect any change in full-time employment
within the next six months?  yes  no If yes, explain. _____________________________________________________________________
____________________________________________________________________________________________________________________
 PART 8. MILITARY SERVICE (Defined by the State of South Carolina as active militaryonly.)
(A) Military installation to which (circle one) you/your spouse/your parent is stationed? ____________________________________________________
Date assignment began in South Carolina?_________ _________ _________ Expected length of assignment in South Carolina? ______________
month
day
year
Note: Attach a photocopy of military orders assigning (circle one) you/your spouse/your parent to active military duty in
South Carolina.
 PART 9. APPLICANT CERTIFICATION
IMPORTANT: Persons who are found to have made or presented willful misrepresentation of facts to improperly gain in-state or in-county residency classification
will be charged tuition and fees past due and unpaid at the out-of-state or out-of-county rate, and, until these charges are paid, such persons will not be allowed
to receive transcripts or graduate from Horry-Georgetown Technical College.
I hereby certify that the information I have provided is accurate and that I am making this application in good faith, based on the belief that I am eligible to pay
tuition and fees at the rate afforded South Carolina/Horry County/Georgetown County.
Signature _______________________________________________________________________________________ Date ______ _______ ______
Residency, Horry Georgetown Technical College, P.O. Box 261966, Conway, South Carolina 29526-6066
FAX (843) 349-7588, residency@hgtc.edu
month
day
year