RESIDENCYAPPLICATION
STUDENTFORM
Thisformistobecompletedbystudentswhoareseekingtoestablisheligibilitytopaythein-staterateon
tuitionandfeesatClemsonUniversity.Theformshouldbecompleted,signed,notarizedandreturnedtotheaddress
belownolaterthanthedaybeforeclassesbeginforanysemesterforwhichthestudentisattemptingtoqualifytopay
thein-staterateontuitionandfees.PleasenotethataParental/Spouse/Guardianformisalsorequiredforstudents
under24yearsofageinordertocompletetheapplicationprocess.
DeterminationofresidencystatuswillbemadeonthebasisoftheSouthCarolinaCodeofLawsandregulatory
guidelinespromulgatedbytheSouthCarolinaCommissiononHigherEducation.
PLEASERETURNTHISORIGINALFORMNOTARIZEDTO: OfficeofStudentFinancialAid
ClemsonUniversity
G-01SikesHall
Clemson,SC29634
PleasecheckONEofthefollowing:
qContinuingUndergraduateStudentqIncomingFreshmanStudentqTransferStudentqGraduateStudent
PERSONALINFORMATION
1.Applicant’sName:________________________________________________________________________________
LASTFIRST MIDDLE
(Preferred)
2.ClemsonUniversityXID:_________________________E-MailAddress:_________________________________
3.Inwhatcategoryareyourequestingresidencystatus?PleasecheckONEofthefollowing:
qIndependentStudent qDependentof:_____________________________Relationship?________________
4.DateofBirth:______________________Age:__________MaritalStatus:________________________________
5.Phonewhereyoucanbereached:_______________________Canamessagebeleftatthisnumber?__________
6.Address:Present___________________________________________(howlonghaveyoulivedhere)____________
Permanent____________________________________________________________________________ Doyou,thestudent,ownthehomeinwhichyoupresentlylive?qYESqNO
Doyou,thestudent,rentthehomeinwhichyoupresentlylive?qYESqNO
Listalladdresseswhereyouhavelivedduringthepasttwoyearsandthedateyoulivedateach(notincludingtheabove
address).
ADDRESS
DATES
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
7.Forwhatsemesterareyourequestingin-statetuitiontobegin?___________________________________________
8.Haveyouappliedforin-statetuitionbefore?qYESqNOIfyes,When?______________________________
OFFICEOFRESIDENCYCLASSIFICATION
9.WhydidyoucometoSouthCarolinaandwhatareyourplansaftergraduation?_______________________________
__________________________________________________________________________________________________
10.DoyouplantoremaininSouthCarolinaaftercollegegraduation? qYESqNO
11.Pleaselistschoolsattendedinthepastfiveyears,andincludedatesofattendance(includingstudyabroad).
Schools
Dates
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
12.Areyouacitizen?qYES qNO
13.AreyouapermanentresidentoftheUnitedStates?qYESqNO
Whatisyournationality?_______________________________________________________
IFYOUAREUNMARRIEDANDare24yearsoldoryounger,PLEASEANSWERQUESTIONS#14to#17(IFNOTSKIPTO
#18)
14. What is your parents’ marital status? ____________________ If your parents are divorced, was any court order
madeassigningyoutothecustodyofeitherparent?qYESqNOIfyes,towhom?___________________________
15.Nameofcustodialparent(s)andtheirpresentaddress:__________________________________________________
__________________________________________________________________________________________________
16.Doeseitherparentcontributetoyoursupport?_________________________________________________________
17.DideitherparentclaimyouasataxdependentonthelastFederalIncomeTaxReturnfiled?____________________
IFYOUAREMARRIED,PLEASEANSWERQUESTIONS#18TO#22(IFNOTSKIPTO#24)
18.Ifyouaremarriedpleasegivefullnameofspouse(ifwife,includemaidenname)andpresentaddress:___________
__________________________________________________________________________________________________
19.Spouse’slasthomeaddress:_______________________________________________________________________
20.Isyourspousedependentuponyou(areyouhis/herpredominantsourceoffinancialsupport)?qYESqNO
21.Areyoudependentuponyourspouse(ishe/sheyourpredominantsourceoffinancialsupport)?qYESqNO
22.Spouse’splaceofemployment:_______________________________________qFull-timeqPart-Time
EMPLOYMENTANDFINANCIALDATA
23.Areyouemployed?qYESqNOIfyes,bywhom?__________________________________________________
24.Datesofemployment:________________
qFull-timeqPart-TimeSCCompany?qYESqNO
25.Whatisyourpresentpredominantmeansoffinancialsupport?___________________________________________
OFFICEOFRESIDENCYCLASSIFICATION
26.Ifyouarefinanciallyindependent,forhowlong?_______________________________________________________
27.DidyoufileaFederalIncomeTaxReturnasanindependentperson? qYES qNO.DidyoufileSouthCarolina
StateTaxReturnasaSCresident?qYESqNO
MISCELLANEOUSDATA
28.DoyouhaveavalidSouthCarolinaissuedstateIDcard?qYESqNO
29.DoyouhaveavalidSouthCarolinadriver'slicense?qYESqNO
IsyourlicensearenewalofapreviouslyissuedSouthCarolinalicense?qYESqNO
30.Doyouownamotorvehicle?qYESqNOIfyes,isitregisteredinSouthCarolina?qYESqNO
IsthisregistrationarenewalofapreviouslyissuedSouthCarolinaMotorVehicleRegistration?qYESqNO
31.Listallvehiclesthatyoucurrentlyownandwhatstatetheyareregisteredin:
VehicleMake/Model State NewlyPurchasedY/N?Ifyes,listdatepurchased
__________________________________________________________________________________________________
__________________________________________________________________________________________________
DECLARATIONOFDOMICILE
Domicile denotes your true, fixed and permanent home and place of habitation. It is the place where you intend to
remainandtowhichyouexpecttoreturnwhenyouleave,withoutintendingtoestablishdomicileelsewhere.
Penalty:Willfulmisrepresentationoffactinanattempttogainresidencyimproperlymayresultintuitionandfeespast
dueandunpaidtobecharged,plusinterestattherateofeightpercent(8%)perannum,plusapenaltyintheamountof
twenty-fivepercent(25%)ofthenon-residenttuitionandfeesforonesemester.
(1)I______________________________________________________________________________declareunderoath:
(a)Mybirthdateis______________________(b)IestablishedmydomicileinSouthCarolinaon___________________
(c)Iresideat_______________________________________________________________________________________
(2)Ihavereadthedefinitionofdomicileandthepenaltyprescribedforwillfulmisrepresentationappearingabove.
NOTARIZATIONREQUIREMENT
_____________________________________________
SignatureofStudent
Stateof_____________
Countyof____________________
Subscribedbeforemethis___________dayof_________________________________________,20___
____________________________________________________
My Commission Expires __________________
NotaryPublic NotarySeal
Revised3/2015
OFFICEOFRESIDENCYCLASSIFICATION
STUDENTCHECKLIST
IfstudentapplyingasIndependent:
q
Parent/spouse/guardianformcompletedandnotarized(mustturninoriginalform)
q
Parent/spouse/guardianwillneedtoturninFederaltaxesshowingparentdoesnotclaimstudent(allincome
q
q
q
q
q
q
q
andsocialsecurityinformationmaybeblockedout)
Studentformcompletedandnotarized(mustturninoriginalform)
Copyofstudent’sdriver’slicense(ifarenewalandoriginaldatedoesnotshowondriver’slicense,pleaseprovideacopy
ofyour3yeardrivingrecordfromtheSCDepartmentOfMotorVehicles)
Copyofstudent’sidentificationcard(ifnodriver’slicense)
Copyofstudent’svehicleregistrationforallvehiclesowned(Ifyoudonothavetheoriginalvehicleregistrationplease
provideacopyofyourofficialvehiclereportfromtheSCDepartmentofMotorvehicles,ifthisisanewlypurchasedvehicle
provideacopyofthepurchaseagreement/billofsale)
Student’srentalagreementforpastyearandcurrentyear
Student’sclosingstatementonhome(ifown)andcurrentpropertytaxifyouhaveownedthehomemorethan2
years
Student’sfulltimeemploymentletterifapplicable(**seestatementbelow,onlyneededifhavenotmetthetwelve
monthrequirement)
q
q
Student’syeartodateearnings
Student’sFederalandStatetaxes(mostrecentfiled,ifyoufiledasapartyearresidentonstateprovidescheduleNR/PR
andifyoufiledStatetaxesintwostatespleaseprovidebothstatestaxes)
q
Student’sdocumentationofFinancialAidiffromanotherschooloriftheywerefromaPrivate
FinancialInstitutionthatdidnotgothroughClemson(inthetwelvemonthspriortothetermyouarewantingin-state
tuitionandfees)
q
q
q
IfyouareapermanentResidentoftheUnitedStatespleaseprovideacopyofyourpermanentresidentcard
CopyofAlienRegistrationCard(I-94)orVisa,pleaseprovideacopy(ifapplicable)
Ifyouaremarriedandaredependentonyourspouseandyouhavebeenmarriedforlessthan12months,
pleaseprovideamarriagecertificate
Spousesfulltimeemploymentletterifapplicable(**seestatementbelow,onlyneededifhavenotmetthetwelve
q
monthrequirement)
q
IfMilitary:provideacopyofyourmostcurrentorders,LeaveandEarningStatement,andMilitaryDeclarationof
Domicile
Ifstudentisapplyingasdependent:
q
Studentformcompletedandnotarized(mustturninoriginalform)
Studentwillnotneedtoturninanyfurtherdocumentation
q
Parent/spouse/guardianwillneedtofollowinstructionsonParentCheckListforstudentapplyingas
dependent **FulltimeemploymentlettersmustbeoncompanyletterheadandtheStatementmust:1)verifyfulltime
employment;2)specifynumberofhoursworkedperweek;3)stateoriginaldateofemploymentinSouth
Carolina;4)specifylengthortermofemployment;ifindefinite,pleaseindicate.Regardlessofemployment
status,provideacurrentverificationofyear-to-dateincometotals.
OFFICEOFRESIDENCYCLASSIFICATION