- Page 1
- Page 2 - Page 3 - Page 4 - Page 5 - Page 6 - Page 7 - Page 8 - Page 9 - Page 10 - Page 11 - Page 12 - Page 13 - Page 14 - Page 15 - Page 16 - Page 17 - Page 18 - Page 19 - Page 20 - Page 21 - Page 22 - Page 23 - Page 24 - Page 25 - Page 26 - Page 27 - Page 28 - Page 29 - Page 30 - Page 31 - Page 32 - Page 33 - Page 34 - Page 35 - Page 36 - Page 37 - Page 38 - Page 39 - Page 40 - Page 41 - Page 42 - Page 43 - Page 44 - Page 45 - Page 46 - Page 47 - Page 48 - Flash version © UniFlip.com |
Massachusetts Community Colleges in-State Tuition Eligibility Form
Please print clearly.
Last Name: _______________________________________
First Name: ______________________________________
MI: ____________
Street Address: ___________________________________________________________________________________________________________ City: _____________________________________________ State: _____________________________ Zip: _________________________
SSN# or Student I.D. Number: ___________________________________________ Are you a U.S. Citizen?: q Yes
Date of Birth: __________________________________
q No
If not, please complete the following:
Are you a Permanent Resident?: q Yes
q No
If yes, list alien registration number: _______________________________________
If you are not a U.S. Citizen or Permanent Resident, please state your Visa or immigration status in detail: ______________________ __________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________ Please check the in-state or reduced tuition eligibility category that applies to you: I have been a Massachusetts resident for six (6) continuous months and intend to remain here.
As proof of my intent to remain in Massachusetts, I possess at least 2 of the following documents, which I shall present to the institution upon request. These documents* are dated within one (1) year of the start date of the academic semester for which I seek to enroll (except possibly for my high school diploma). The institution reserves the right to make any additional inquiries regarding the applicant’s status and to require submission of any additional documentation it deems necessary.
Please check-off those documents you possess as proof of your intent to remain in Massachusetts:
q Valid Driver’s license q Valid Car registration q Mass. High School Diploma
q Utility bills* q Voter registration* q Signed lease or rent receipt* q Other:
q Employment pay stub* q State/Federal tax returns* q Military home of record*
q Record of parents’ residency for unemancipated person*
I am an eligible participant in the New England Board of Higher Education’s Regional Student Program. I am a member of the armed forces (or spouse or unemancipated child) on active duty in Massachusetts.
Certification of Information
I certify that this information is true and accurate. I understand that any misrepresentation, omission or incorrect information shall be cause for disciplinary action up to dismissal, with no right of appeal or to a tuition refund. Applicant’s Signature: _______________________________________________________________ Parent/Guardian Signature (Applicant is under 18 years old): __________________________________ Date: ___________________________ Date: _________________________
For Official Use Only – DO NOT WRITE IN THIS BOX
I have reviewed the above information in order to determine this individual’s eligibility to receive the in-state tuition rate. Based on my review I have determined that this individual: IS eligible for the in-state tuition rate. IS NOT eligible for the in-state tuition rate.
I am unable to make a determination at this time. The following additional information has been requested from the applicant:
Authorized College Personnel: ____________________________________________________________
Date: ________________________
|