FLORIDA AGRICULTURAL AND MECHANICAL UNIVERSITY

Office of the University Registrar 103 Foote-Hilyer Administration Center Tallahassee, FL 32307-3200

Office: (850) 599-3115; Fax: (850) 412-7248; Email: registrar@famu.edu

Please read the Residency information [click here] carefully before completing this form. Your request for residency

reclassification for tuition purposes will not be considered without a completed signed form and appropriate documentation

attached. Please see Registrar’s website for schedule and deadlines on the academic calendar

STUDENT NAME: Last First Middle Initial Date of Birth

STUDENT ID Student Major Email Address Please Do Not Enter Social Security #

THIS REQUEST IS FOR TERM/YEAR Fall _______ Spring ________ Summer ________

PLEASE CHECK ONE: I am Independent I am Dependent (See definition www.famu.edu\registrar\residency reclassification)

“Your financial aid award may be affected if you change from non-Florida to Florida residency status.”

REQUIRED DOCUMENTS ISSUE DATE Florida voter registration __________________

Florida driver’s license __________________

Florida vehicle registration __________________

Proof of real estate property ownership in Florida __________________

Proof of lease for apartment/house (12-month period) in Florida __________________

Florida Business Incorporation __________________

Florida Professional/occupational license __________________

Florida Declaration of Domicile __________________

Proof of permanent full time employment in Florida __________________

Proof of reliance upon Florida sources of support (Homeless, Foster Public Assist) __________________

Student's federal tax return for current tax year __________________

Student’s Form W-2 Wage and Tax Statement(s) for current tax year __________________

Parent's federal tax return for current tax year __________________ If you do not meet the 12-month requirement and believe you qualify for temporary in-state status under the exception category

listed below. Please check all that applies (attached evidence/proof);

Member of the U.S. Armed Forces on active duty stationed in Florida and their spouse and dependents or military personnel not

stationed in Florida whose home of record or state of legal residence certificate DD Form 2058 is Florida

Married to a Legal Florida resident and intend to make Florida a permanent home

Full-time instructional or administrative employees of Florida public schools, community colleges, or institutions of higher education or their spouse and dependents

Part of the Latin American/Caribbean Scholarship Program. Receive a scholarship from the U.S. Government (federal) or Florida state government (must attend, on a full-time basis, a Florida institution of higher education)

Qualified beneficiary under the terms of the Florida Pre-Paid College Program

Full-time employee of a state agency or political subdivision of the state whose student fees are paid by the state agency or political subdivision for the purpose of job-related law enforcement or corrections training

Southern Regional Education Board's Academic Common Market graduate student

I do hereby affirm/swear that the information contained herein is true and accurate to the best of my knowledge

_____________________________ ____________

Applicant’s Signature Date

STUDENT PERSONAL INFORMATION (Please Print)

DD

RESIDENCY RECLASSIFICATION FOR TUITION PURPOSES FORM

REQUIRED DOCUMENTS (You must provide copies to be considered)