Residency Affidavit 2022

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Revised'6/1/22

pg 1

FLORIDA'RESIDENCY'DECLARATION

STATEMENT'OF'RESIDENCY'

Students shall be'classified as residents or non-reside nts for'the purp ose of'assessing tu ition at'St. Johns River'State Co llege based

on'the provisions of Florida Statute 1009.21 and'State Board'of Education Rule 6A-10.044. A'Florida resident is a'person who has

maintained legal residency in Florida for at least twelve consecutive months prior to' the first day of classes. The person responsible

for'providing proo f of residency, the “Claimant,”'depends upon'the student’s independent or dependent status. Living'in F lorida in

itself will'not establish legal'residence'for 'tuition 'purposes. All U.S. citizen'dependent students who'meet the statutory requirements

for' Florid a residen cy , regardless of' parental immig ra tio n sta tu s in the U.S., will' be classified as residents for tuition purposes. All

non-U.S. citizen students' must provide proof of an eligible immigration status' in the U.S. in addition to meeting statutory

requirements for'residency for'tuition purposes.

INDEPE N D E N T !VS. !DEP E N DENT

Please'read and determine'your claimant status

Indepen de n t !Student

If 'you 'ar e '24 'years 'of 'age 'on 'the 'first 'd a y 'of 'classes 'for 'your 'fir st 'term,'you 'are 'indep e n d en t . ''Based 'on 'age 'alon e, you are considered

the claimant'for res iden cy and do n ot need to provide'any documents to supp ort your being the claimant.

If 'you 'ar e 'under 'th e 'age 'of '24 ,'in 'order 'to 'be 'the 'cla imant,'you 'must 'pro ve 'indepen d e n ce 'by 'prov id in g 'one of the documents below:

• Marriage certificate or divorce papers

• Tax transcript of the m ost recent tax year showing the student claimed one or more dependents

• Tax transcript of the most recent tax year showing that the student earned at least 51% of the cost of attendance as

defined'by the SJR'State Financial Aid'Office'and that student claimed independence

• DD214 or official records showing that the student served on active duty in the US Armed Forces

• Death certificates of deceased parents or documentation the'student is or was a'ward of the'court

Dependent Student

If you are under the age of 24 on the first day'of classes for your first term, you are considered dependent for residency'purposes. A

parent or guardian'(parental role) will be the claimant. Additional documentation'may be needed'to'support the relationship'for

claimant and student. Such documentation may'include:

• Legal guardianship documentation from a U.S. court showing the claimant as'legal guardia n

• Tax transcript of previous 3'years showing the student is'a dependen t of claimant

• Marriage license showing'that the'student is married to the'claimant

Please provide clear copies of two of the fo llowing documents from the CLAIMANT. At least one of the'documents must come from'Tier 1.

Docum en ts must show physical'presence in Florida during the'12-month period prior to the first day of class. Additionally, there must be no

information contradicting the applicant’s claim of residency (i.e.'a driver’s license from another state).

Tier 1 Tier2

•

A Florida voter’s registration card

•

A declaration of d om icile in Florida

•

A Florida driver’s licen se

•

A Florida professional or occupational lic ense

•

A State of Florida identification card

•

Florida incorporation

•

A Florida vehicle regis tration

•

Proof of membersh ip in a Florida based charitable or professional

•

Proof of a homestead exemption of owned property in Florida

organization

•

Proof of permanent full-time employment in Florida for'at least 30

•

Any other documentation th at supports the student’s request fo r

hours per week for the previous 12-month period

resident statu s, including, but not limited to, utility bills and proof of

•

Transcripts from a Florida high school for 2 or more years if the

12'consecutive months of payments;'a lease agreement and proof of

Florida high school diploma or GED was earned withi n the last 12

12'consecutive months of payments; or an official state,'federal, or

months

court docume nt evidencing legal ties'to Florida

•

Proof of immediate fam ily ties to Florida may be considered

Signature'of Claimant: Date:

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Revised'6/1/22 pg 2

All students must complete this section:

Student'Name:

Student'Date of Birth:

Student'ID or Last 4 of SSN*:

Phone Number:

If student is claimant: Are!you!a!U.S.!Citizen? Yes'' No'

Non U.S. Citizens - In 'order 'to 'q u a lify 'as a 'Florida 'reside n t 'f o r 'tuition 'pu rp o se s, 'y o u 'must 'be a 'lawfu l'p e rm a n e n t 'r esi d en t 'alien, 'legal'

alien granted indefinite'stay'by'the Imm igration and Naturalization Services, or must possess an approved V isa'Category. Th e'

following are the approv ed categories: A, E, G, H 1B , I, K, L, N, O-1, R, S, T, U, V, NATO 1-7, TPS, Asylee, Refugee, and Parolee.

Non U.S. citizens: legible 'co p y 'of 'current 'immigratio n 'docume n t 'required - resid en t'alien 'card, Visa and'I-94'card, etc.

o I'am'NOT 'claiming'in-state'residency'for'tuition'purposes.'(Please 'complete'section'1'below)

o I'am'claiming'in-state'residency'for'tuition'purposes.'(Please'complete'sections'2'and'3'below)

1. NON-FLOR IDA RESIDENT:

I'understand 'th a t 'I'do 'n o t 'qu a lify 'a s a 'Florida 'residen t 'for 'tu itio n 'p u rp o se s 'fo r 'the 'te rm 'for 'which 'this 'app lica tio n is submitted and th a t if I'should

qualify for some future term, it will be necessary for me to'file the required'documentation'prior to'the beginning of the term in order'to be

considered for Florida residency'classification. I understand that continuous full-time e nro llm ent'a t'St. Johns River'State C ollege may make me

ineligible for reclassification for in-state tuition. Please refer to an Admissions'Advisor for possible exceptions.

Signature:

Date:

2. FLO RIDA RESIDENT: This is a'brief summary of the State of Florida Residency Requirements/Exceptions.

Please'select one'of the'follo wing residency classifications:

I'am a'qualified'beneficiary under the Florida Pre-Paid p ost-secondary expense program, s.1009.988 (2), F.S.

(required:'copy 'of card).

I'am 'an 'indepen d e n t 'an d 'h a ve 'm a in ta in e d 'Le g al're s ide n c e in 'Florida 'for 'at 'least '12 'm o n th s.

I'am a 'de pe n d e n t 'stu de n t 'un d e r 'the 'a ge 'o f '24 , and my parent or guardian has maintained legal residence'in the'state'

of Florida for at least 12 months.

I'am'a'dependent'person'under'the'age'of 24'who'has'resided'for'five 'years'with'an'adult'other'than'my'parent'

or'legal guardian,'and'they'can'demonstrate'legal 'residence'in'Florida'for'at'least'12'months.

I'am a 'm ember 'of 'the 'armed 'forc e s 'of 'th e 'U.S., and I am stationed in the'state'of Florida'on active m ilitary duty

pursuant to'military orders, or whose home of record'is Florida, or'I am a mem b er’s spouse or depend ent child

(Required: copy of'military orders, DD214, DD2058'showing home'of record).

I'am a 'full'time employee'of a'state'agency or political sub divisio n of the sta te whose student fees'are paid by the'

state agency'or political subdivision for'the job related law enfo rc ement or corre ction s training.

3. Claimant Name: Relationship'to'Student:

Claimant'Address:

City: State: ZIP:

Date Claimant Established Legal Florida Residence:

'Month: 'Year:'

Please complete, at a minimum, two of the following:

Issue'

Vehicle'Plate/

Issue'

Driver’s License or ID'No.:

Date:'

Tag 'No.:'

Date:

Voter Registration No.:

'County:' 'Issue'Date:'

(Additional information'may be required.)

By signing this document, you'are acknowledging:

• Your residence in Florida'has been for the purpose of establishing a'permanent home and'is not only for the purpose of attending a

Florida'state post-secondary'institution.

• That providing false information in th is affidavit'will subject'you to penalties pursuant'to 837.06, F lorid a Statutes.

• That you'have provided'all documents necessary to'show your claim to'Florida residency, as w ell as all documents to show your ability to

act as CLAIMANT'to the'student, whether as a'parent, guardian, or the'student.

SJR STATE COLLEGE NON-DISCRIMINATION STATEMENT

St. Johns River State College, an equal access institution, prohibits discrimination in its employment, programs, activities, policies and procedures based on race, sex, gender, gender

identity, age, color, religion, national origin, ethnicity, disability, pregnancy, sexual orientation, marital status, genetic information or veteran status. Questions pertaining to

education equity, equal access or equal opportunity should be addressed to the College Title IX Coordinator/Equity Officer: Charles Romer, Room A0173, 5001 St. Johns Avenue,

Palatka, FL 32177; (386) 312-4074; [email protected]. Anonymous reporting is available at SJRstate.edu/report. Inquiries/complaints can be filed with the Title IX

Coordinator/Equity Officer online, in person, via mail, via email or with the US Department of Education, Office of Civil Rights, Atlanta Office, 61 Forsyth St. SW Suite 19T10, Atlanta,

GA 30303-8927.

*'Notification'of'Social'Security'Number'Collection'and'Usagep Statute'119.071(5)p please'refer'to'the'college'catalog'for'more'information'(https://www.sjrstate.edu/catalog/

info.pdf'