Tri-County Techical College

RESIDENCY APPLICATION

Parent/Spouse/Guardian Form

This form is to be completed by the parents, spouse, guardian or any person having legal custody of any student or prospective student who is seeking to establish eligibility to pay the in-state rate on tuition and fees at Tri-County Technical College.

The questionnaire is to be completed by one of the following persons, as the situation requires: by the parent providing majority financial support; or by each parent if divorced/separated; by the student's legally appointed guardian; by the spouse if the student is married. Please be advised that if guardianship or custodianship was created primarily for the purpose of conferring South Carolina domicile for tuition and fee purposes on such child or dependent person, it shall not be given consideration or recognition.

The form should be completed, signed, notarized, and returned to the address below at least two weeks prior to registration for the semester or summer term for which the student is attempting to qualify to pay the in-state rate on tuition and fees.

Determination of residency status will be made on the basis of the South Carolina Code of Laws printed on the insert and regulatory guidelines promulgated by the South Carolina Commission on Higher Education, for information call Scott Harvey at 864-646-1556.

Return to: Mr. Scott Harvey

Tri-County Technical College

P.O. Box 587

Pendleton, SC 29670

PERSONAL INFORMATION

The student or prospective student whose resident status is under consideration is ___________________,

who is hereinafter called "student."

1. Name of person answering questionnaire: ___________________________________________

2. Relationship to student: ________________________________________________________

3. Legal basis for exercising custody of student (father, mother having custody by court decree, guardian, spouse, etc.)

If custody awarded by court decree, provide a copy of such.

4. What is your present address (street, city, and state)? __________________________________

__________________________________________________________________________

5. How long have you lived in the state listed in question 4 above?____________________________

6. What do you consider to be your "permanent" home address?_____________________________

__________________________________________________________________________

7. Do you have any intention at present of moving from your current address?________________ If so, to what place?__________________________________________________________________________

8. If not living at your "permanent" home address (question 6), do you intend to live there sometime in the future?

9. Are you a citizen or permanent resident of the United States? _________ If not, what is your nationality?

(If you hold an Alien Registration Card (I-94) or visa, please attach a copy.)

10. Do you pay taxes on real estate in South Carolina? ___________ On personal property?________

List all real property you own in South Carolina:_______________________________________

Do you pay South Carolina Income Tax? ______________ If so, for how long?______________

11. Do you own real estate in any state other than South Carolina?____________________________

Do you claim homestead exemption in any state? _____________ Where?__________________

Do you own or rent the home in which you are presently living?___________________________

Do you pay income tax to any state other than South Carolina? ________ Which?_____________

12. Have you ever lived in South Carolina? ____________ If so, when?_______________________

13. If you live in South Carolina, how long have you lived here? (Give dates)_____________________

__________________________________________________________________________

14. Has the student lived in South Carolina?_____________________________________________

EMPLOYMENT AND FINANCIAL DATA

15. What is your occupation?_______________________________________________________

Are you self-employed? __________ If so, attach a notarized employment verification on company letterhead.

If not, who is your employer?____________________________________________________

Where do you practice your occupation?____________________________________________

(Note: If you are employed full time in the state of South Carolina, please attach statement from your employer. Statement must: 1) verify full-time employment; 2) specify number of hours worked per week; 3) state original date of employment in South Carolina; 4) specify length or term of employment; if indefinite, so state.)

16. If in government or military service, do official records show you to be a resident of South Carolina?

______________ If in active military service, provide a copy of your most current orders, Leave and Earning Statement, and Military Declaration of Domicile.

17. Do you maintain any bank accounts in South Carolina? _________ If so where?______________

18. Do you own any insurance policies with an insurance carrier in the state of South Carolina? ______ If so, name of insurance company.___________________________________________________________

MISCELLANEOUS DATA

19. Do you have a valid South Carolina Driver's License? _______ If yes, attach a copy of your license.

20. Do you own an automobile(s)?_____ Is the vehicle(s) registered in South Carolina?________ Attach a copy of your registration certificate for all vehicle(s) owned.

21. Are you registered to vote? ________ If so, where did you register? ___________ Have you ever voted in South Carolina? _____ When? __________ Have you ever voted in another state?_____ Where?_____ When? _________ (If you are registered to vote in South Carolina, please attach a copy of your voter registration card.)

22. Did the student qualify as a tax dependent on the Federal Income Tax Return you filed for the preceding tax year? _________ Tax Year ___________ If the answer is "No," please attach a copy of that tax return to this questionnaire. (You may black out all monetary figures if you desire.)

23. Will the student qualify as a tax dependent on the Federal Income Tax Return that you (Parent, Spouse -- Circle one) will file for the current year? Yes______ No______

(Note: You may be required to submit a copy of the current year's tax return once it has been filed. You will be notified if this information is needed.)

24. Please give any other information you consider relevant to the student's claim of residence._______

__________________________________________________________________________

DECLARATION OF DOMICILE

(Number 25 to be completed only if parent/spouse/guardian is asserting domicile in South Carolina)

25. Domicile denotes your true, fixed and permanent home and place of habitation. It is the place where you intend to remain and to which you expect to return when you leave, without intending to establish domicile elsewhere.

Penalty: Willful misrepresentation of fact in an attempt to gain residency improperly may result in tuition and fees past due and unpaid to be charged, plus interest at the rate of eight percent (8%) per annum, plus a penalty in the amount of twenty-five (25%) of the non-resident tuition and fees for one semester.

(1) I ______________________________________________________ declare under oath:

(a) My birth date is _____________________

(b) I established my domicile in South Carolina on__________________________________

(2) I have read the definition of domicile and the penalty prescribed for willful misrepresentation appearing above.

NOTARIZATION REQUIREMENT

26.

STATE OF ______________________ ______________________________

County of _______________________ Signature of Parent/Spouse/Guardian

Subscribed before me this _______________ day of __________________________________, 20_____

_______________________________ ____________________________________

My Commission Expires Notary Public for South Carolina

Notary Seal

Revised: April 2, 2008