Tri-County Technical College

RESIDENCY APPLICATION

Student Form

This form is to be completed by students who are seeking to establish eligibility to pay the in-state rate on tuition and fees at Tri-County Technical College. The form should be completed, signed, notarized and returned to the address below at least two weeks prior to registration for any semester or summer term for which the student is attempting to qualify to pay the in-state rate on tuition and fees. Please note that a Parental/Spouse/Guardian form is also required to complete the application process.

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

1. Applicant's Name:_____________________________________________________________

Last First Middle

2. Social Security Number: __________/_____ /________

3. Date of Birth: ____________________________ Age: ________ Marital Status:___________

4. Permanent Phone: ______________________ Present Daytime Phone:___________________

5. Address: Present_____________________________________________________________

Permanent___________________________________________________________

List all addresses where you have lived during the past five years and give the dates you lived at each.

(Give most recent address information first.)

Address Dates

___________________________________________________________________________

6. Have you applied for in-state tuition before? ___________________________ If so, when?_____

7. For what semester are you requesting in-state tuition to begin?_____________________________

8. On what date did you pick up this student questionnaire?___________________ On what date did you return the questionnaire to this office?______________________________________________________

9. If you received this questionnaire by mail, on what date did you receive it? ________________ On what date did you mail this questionnaire back?_________________________________________________________

10. Why did you come to South Carolina?_______________________________________________

11. When did your present (latest) stay in South Carolina begin?_______________________________

12. How long have you lived here?____________________________________________________

13. List schools attended in the past five years, and include dates of attendance.

Schools Dates

___________________________________________________________________________

14. Did you attend any out-of-state schools as a South Carolina resident?__________ If so, which?____

15. If you attended an institution other than Tri-County Technical College last semester, state name and location of institution.

___________________________________________________________________________

16. Where do you expect to live in the future?____________________________________________

17. 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.)

18. Are you registered to vote?____________ Where?____________ When did you register?_______

Have you ever voted in South Carolina?_____________ When?______________ Have you ever been

registered in or voted in another state?__________ Where?______________ When?__________

(If you are registered to vote in South Carolina, please attach a copy of your voter's registration card.)

19. Name of parents and their present address___________________________________________

___________________________________________________________________________

20. Give cities, states, and dates where your parents lived during the past five years. (If 25 or older, skip to question 28.)

Cities/States Dates

___________________________________________________________________________

21. Father's occupation and employer, specify if self employed._______________________________

22. How long has your father lived continuously in South Carolina, if at all?__________ Where was his last previous domicile?___________________________________________________________________________

23. How long has your mother lived continuously in South Carolina, if at all?_________ Where was her last previous domicile?___________________________________________________________________________

24. If your parents are divorced, was any court order made assigning you to the custody of either parent?__________ Father or mother?___________________________________________________________________

25. Do your parents contribute to your support?___________________________________________

26. Did your parents claim you as a tax dependent on the last Federal Income Tax Return they filed?____

27. If married, please give full name of husband or wife (maiden name) and permanent address________

___________________________________________________________________________

(If married within the last 12 months please provide a copy of your marriage certificate.)

28. Spouse's place of employment_____________________________ From __________ To______

29. Full or part-time_______________________________________________________________

30. Spouse's last previous home address:________________________________________________

31. Is your spouse dependent upon you (are you his/her predominant source of financial support)?______

32. Are you dependent upon your spouse (is he/she your predominant source of financial support)?_____

33. Where did you spend most of your time last summer (or during the current summer if this application is filled out during the summer?____________________________________________________________________

34. Where will you spend most of your time next summer?__________________________________

EMPLOYMENT AND FINANCIAL DATA

35. Are you employed?__________ If so, by whom?______________________________________

36. Dates of employment: From_________________ To_________________ Full or Part-time?____

(If full time, please attach a 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.) Regardless of employment status, provide a current verification of year-to-date income totals.

37. What is your present predominant means of financial support:______________________________

If you are an independent person, please provide verification of year-to-date earnings from employment for the current tax year.

38. If you are financially independent, for how long?_______________________________________

39. Do you have a checking account at a bank in South Carolina:_________ If yes, how long have you had a checking account at any bank in South Carolina?______________________________________________

40. Do you have a savings account at a bank in South Carolina:___________ If yes, how long have you had a savings account at any bank in South Carolina?____________________________________________________

41. Do you have any of your personal property at a location in another state?_________ If yes, in what state?

42. Do you own any real property in South Carolina?________________ If yes, give purchase date and description of property.____________________________________________________________________

43. Did you file a Federal Income Tax Return as an independent person and/or a resident South Carolina State Tax Return for the previous year?_________ ***If you are asserting status as an independent person attach a copy of the Federal and State Income Tax Return for the previous year. Be sure the tax returns you submit are signed.

44. Do you currently have any Student Loans from the State of South Carolina?________ Do you currently have any student loans from any state other than South Carolina? If yes, what state?__________________________

MISCELLANEOUS DATA

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

46. Do you have a valid South Carolina driver's license?____________ (If yes, attach a copy of your license.) Is your license a renewal of a previously issued South Carolina license? If yes, give date of original issue.___

47. Do you own a motor vehicle?_____________ If so, is it registered in South Carolina?_____________ (If yes, attach a copy of your registration certificate.) Is this registration a renewal of a previously issued South Carolina Motor Vehicle Registration?____________ If yes, what was the original date of issue? Have you previously owned another vehicle?_______________ If yes, in what state was it registered?_________________________

(Provide vehicle registration history.) If you do not own a car, whose car do you drive?_________

In what state is it registered? ____________________ In what state is the insurance carried on the car

that you own or drive?__________________________________________________________

48. Summarize your claim for residence under the regulations for determining residence classification. (Please refer to the specific section of the law you believe to be applicable.)

___________________________________________________________________________

DECLARATION OF DOMICILE

49. 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

50.

STATE OF SOUTH CAROLINA ______________________________

County of ___________________ Signature of Student

Subscribed before me this _______________ day of __________________________________, 20_____

________________________________________ ______________________________

My Commission Expires Notary Public for South Carolina

Notary Seal

Revised: April 1, 2008