Application for In-State Tuition Rates
 
 
  • Student  Information

Student Name:  

Social Security or Student I.D.

Local Address:  

Local Phone number:

Date of Birth:

Permanent Address:  

If your permanent address is different than your local address, how many months out of the year do you live at the permanent address?

Email address:
Are you a U.S. Citizen?   Yes    No     If not, please specify:
Country of origin:
Type of Visa: (Please attach a copy of both front & back of VISA or green card.)
Date of Issue:
Expiration Date:

Term in which you are requesting in-state tuition rates (Must be a future term):

Beginning with your current address, please list your residence locations for the past four years with specific beginning and ending dates:
Current:

From: To:

Prior:

From: To:

Prior:

From: To:

Prior:

From: To:

1. Does your parent or guardian provide 50% or more of your financial support or claim you as a tax dependent?      Yes   No

2. If you are married, do you wish to claim eligibility for in-state tuition rates based on your spouse’s domicile?       Yes      No    N/A

    If yes, does your spouse provide over 50% of your financial support?  Yes  No

3. Do any of the following characteristics apply to you?  Place a check mark beside all that apply:

Age 24 or older                                                                                 Ward of the court or was a ward of the court until age 18

Veteran or active duty member of the U.S. Armed Forces       If both parents are deceased, no adoptive or legal guardian 

Graduate student                                                                              Legal dependents other than a spouse 

4. What are your post graduation plans?  Please attach any documentation you have to confirm these plans.

 5. If you checked any of the criteria in item #3, or if you answered ‘No’ to #1 or #2, please fill out the following table, based on your monthly income and expenses.
 

Source of expenses (i.e., telephone bill, rent, etc.)

Monthly Cost (Estimate)

Amounts of Financial Support/Income & Sources

 

 

 

 

 

 

 

 

 

 

 

 
  • Domicile/Supplemental Information

1. Have you been employed in Virginia for the past year?        Yes   No
         If no, were you  Not employed or  Employed in another state

2. Was a tax return filed or income taxes paid to Virginia as a full-or part-year resident on all earned income last year?  Yes No
          If no, were taxes paid to: Another state or Didn’t file

3. Are you a registered voter in Virginia?  Yes No
         If no, are you registered to vote in another state?   Yes No

4. Do you hold a valid Virginia drivers’ license?  Yes No
         If no, do you hold a license in another state?  Yes No

5. Did you operate a motor vehicle registered in Virginia during the last year?  Yes No
         If no, is it registered in another state?  Yes No

6. Have you lived outside Virginia for the past year?  Yes No
         If yes, will you have been employed in Virginia and earned at least $10,300 during the past year?  Yes No
         Paid Virginia income taxes on all taxable income earned in Virginia during the past year?  Yes No

8. Do you have health insurance?  Yes No
    If yes, who is responsible for paying the premium?  What is the approximate cost?

9.  Do you have auto insurance?  Yes No
     If yes, who is responsible for paying the premium?  What is the approximate cost?

10. Why did you move to Virginia?

11. Please provide any other information you feel is relevant to your case.  Additional pages may be attached.

  • For Military Applicants Only

Who is a member of the Armed Forces?  Self Parent/Legal guardian Spouse

Answer the corresponding questions according to your answer:

SELF/SPOUSE

1. Have income taxes been paid to Virginia on all military income for the last year?  Yes No
       If no, have income taxes been paid to another state?  Yes No

2.  Does the current Leave/Earnings statement reflect Virginia withholding?  Yes No
        If yes, effective date of change to Virginia  

PARENT/LEGAL GUARDIAN

1. Have income taxes been paid to Virginia by the military parent for the last year? Yes No
    If “no” has non-military parent/guardian paid Virginia taxes on all earned income for the last year? Yes No

2. Does the current military Leave/Earnings Statement reflect Virginia withholding? Yes No
    If “yes”, effective date of change to Virginia

3. Does the military member claim you as a dependent for federal and Virginia income tax purposes? Yes No

  • Parent/Legal Guardian/Spouse Information

 Please have your parent/legal guardian or spouse answer the following questions.

 What is your relationship to the applicant?

Mother  Father  Legal guardian  Spouse

1. Have you been employed in Virginia for the past year?   Yes   No
         If no, were you   Not employed or  Employed in another state

2. Was a tax return filed or income taxes paid to Virginia as a full-or part-year resident on all of their earned income last year?  Yes No
          If no, were taxes paid to: Another state or Didn’t file

3. Are you a registered voter in Virginia?   Yes No
         If no, are you registered to vote in another state?   Yes No

4. Do you hold a valid Virginia drivers’ license?  Yes No
         If no, do you hold a license in another state?  Yes No

5. Did you operate a motor vehicle registered in Virginia during the last year?  Yes No
         If no, is it registered in another state?  Yes No

6. Have you lived outside Virginia for the past year? Yes No
         If yes, will you have been employed in Virginia and earned at least $10,300 during the past year?  Yes No
         Paid Virginia income taxes on all taxable income earned in Virginia during the past year?  Yes No

7. Did you claim the applicant as a dependent for federal and Virginia income tax purposes? Yes No

  • Parent/Legal Guardian/Spouse Information

Beginning with your current address, please list your residence locations for the past four years with specific beginning and ending dates:
Current: From: To:
Prior: From: To:
Prior: From: To:
Prior: From: To:

  • Parent/Legal Guardian/Spouse Certification and Signature

I certify that all of the information I provided in this application is true and accurate.  I understand that this application is a legally binding document and that if I provide fraudulent information, the applicant and/or I may be subject to repayment of tuition, dismissal, or both.  I agree to furnish the college or university with supporting documentation related to my application if I am requested to do so.

Signature: Date:

  • Student Certification and Signature 

I certify that all of the information I provided in this application is true and accurate.  I understand that this application is a legally binding document and that if I provide fraudulent information, I may be subject to repayment of tuition, dismissal, or both.  I agree to furnish the college or university with supporting documentation related to my application if I am requested to do so.

Signature: Date:

State Council of Higher Education for Virginia (SCHEV)
101 North Fourteenth Street
Richmond, VA 23219
Phone: 804.225.2600
Fax: 804.225.2604
TDD: 804.371.8017
www.schev.edu
115 Martin Hall | PO Box 6904 | Radford, VA 24142 - Fax: 540.831.6642