Declaration of Residency Form
Directions: Please mark the items in the criteria section that pertain to you and submit all supporting
documentation. Sign and date the form and submit it to the Campus Registrar’s Office at the time of
registration. LAST DAY TO SUBMIT DOCUMENTATION FOR INSTATE TUITION CONSIDERATION
FOR FALL SEMESTER (201051) is Monday, AUGUST 24, 2009. After this date, only students who
are late registering can provide documentation for instate consideration at the time of registration.
Name of Student: Last, First, MI Date of Birth MM/DD/YR
Mailing Address: Street, Apt. Complex/Development City State ZIP
HOME ( ) _______________________________WORK (Optional) ( )_________________
Please indicate your eligibility status:
I am a US Citizen
I am a Permanent Resident, Temporary Permanent Resident, Asylee, Refugee, Parolee, or have
Temporary Protected Status and my Permanent Resident Card, I-94, INS Form I-797 or
equivalent BSCIS documentation indicates a date received six months prior to registration.
(Documentation must be submitted with Declaration).
I understand that eligible students are considered Delaware residents at the time of registration at
Delaware Technical & Community College if they meet one of the following conditions.
( ) Delaware has been my domicile and continuous residence for at least six (6) consecutive
months prior to the date of registration. (See back of form for documentation requirements)
SUPPORTING DOCUMENTATION – One of the following is required.
Delaware Drivers License or Delaware ID Card
Delaware Resident Income Tax Form
Copies of Utility Bills
Fully Executed Lease or HUD-1 Settlement Statement
Copies of Bank Statements
Copies of Official Documents confirming receipt of any type of Social
Services from the State of Delaware
( ) I am employed full time (at least 30 hours) in the State of Delaware for at least six (6)
consecutive months prior to the date of registration
SUPPORTING DOCUMENTATION – ALL of the following are required.
A letter from the employer on the employer’s letterhead stating the start date of
employment, hours of work/week and contact information for verification
purposes OR pay stubs demonstrating employment of at least 30 hours/week
during the 6 consecutive months prior to registration AND
IRS Form W-2 showing payment of Delaware income taxes or a copy of any
state income tax return for the immediately preceding tax year showing the
payment of income taxes to the State of Delaware
( ) I am active duty military stationed in Delaware or am a dependent/exemption of a person with
this status and am supplying supporting documentation.
( ) I am a dependent of my parent(s) or legal guardian(s) who meet Delaware residency
requirements and am attaching the appropriate official Federal Tax Form 1040 and the
appropriate parental documentation.
I understand that failure to supply accurate information may disqualify me for consideration and
that the sole purpose of changing my residency status is to ensure that I obtain in-state tuition.
Student Signature Date Registrar Signature Date
Term ______________________ Registrar’s Decision ____________
SUPPORTING DOCUMENTATION REQUIREMENTS
1. Delaware Drivers License or Delaware Identification Card with issue date of
at least 6 months prior to registration OR a copy the driving record of the
student that shows possession of Delaware License for at least 6 months
prior to the date of registration.
2. An official copy of a Delaware Resident Income Tax form in the name of the
student or the student’s parent, legal guardian or spouse with whom the
student resides listing a date of residency at least 6 months prior to the
date of registration.
3. Copies of Utility Bills in the name of the student or the student’s parent,
legal guardian or spouse with whom the student resides for at least six
consecutive months prior to registration.
4. A copy of a fully executed lease, HUD-1 Settlement Statement or deed for
your primary residence in the name of the student or student’s parent, legal
guardian or spouse with whom the student resides dated at least six
months prior to registration.
5. Copies of bank statements in the name of the student or the student’s
parent, legal guardian or spouse with whom the student resides for six
consecutive months prior to registration and bearing a Delaware address
(other than a post office box).
6. Copies of official documents confirming the receipt of any type of social
service from the State of Delaware or any political subdivision thereof (i.e.,
WIC Benefits, food stamps, Medicaid, etc.) in the name of the student,
student’s parent, legal guardian or spouse with whom the student resides
for six consecutive months prior to registration.