decl_of_residency

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					                                  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.

ID# _______________

___________________________________________                             ______________________
Name of Student: Last, First, MI                                        Date of Birth MM/DD/YR

Mailing Address: Street, Apt. Complex/Development                City             State        ZIP

HOME (         ) _______________________________WORK (Optional) (                   )_________________
Telephone Numbers

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.

				
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