Application for In-State Tuition

Section 1: To be completed by YOU, THE STUDENT.

This form must be completed to claim entitlement to Virginia in-state tuition rates pursuant to section 23.1-5, Code of Virginia. Answers must reflect information that is true for at least 1 year prior to term of enrollment.

Lancer's Name (Last, First Middle)

Date of Birth

Longwood Student ID (L-number)

Can be found in your acceptance letter and your student portal

Citizenship

U.S.Non-U.S.

If not U.S., VISA type or Resident Alien #:

Are you, your spouse and/or a parent active duty or a veteran of the U.S. Armed Forces?

Me and/or my spouseOne or both of my parents/guardiansNot Applicable

What type of student are you?

New undergraduate studentNew graduate studentCurrent student hoping to reclassify my domicileRe-admitted student

Dependent Status

Does your parent, legal guardian or spouse provide 51% or more of your financial support and/or claim you as a dependent?

YesNo

DEPENDENT STUDENT

Based on the information provided thus far, you should complete this form as a DEPENDENT student. Please provide the following information on your parent, guardian or spouse.

Parent/Guardian/Spouse Name (Last, First Middle)

Relationship to the future Lancer?

FatherMotherLegal GuardianSpouse

Citizenship

U.S.Non-U.S.

If not U.S., VISA type or Resident Alien #:

I acknowledge that my parent, guardian or spouse will need to complete the questions on the next page.

I Understand

INDEPENDENT STUDENT

Based on the information provided thus far, you should complete this form as an INDEPENDENT student. Please provide the following information based on yourself.

I acknowledge that I will need to complete the questions on the next page based on my own experience.

I Understand

Certification and Signature(s)

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 or dismissal. I agree to provide the college with supporting documentation related to my application, if I am requested to do so.

By checking this box and typing my full name below, I electronically sign this form

Name

Student's Name

Date