Application for In-State Tuition

This section 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.

Longwood Student ID (L-number)

Can be found in your acceptance letter or your student portal.

Legal First Name

Middle Name

Last Name

Date of Birth

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

Note: Claiming dependent status is not necessarily tied to financial responsibility, but rather to the legal or familial relationship that qualifies someone for this designation.

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 First Name

Middle/Maiden Name

Last Name

Relationship to the future Lancer?

FatherMotherLegal GuardianSpouse

Note: You will need to send a copy your legal guardianship paperwork after sumbitting this form.

-

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

ESTABLISHING RESIDENCY

REMINDER: This section should be completed by your PARENT, GUARDIAN OR SPOUSE.

I Understand

How long have you resided in Virginia? (X years, X months)

CURRENT Address

Street Address

City

State

Zip Code

Please provide the month and year of the beginning of residency at this address.

Month

Year

Residency End

Month

Year

Residency Duration Calculation

Residency Populated

PRIOR Address

You have indicated that you have lived at your current address for less than 24 months. Please provide the address of where you lived prior to your current home.

Street Address

City

State

Zip Code

Please provide the month and year of the beginning and end of residency at this address.

	Month	Year
Residency Start
Residency End	If you are currently living at this address, provide the current month and year.

Filed a tax return or paid income taxes in Virginia on all earned income?

YesNo

Filed a tax return or paid taxes in ANOTHER state?

YesNo

Do you hold a valid Virginia driver's license, learner's permit or DMV-issued ID?

YesNo, but I do for another state. I do not have either.

Date Issued/Re-issued

Owned or operated a motor vehicle with Virginia license plates?

YesNo, but I do for another state. I do not own or operate.

Are you registered to vote in Virginia?

YesNo, registered in another state. I am not registered to vote

Have you lived outside of Virginia, but commuted to a work site in Virginia?

YesNo

Have you earned at least $15,080 in Virginia in the past year?

YesNo

Certification and Student Signature

I, the STUDENT, 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 (NOT Parent's Name)

Date