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Form Name	Fscj Requirements
Form Length	2 pages
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Avg. time to fill out	30 sec
Other names	florida fscj residency form, residency statement affidavit form, affidavit of residence manatee county, lake county fl affidavit oof residency

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Residency Statement/Affidavit

Factors Affecting Florida Residency for Tuition Purposes: (No single piece of documentation will be considered conclusive.)

1.Immigration Status- Non-U.S. citizen applicants and/or parents must provide evidence of eligible legal immigration status in the U.S. before being considered for Florida resident fees. Please review www.flvc.org (Residency Guidelines) for more specific information on non-U.S. citizen categories that are eligible to be considered for in-state fees. International (F-1) applicants are NOT ELIGIBLE for Florida tuition rates.

2.Dependency Status- The determination of dependent or independent status is important because it is the basis for whether an applicant will submit his/her own documentation of residency (as an independent) or his/her parent(s) or guardian(s) documentation of residency (as a dependent). Applicants under 24 are automatically considered “dependent” unless they can prove otherwise. Applicants age 24 and over will automatically be considered independent. Additional documents such as tax returns and birth certificates may be requested to verify independent/dependent status.


	CRITERIA FOR INDEPENDENT STATUS (FL RESIDENCY GUIDELINES): An applicant who meets any one of the	REQUIRED DEPENDENCY PROOF
	following criteria shall be classified as an independent for the determination of residency for tuition purposes:	(Additional documents may be requested)


	Is 24 years of age or older by the first day of classes of the term for which residency is sought.

	Is currently married.	Marriage certificate.

	Have children who receive more than half of their support from the applicant.	Recent tax return showing dependent
		child(ren).
		child(ren).
	Have other dependents who live with and receive more than half of their support from the applicant.	Recent tax return showing dependent(s).
	Is a veteran or is currently serving in the United States Armed Forces for purposes other than training.	Military discharge papers, military orders, or
		DD214.
		DD214.
	Both of the applicant's parents are deceased, or the applicant is or was (until age 18) one of the following:	Death certificates (both parents) or court
		documents showing ward of the court or
	(a) ward of the court or (b) in foster care.	documents showing ward of the court or
	(a) ward of the court or (b) in foster care.	foster care status.
		foster care status.
	Determined homeless by a school district homeless liaison, emergency shelter or transitional housing program.	Signed documentation on official letterhead
		from a school district or agency.
		from a school district or agency.
	Provides more than 50 percent of their own cost of attendance. Florida State College requires proof of $8,300.	Recent tax return and W-2 forms, pay stubs,
Applicant tax return must show at least one exemption. Applicants who do not submit a tax return & W-2’s		Recent tax return and W-2 forms, pay stubs,
		or employer earnings verification.
	as proof of income, must submit parent’s recent tax return showing they were not claimed as a dependent.	or employer earnings verification.

3.Documentation of Residency- If an applicant does not qualify for a statutory residency exception or qualification; they must submit documentation that they (or a parent or legal guardian if a dependent) have been a Florida resident for at least 12 months prior to the first day of classes for which the applicant is enrolling. At least two of the following documents must be submitted, with dates showing proof of the 12month-requirement. The

Residency Statement/Affidavit must be submitted on or before the last day of registration/add drop of the Term for which Florida residency is sought. Refer to the “Registration Calendar” within the appropriate Term's Class Schedule for registration deadlines.

First Tier (at least one of the two documents submitted must be from this list)- Dated 12 months prior to the first day of classes.

•Florida Driver's license (if known to be held in another state previously, must have relinquished)

•State of Florida identification card (if evidence of no ties to another state)

•Florida voter registration card

•Florida vehicle registration

•Proof of a permanent home in Florida that is occupied as a primary residence of the claimant

•Proof of homestead exemption in Florida. (proof for the previous year)

•Transcripts from a Florida high school for multiple years (2 or more years) if Florida high school diploma or equivalency degree was earned within last 12 months

•Proof of permanent full-time employment in Florida (one or more jobs for at least 30 hours per week) for a consecutive 12-month period

ONLINE DOCUMENT RESOURCES:

Driver License & Vehicle Check

http://www.flhsmv.gov/

Voter

http://registration.election.myflorida.com

Court Documents

Duval- www.duvalclerk.com/ccWebsite FL Counties- www.myfloridaclerks.com

Duval Property Search or Tax Records

http://apps.coj.net/pao_propertySearch http://fl-duval-taxcollector.governmax.com/

Second Tier (may be used in conjunction with one document from First Tier)- Dated 12 months prior to the first day of classes.

•Declaration of domicile in Florida (12 months from the date the document was sworn and subscribed)

•A Florida professional or occupational license (must be current and meet the 12-month requirement)

•Florida incorporation (must be current and meet the 12-month requirement)

•Documents evidencing family ties in Florida (generally refers to legal or court documents for a dependent applicant )

•Proof of membership in Florida-based charitable or professional organization (must be current and meet the 12-month requirement)

•Any other documentation that supports the applicant's request for residency status Examples of “other” documentation:

1)Utility bills and proof of 12 consecutive months of payments (service must be current, cell phone bills are not acceptable)

2)Lease agreement and proof of 12 consecutive months of payments (private lease agreements must be notarized)

3)State or court documents evidencing legal ties to Florida

4)Benefit histories from Florida agencies or public assistance programs for a consecutive12-month period.

5)DJJ Address Verification Form in conjunction with parental/guardian 12 month documentation.

Unacceptable Documents (may not be used)

Hunting/fishing licenses	Shopping club/rental cards	Passport
Library cards	Birth certificate	Concealed Weapons/Gun Permit

Florida State College at Jacksonville provides equal access to education, employment, programs, services and activities and does not discriminate on the basis of age, race, color, national origin, sex, disability, religious belief, or marital status. The College Equity Officer has been designated to handle inquiries regarding the non-discrimination policies and may be contacted at equityofficer@fscj.edu. Florida State College at Jacksonville is a member of the Florida College System and is not affiliated with any other public or private university or college in Florida or elsewhere. Florida State College at Jacksonville is accredited by the Commission on Colleges of the Southern Association of Colleges and Schools (“SACSCOC”) to award the baccalaureate and associate degree. Contact the Commission on Colleges at 1866 Southern Lane, Decatur, Georgia 30033-4097, or call (404) 679-4500 for questions about the accreditation of Florida State College at Jacksonville. The Commission is to be contacted only if there is evidence that appears to support an institution’s significant non- compliance with a requirement or standard.

Admissions Revised 9/12

Residency Statement/Affidavit

Applicant Name_______________________	______________________	_________________ Date of Birth____/____/____ Connections User ID__________________________
Last	First	Middle

Did you submit a Readmission Application?

Yes

No Telephone ( _____)______________________ E-mail ________________________________@_________________

U.S. Citizen?

Yes

No (complete Immigration Info) Non U.S Citizens: Legible copy of current immigration document required-resident alien card, Visa and I-94 card, etc.

Immigration: Alien Resident?

Yes

No Alien Number ______________________ Visa Type _______ Expiration Date________________ Other_____________________

Documents supporting the establishment of legal residence must be dated, issued or filed 12 months before the first day of classes for which a Florida resident classification is sought. All documentation is subject to verification. Additional documents such as tax returns, birth certificates, court documents, etc. may be requested.

PLEASE CHECK THE BOX THAT APPLIES TO YOUR CLAIM OF FLORIDA RESIDENCY		REQUIRED PROOF (See page 1 for additional information)	CLAIMANT
I am an independent person at least 24 years of age and have maintained legal residence in		Two documents meeting the 12-month requirement.	Applicant
		Two documents meeting the 12-month requirement.	Applicant
Florida for at least 12 consecutive months.		At least one document MUST be from the First Tier.
Florida for at least 12 consecutive months.		At least one document MUST be from the First Tier.
I am a person under the age of 24, have maintained legal residence in Florida for at least 12		Proof of independence status and two documents	Applicant
consecutive months but want to be considered as independent for tuition purposes.		meeting the 12-month requirement. At least one
		document MUST be from the First Tier.


I am a qualified beneficiary under the terms of the Florida Pre-Paid Program 1009.98.		Copy of current Florida Prepaid Card.	Applicant
I am a dependent person under the age of 24 and my parent or legal guardian has		Two documents meeting the 12-month requirement.	Parent or legal
		Two documents meeting the 12-month requirement.	Parent or legal
maintained legal residence in Florida for at least 12 consecutive months.		At least one document MUST be from the First Tier.	guardian
		At least one document MUST be from the First Tier.	guardian
A Florida public college/university declared me a Florida resident for tuition purposes and		Name of school:________________________________	Applicant
			Applicant
my last enrollment was within the last 12 months. Additional verification may be required.
		and Official college transcript showing FL residency.
		and Official college transcript showing FL residency.
I am a dependent person who has resided for five years with a legal resident adult relative		Documentation of relationship and two documents	Relative (proof
other than my parent or legal guardian. Documentation of relationship required- Relative		meeting the 12-month requirement. At least one	required for relative
tax returns for the last five years, public school or court documentation of relationship.		document MUST be from the First Tier.	& applicant)
		document MUST be from the First Tier.	& applicant)
I am a full-time instructional or administrative employee of a Florida public school,		Employment verification letter/form. Dependent proof	Qualified employee


co	u it college or u i ersit , or I a the e plo ee’s spouse or depe de t child.	required- current tax return and/or marriage cert.
co		required- current tax return and/or marriage cert.
Full-time employees of state agencies or political subdivisions of the state when the		Employer paperwork (law enforcement or corrections)	Qualified employee
applicant fees are paid by the state agency or political subdivision for the purpose of job-		showing fee coverage.
related law enforcement or corrections training.
related law enforcement or corrections training.
Active duty member of the Armed Services of the United States residing or stationed in		Military orders (stationed in FL), DD2058 (FL home of	Active Duty
Florida; or military personnel not stationed in Florida whose home of record or state of legal		record), or military docs showing home of record.	Member
residence certificate DD Form 2058, is Florida (and spouse/dependent children).		Dependents must submit supporting military docs.


Active drilling members of the Florida National Guard residing or stationed in Florida.		Military orders (stationed in FL), DD2058 (FL home of	Active Duty
		Military orders (stationed in FL), DD2058 (FL home of	Active Duty
		record), or military docs showing home of record.	Member
		record), or military docs showing home of record.	Member
Active duty members of the Armed Services of the United States (and spouse/dependent		Military orders stationed in Kings Bay, GA. Dependents	Active Duty
children) attending a public community college or state university within 50 miles of the		must submit supporting military documents.	Member


military establishment where they are stationed, if such military establishment is within a

county contiguous to Florida. Eligible Base: Naval Base Kings Bay , GA.
Active duty members of the Armed Services of the United States residing or stationed in this		Military orders (stationed in FL), DD2058 (FL home of	Active Duty
state, their spouses and dependent children, and active members of the Florida National		record), or military docs showing home of record.	Member
Guard who qualify under s. 250.10 (7) and (8) for the tuition assistance program.		Dependents must submit military docs and TA proof.


I am a permanent resident alien, legal alien or eligible non-immigrant category, granted		Immigration documentation and two documents	Applicant
indefinite stay by the U.S. Citizenship and Immigration Services, and have maintained legal		meeting the 12-month requirement. At least one
		meeting the 12-month requirement. At least one
residence in Florida for at least 12 months. Staff will review dependency status.		document MUST be from for the First Tier


None of these circumstances apply, but I would like to continue my request for Florida		Complete the claimant section below and the


residency.		Residency Supplemental Form
residency.		Residency Supplemental Form

PERSON CLAIMING FLORIDA RESIDENCY

Relationship to Applicant:

Applicant/Student Parent

Legal Guardian (Court documentation required)

Spouse (Marriage cert. or military docs required)

Other___________

Documentation required

Clai a t’s Na e___________________________________________________________________________________________________Claimant Birth Year___________________

Last

First

Middle

Claimant is a U.S. Citizen? Immigration: Alien Resident?


Yes		No (complete Immigration Info) Non U.S Citizens: Legible copy of current immigration document required-resident alien card, Visa and I-94 card, etc.
	Yes		No Alien Number ________________________ Visa Type _________ Expiration Date________________ Other_______________
	Yes

Clai a t’s Address________________________________________	_________________________________	________________ ________________		_________________
Number/Apt.# or P.O. Box and Street	City	State	ZIP Code	County
Date Claimant Established Legal Residence in Florida _________\________\_________Telephone (________)________________________			(________)________________________
		Home or Cell		Work

Provide information regarding two of the three documents listed below. Documents supporting the establishment of legal residence must be dated, issued or filed 12 months before the first day of classes for which a Florida resident classification is sought. Please review the required proof (see table above) linked to your residency claim.

Clai	a t’s License or State I.D. _________________	___________________________________________________________________			_________\________\_________
	State	Number			Issue Date
Clai	a t’s Voter Registratio _________________	_________________________________		_____________________________	__________\________\_________
	State	Number		County	Issue Date
Clai	a t’s Vehicle Registration _________________	_________________________________		_____________________________	__________\________\_________
	State	Title Number	or	VIN Number	Issue Date

I do hereby swear or affirm that the above named applicant meets all requirements indicated in the checked category above for classification as a Florida resident for tuition purposes. I understand that a false statement in this affidavit will subject me to penalties for making a false statement pursuant to 837.06, Florida Statutes.

Clai a	t’s Legal Signature ________________________________________________________________________________________	Date____________________________
Applica	t’s “ig ature (If other than claimant) _________________________________________________________________________	Date____________________________
		Admissions Revised 9/12

Print and Sign. Return this form to your campus Student Success Center or fax to the Welcome Center (904) 633-5955.

Fscj Requirements – Fill Out and Use

Florida Residency Statement Affidavit Details

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