Application for Classification as a South Carolina Resident

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n has physically resided and established a permanent home in South Carolina 2or at least 12 months immediately preceding the term 2or which I am requesting resident status. n is a permanent 2ull-time employee in South Carolina who has been domiciled in the state 2or less than 12 months. n has retired to South Carolina and has been domiciled in the state 2or less than 12 months. n is on active military duty in South Carolina. *(Please skip Parts 2, 3, 4, 5 and A2fdavit o2 Financial Independence.) Part 2. D-micile i,%-rmati-, (A) How long have you physically and continuously resided in South Carolina? From ______________ to ________________ (B) Date you claim permanent residence in South Carolina began __________________________ Applicati-, %-r Classifcati-, as a S-2th Car-li,a Reside,t (D-miciliary) %-r T2iti-, a,d Fee P2rp-ses P Return this completed application with copies o 0 all requested documents to the appropriate o 0fce be 0ore the posted deadline 0or the term you are requesting resident status. P Students currently enrolled at Coastal Carolina University should submit this application to the O 0fce o 0 the Registrar. New students and students applying 0or readmission to Coastal Carolina University should submit this application to the O 0fce o 0 Admissions. _______________________________________________________________________________________ Coastal Carolina University " P.O. Box 261954 " Conway, SC 29528-6054 New Students: Of+ce of Admissions, 843-349-2151 " Continuing Students: Of+ce of the Registrar, 843-349-2019 (C) Addresses where you have lived 2or more than 30 days during the past 24 months. Begin with current address. Address City/State Dates ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ (D) Do you own or rent your current residence? n Own n Rent I2 own, when did you purchase it? ________________ I2 you rent, attach a copy o2 your current lease and, i2 possible, the earliest lease you still have. I2 you own, show proo2 o2 purchase and ownership 2or your current residence. (E) Are you a U.S. citizen? n Yes n No I2 not, type o2 visa _________________________________________________ Alien registration number _________________________________________ Date o2 issue _______________________ Note: Attach a copy o 4 visa or alien registration card ( 4ront and back). (F) Are all, or substantially all, o2 your possessions in South Carolina? n Yes n No I2 not, in what state are most o2 your possessions? __________________________________________________________ (G) Do you have a checki,g acc-2,t at a ba,k i, S-2th Car-li,a ? n Yes n No I2 yes, how long have you had the account? _______________________________________________________________ (H) Do you have a savi,gs acc-2,t at a ba,k i, S-2th Car-li,a ? n Yes n No I2 yes, how long have you had the account? _______________________________________________________________ (I) Do you have a checking or savings account at a bank in another state? n Yes n No I2 yes, in what state? ________________________________________________________________________________ (J) Do you have a valid S-2th Car-li,a driver 9s lice,se -r state-iss2ed S-2th Car-li,a ID card ? n Yes n No Date o2 issue __________________________ Note: I 4 you have a South Carolina driver 9s license, attach a photocopy. Do you have a valid driver 9s license 2rom another state? n Yes n No I2 yes, in what state? ______________________ (K) Is the m-t-r vehicle which y-2 2se registered in your name? n Yes n No I2 not, in whose name is it registered? _________________________________ Relationship _______________________ In what state is it registered? _____________ In what state did you (or current owner) purchase the vehicle? ___________ _ Date purchased _______________________ Date o2 current registration certifcate ______________________________ Note: I 4 your motor vehicle is registered in South Carolina, attach a copy o 4 the current vehicle registration certifcate and, i 4 possible, the earliest registration you still have. Part 3. I,c-me Ta5 i,%-rmati-, (A) Did you fle %ederal a,d state i,c-me ta5 ret2r,s in any state during the past 24 months? n Yes n No I2 yes, when and in what state did you fle the returns? ______________________________________________________ Date fled State Tax year _________________________________________________________________________________________________ _________________________________________________________________________________________________ (B) Will you fle a state i,c-me ta5 ret2r, 2or the current tax year? n Yes n No I2 yes, in what state will you fle? ________________________________ Note: Attach a signed photocopy o 4 your 4ederal and state income tax return 4or the previous year. (C) Person who last claimed you as a dependent (or exemption) on a Federal i,c-me ta5 ret2r, . Do not list yoursel2. Name _________________________________________________________ Relationship ____________________________ City/State o2 residence o2 person ______________________________ Tax year person last claimed you as a dependent ______ _ (D) Will you be claimed as a dependent (or exemption) on someone 9s Federal i,c-me ta5 ret2r, 2or the current year? n Yes n No I2 yes, give name and address o2 person who will claim you: Name _________________________________________________________ Relationship ____________________________ City/State o2 residence o2 person ____________________________________________________________________________ Part 4. Empl-yme,t i,%-rmati-, (A) List all employment 2or the previous 24 months. Begin with most recent employment. Dates Employer City/State Full-time or Number o2 From 3 To part-time hours per week ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ (B) I2 currently employed 2ull-time, do you expect any change in your employment status within the next six months? n Yes n No I2 yes, explain ___________________________________________________________________________ Note: I 4 you are requesting in-state status based on 4ull-time employment in the state, attach a letter (on letterhead statione ry or notarized) which states (a) the e 4 4ective date o 4 your employment in South Carolina, (b) that such employment is on a 4ull-time basis, and (c) the num ber o 4 hours you work per week (please provide your most recent pay stub that supports this claim) and (d) your eligibility 4or 4ull-time benefts. Perso ns who are sel 4-employed should provide a notarized statement certi 4ying the 4oregoing in 4ormation and submit a copy o 4 their South Carolina business l icense. Part 5. Ed2cati-,al i,%-rmati-, (A) List high schools attended: Dates Name o2 high school City/State ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ( B) List all colleges and universities attended. Include attendance at Coastal Carolina University. Dates Name o2 institution City/State Full-time or Resident or part-time non-resident ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ Part 6. D-micile -% pers-, 2p-, wh-m i,-state determi,ati-, is t- be based, i% ,-t sel% Name o2 person ___________________________________________________________________________________ Relationship (parent, legal guardian, spouse) __________________________ Note: I 4 based on spouse, photocopy marriage license. (A) How long has the person been a legal resident o2 South Carolina? _____________________________________________ (B) Is this person a U.S. citizen? n Yes n No I2 no, type o2 visa ____________________ Date o2 issue _______________ Note: Attach photocopy o 4 the person 9s and your visa or alien registration card ( 4ront and back). (C) Has the person ever claimed you as a dependent (or exemption) 2or 2ederal income tax purposes? n Yes n No I2 yes, tax year person last claimed you ____________________________________________________ Will person claim you as a dependent on the current year 9s 2ederal return? n Yes n No (D) Does person have a driver 9s license? n Yes n No I2 yes, in what state? _____________ Date o2 issue _____________ Note: I 4 person has a South Carolina driver 9s license, attach a photocopy o 4 the license. (E) Does person own a car? n Yes n No I2 yes, in what state is the car registered? _______________________________ Date o2 current vehicle registration certifcate ____________________________________________________________ Note: I 4 vehicle registered in South Carolina, attach photocopy o 4 current registration certifcate. (F) Did person fle a South Carolina income tax return 2or the previous tax year? n Yes n No I2 yes, date fled __________ Will person fle a South Carolina return 2or the tax current year? n Yes n No Note: I 4 person fled a South Carolina return 4or the previous tax year, attach a signed photocopy (fnancial data on person 9s tax return may be marked out). Part 7. Empl-yme,t -% pers-, 2p-, wh-m i,-state determi,ati-, is t- be based, i% ,-t sel% (A) List employment o2 person 2or last 24 months. (Begin with most recent employment.) Dates Employer City/State Full-time or Number o2 Part-time hours per week _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ (B) I2 person is employed 2ull-time, does person expect any change in 2ull-time employment within the next six months? n Yes n No Note: I 4 requesting in-state status based on person 9s 4ull-time employment, attach a letter (on letterhead stationery or notar ized) which states (a) the person is employed 4ull-time in South Carolina, (b) the e 4 4ective date o 4 person 9s 4ull-time employment in the state, (c) the number o 4 hours person works per week (please provide your most recent pay stub that supports this claim,) and (d) his/her eligibility o 4 4ull-time benefts. I 4 person is sel 4-employed, attach notarized statement 4rom person certi 4ying the 4oregoing in 4ormation and attach copy o 4 pers on 9s business license. Part 8. Military service (A) Military installation to which you/your sponsor is stationed _________________________________________________ Date assignment began in South Carolina _______________________________________________________________ (B) Expected length o2 assignment in South Carolina _________________________________________________________ Note: Attach copy o2 military orders assigning you/your sponsor to active duty in South Carolina. Part 9. Ma,dat-ry I hereby certi2y that the in2ormation I have provided is accurate and complete. I 2urther understand that 2alsifcation or 2ailu re to provide the correct in2ormation may lead to disqualifcation o2 my application 2or admission to Coastal Carolina University. Signature o2 Applicant ______________________________________________________ Date ______________________ Signature o2 Parent or Legal Guardian __________________________________________ Date ______________________ (i2 applicant is under 18 years o2 age) IMPORTANT: Persons who are 2ound to have made or presented will2ul misrepresentation o2 2acts to improperly gain South Carolina resident status will be charged tuition and 2ees past due and unpaid at the out-o2-state rates, plus interest at the rate o2 eight (8) percent per annum, plus a penalty amounting to 25 percent o2 the out-o2-state rate 2or one semester; and until these charges are paid such students will not be allowed to receive transcripts o r graduate 2rom the university. 9/08 Reside,cy Checklist Please s2bmit c-pies -% ALL d-c2me,ts listed bel-w %-r the categ-ry %-r which y-2 are claimi,g S-2th Car-li,a reside,t stat2s. Independent status n South Carolina Driver 9s License or State Identifcation Card issued 12 months prior to the beginning o2 the academic semester n South Carolina Vehicle Registration Card n A2fdavit o2 Financial Independence and proo2 o2 income (i.e., W-2 9s and pay stubs) n Federal Income Tax 2orms fling as an independent person and showing no one else claims the student in the previous tax year n South Carolina State Tax Forms n Proo2 o2 a permanent domicile in South Carolina; i.e. copies o2 all leases during the 12 months preceding term o2 application, proo2 o2 purchase o2 your current residence Dependent status Copies o2 these documents must be supplied by the person upon whom in-state determination is based: n South Carolina Driver 9s License or State Identifcation Card issued 12 months prior to the beginning o2 the academic semester n South Carolina Vehicle Registration Card n Federal Income Tax Returns demonstrating the relationship to the student in the previous tax year 3 i.e., claiming the student as a dependent or a joint fler n South Carolina State Tax Form n Proo2 o2 a permanent domicile in South Carolina; i.e. copies o2 all leases during the 12 months preceding term o2 application, proo2 o2 purchase o2 your current residence Full-time employment or retirement status in South Carolina n South Carolina Driver 9s License or State Identifcation Card n South Carolina Vehicle Registration Card n Federal Income Tax Form fling as an independent person in the previous tax year n State o2 South Carolina Income Tax Returns n Letter o2 2ull-time employment verifcation on appropriate corporate letterhead or retirement verifcation and most recent pay stub or deposit n Proo2 o2 a permanent domicile in South Carolina; i.e. copies o2 all leases during the 12 months preceding term o2 application, proo2 o2 purchase o2 your current residence Active military status n Military orders assigning applicant or sponsor to active duty in South Carolina Any and all documentation must be provided that supports a claim o2 residency 2or tuition and 2ee purposes. Note: Your Application 2or Classifcation as a South Carolina Resident will be reviewed by o2fcial South Carolina State Auditors - - retain all documentation regarding your application. O2fce o2 Admissions P. O. Box 261954 " Conway, South Carolina 29528-6054 " 843-349-2170 or 1-800-277-7000 I certi2y that the in2ormation reported on this 2orm is, to the best o2 my knowledge, correct and complete. I agree to provide, i2 requested, documentation to confrm my fnancial independence. Signature o2 Student/Applicant Date Note: All in2ormation on this 2orm must be completed prior to a review o2 your residency status. A2fdavit o2 Financial Independence Name Social Security number Please provide in2ormation concerning your sources o2 2unds and expenses 2or the 12-month period prior to the semester in which you are requesting resident status. SouRCES oF FunDS ExPEnSES Your earned income * $ Rent/Mortgage $ ( must include W-2 9s and o2fcial payroll stubs) Money 2rom Father Utilities Money 2rom Mother Medical/Dental Money 2rom Guardian Tuition and Fees Money 2rom Spouse Books/Supplies Veteran Administration benefts * Transportation Social Security benefts * Auto Insurance Scholarships * Other Insurance Grants * Clothing Loans * (excludes Parent Loans) Food (Type) Miscellaneous (Type) Other (Explain) * Total $ Total $ * Documentation must be submitted to veri2y these amounts.

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