Download student tax release authorization

CURRENT ENROLLED STUDENT APPLICATION
RECLASSIFICATION REQUEST FOR VIRGINIA IN-STATE TUITION
Instructions:
This form is to be completed by CURRENTLY ENROLLED, RETURNING DEGREE-SEEKING students claiming
entitlement to Virginia in-state tuition rates pursuant to Section 23-7.4 of the Code of Virginia. DO NOT USE THIS
FORM IS YOU ARE AN ENTERING FRESHMAN OR FIRST SEMESTER GRADUATE OR NEW TRANSFER
STUDENT. All questions must be answered completely. Attach explanatory information as necessary. Where questions are
not applicable; write N/A. The application must be signed by the student and parent/guardian (if applicable). Part I must
be completed by the student. The parent or legal guardian must complete part II if the student is an undergraduate, under
age 24, unmarried, not in the military and does not have dependents.
The application MUST BE RECEIVED IN THE JMU UNIVERSITY BUSINESS OFFICE, Student Success Center, MSC
3516, Harrisonburg, VA 22807 PRIOR to the first day of classes for the session in-state rates are requested. By law,
applications will NOT be approved retroactively. All summer semester requests must be received prior to the first day of
classes for the first summer session in May.
Supporting Documents:
The MOST RECENT YEAR'S FEDERAL AND STATE TAX FORMS FOR THE STUDENT AND THE
PARENT/GUARDIAN/SPOUSE are required and, if available, should be submitted with the application. Income tax
returns must be dated and signed. A photocopy of a current Immigration Visa must be submitted if applicable.
The applicant may also submit any additional documents to support entitlement to Virginia in-state tuition.
Guidelines for Eligibility:
It is incumbent on the applicant to provide clear and convincing evidence for entitlement to in-state tuition rates. In
general, to be eligible for in-state tuition rates, the person providing the majority of the dependent student's financial
support must be domiciled in Virginia for a minimum of one year immediately prior to the first official day of class for the
session in-state rates are requested.
Domicile is defined as the "present, fixed home to which you return following temporary absences and at which you intend
to stay indefinitely." Domiciliary status shall not ordinarily be conferred by the performance of acts, which are auxiliary to
fulfilling educational objectives, or are required or routinely performed by temporary residents of the Commonwealth. Mere
physical presence or residence primarily for educational purposes shall not confer domiciliary status. A matriculating
student who has entered JMU as out-of-state shall be required to refute by clear and convincing evidence the presumption
that he is in the Commonwealth of Virginia for the purpose of attending school and not as a bona fide domicile.
THE CODE OF VIRGINIA REQUIRES THE INSTITUTION TO REQUEST PROOF OF DOMICILE IF THERE IS
EVIDENCE THAT DOMICILE MAY HAVE CHANGED FROM VIRGINIA TO ANOTHER STATE OR COUNTRY.
7/07
1
PART I - STUDENT INFORMATION
1. Full Name:
2. Date of Application:
3. Social Security #
JMU ID#
4. Local Address:
Valid Until:
5. Permanent Address:
Valid Until:
6. Telephone Numbers: Home:
Cell:
7. Date of Birth:
Work:
8. Marital Status:
9. Citizenship:
U.S. Citizen
Permanent Resident
Temporary Resident
Political Asylum/Refugee
If you are not a U.S. Citizen, please specify:
Please include a copy of all immigration
papers
Type of Visa:
Expiration Date:
Country of Origin:
Date of Issue:
10. Semester you are applying for Virginia Status:
11. During the past two (2) years, list all addresses in
Virginia: Please provide complete addresses.
Dates of Residence:
If residence has not been continuous, please explain:
2
12. During last five (5) years, list all addresses outside of
Virginia: Please provide city and state.
From:
To:
13. During last three (3) years, list all employers and
address: Please provide city and state.
From:
To:
14. List ALL high schools, colleges, universities attended:
From:
To:
15. Attendance at JMU:
Date of First enrollment:
If not continuous, please explain:
Expected date of graduation:
16. Have you paid a state income tax to ANY state during
one or more of the last three years?
If so, where?
17. Are you registered to vote?
If so, where?
When did you register?
18. Do you hold a valid Virginia driver’s license?
When were you first licensed in Virginia?
If you do not have a Virginia license, where are you
licensed?
19. Do you operate a motor vehicle?
In what state is it registered?
In whose name is it registered?
Last renewal date:
When was it registered?
20. Do you own real property?
Date of purchase?
If yes, what is the location?
21. Do you have a bank account?
If yes, where?
Date opened?
22. Do you receive any financial aid?
If yes, what?
3
If other than Virginia, did you have to claim legal
residence to qualify?
If other than Virginia, what state?
23. Parent’s/Legal Guardian’s/Spouse’s domicile:
24. Will you be claimed as a dependent on your
parents’/legal guardian’s most current tax returns?
25. Have your parents’/legal guardian/Spouse provided the
majority of your financial support during the past year?
26. Military Exception:
Are you claiming eligibility through your military
parent?
Home of record:
Are you claiming eligibility through your non-military
parent?
27. Will you be age 24 years or older on the first day of the
semester for which you are claiming eligibility?
Are you an undergraduate or graduate student?
Are you married? Date of marriage?
If your military parent is based in VA,
please provide a copy of the orders.
If so, are you financially dependent on your
spouse during the previous 12 months?
Are you’re a veteran or active duty member of the U.S.
Armed Forces?
28. When and why did you initially move to Virginia?
29. Do you presently have the intention of remaining
indefinitely in Virginia, and why?
I hereby certify that the information given in this document is true and accurate. I also understand that if I
provide erroneous information in an attempt to evade payment of out-of-state fees, I shall be charged out-ofstate fees for each term attended and I may be subject to dismissal from James Madison University.
MUST BE DATED AND SIGNED BY STUDENT.
Student’s Signature_________________________________ Date ____________________________
4
PART II
PARENT/LEGAL GUARDIAN/SPOUSE INFORMATION
1. Name of Parent/Legal Guardian/Spouse:
Relationship to Applicant:
2. Current Address:
3. Home Address, if different:
4. Telephone Number:
5. Are you a citizen of the United States:
If not, please specify the type of visa you hold and Type:
include copy with application:
Date Issued:
Expiration Date:
6. Have you been a permanent resident of Virginia for
the past twelve (12) months?
If no, please list state of legal residence:
7. Was applicant claimed as a dependent on your most
recent federal or state income tax returns?
8. Have you provided the majority of the
applicant’s financial support over the past year?
9. If you are the applicant’s guardian, is this by court
decree? If so include copy of court order with
application.
10. Are the applicant’s parents deceased?
11. Marital status of parents:
12. List all home addresses over the past two years:
From:
To:
13. List your employment for the past year:
Please include city and state
From:
To:
5
14. Are you registered to vote?
Where and When did you register?
Where did you last vote?
15. Do you have a valid Virginia Driver’s License?
When was it issued?
16. Do you own a motor vehicle?
Where and when was it registered?
17. Do you own real property in Virginia?
Where and when was it purchased?
Last renewal?
18. Location of banking institution:
19. Military Service during the last five (5) years:
Date of entering service:
Home of Record:
State where you are currently paying income
taxes:
Location of current base?
20. Do you intend to remain in Virginia
indefinitely?
Explain social or economic ties to Virginia:
I hereby certify that the information given is true and accurate. I also understand that if I provide erroneous
information in an attempt to evade payment of out-of-state fees that out-of-state fees will be charged to the
applicant for each term attended and the applicant may be subject to dismissal from James Madison University.
MUST BE SIGNED AND DATED BY PARENT/LEGAL GUARDIAN/SPOUSE
Parent ______________________________________ Date ___________________________
Legal Guardian ______________________________ Date ___________________________
6