In-State Residency Application

Student ID (if issued)

* First Name

Middle Name

* Last Name

* Birthdate

* Email Address

* Phone Type

* Home Phone Number

* Mobile Text Number

* Mobile No Text Number

* Work Number

* Permanent Home Address

Country

Street

City

Region

Postal Code

*My local home address is different then my permanent home address.

Yes

No

* Local Home Address

Country

Street

City

Region

Postal Code

*Have you lived at any other addresses in the past three years?

Yes

No

Not including your current address, list all of the addresses where you have resided during the past three years.

Country

Street

City

Region

Postal Code

* From

* To

* Add another address?

Yes

No

Country

Street

City

Region

Postal Code

* From

* To

* Add another address?

Yes

No

Country

Street

City

Region

Postal Code

* From

* To

* Add another address?

Yes

No

Country

Street

City

Region

Postal Code

* From

* To

* Add another address?

Yes

No

Country

Street

City

Region

Postal Code

* From

* To

Vermont Residency Information

* Why did you move to Vermont?

* What date did you first move to Vermont?

* How long have you continuously lived in Vermont other than temporary interruptions for military service or to attend school in another state?

Years

Months

If there were interruptions of Vermont residency, please list dates of interruptions and reasons below

Recent Tax Information

List the state(s) in which you filed a state income tax return during the past three years, starting with the most recent tax year.

* Year taxes filed for

I did not file taxes for this year

State taxes filed for:

Date taxes were filed:

Address listed on tax return

Country

Street

City

Region

Postal Code

Attach a copy of your most recent tax statement to this application. A photo is acceptable as long as the image is clear.

Tax Year #2

* Year taxes filed for

I did not file taxes for this year

State taxes filed for:

Date taxes were filed:

Address listed on return was the same address as listed above?

Yes

No

Address listed on tax return

Country

Street

City

Region

Postal Code

Tax Year #3

* Year taxes filed for

I did not file taxes for this year

State taxes filed for:

Date taxes were filed:

Address listed on return was the same address as listed above?

Yes

No

Address listed on tax return

Country

Street

City

Region

Postal Code

Military Background

* Are you an active duty member of the armed forces?

Yes

No

Do you have military orders transferring you to Vermont?

Yes

No

* Are you a veteran of the armed forces?

Yes

No

* Are you a dependant or spouse of military member who is active or has been discharged?

Yes

No

Active duty and honorably discharged military personnel (as well as the spouses and dependents of such military service members) who don’t otherwise qualify for in-state status may be eligible based on their military service. To be considered, please attach documentation such as the following at the end of this application:

Proof of active military status or discharge. This can include such items as:
- Current military orders of applicable service member
- DD214 with an honorable discharge
- NGB22 with an honorable discharge (National Guard)
- DD256 with an honorable discharge (Reservist)
(For Spouses) Proof of Marriage (Marriage License, Federal tax filings showing married status, etc.)
(For Dependents) Proof of Dependency (Federal tax filings showing dependent status, etc.)

Property Ownership

*Do you own property in Vermont?

Yes

No

Date of Purchase

Did you file a Homestead Declaration with the Vermont Department of Taxes?

Yes

No

Address of Property

Country

Street

City

Region

Postal Code

Attach a copy of your property tax statement to this application. A photo is acceptable as long as the image is clear.

License and Registration Information

*Do you have a driver's license or state ID?

Yes

No

Have you had a driver's license or state ID within the past three years?

Yes

No

*List all the driver's licenses or state IDs held within the past three years.

Date Acquired

State License was for

Is this license still valid?

Attach a copy of your Vermont license/ID to this application. A photo of the license/ID is acceptable as long as it is clear.

Delete_ID_
Date Acquired Date Acquired State License was for Is this license still valid?

Add Another Driver's Licence

*Do you have a registered car?

Yes

No

What state is the car registered in?

Date of Registration

Attach a copy of your Vermont registration to this application. A photo of the registration is acceptable as long as it is clear.

Voter Information

*Are you a registered voter in Vermont?

Yes

No

Date of voter registration

City or town of voter registration

During the past two years, have you been registered to vote in any other town other than the town listed above?

Yes

No

City/town and state of previous voter registration

Attach a copy of your Vermont voter registration to this application below. A photo of the voter registration is acceptable as long as the image is clear.

School Information

*What is the name of the high school you graduated or will graduate from?

*What year did you graduate or are expecting to graduate high school?

*Are you eligible for in-state status at any other public college in any other state?

Yes

No

If yes, which state?

*Have you attended any other college/university in the past three years?

Yes

No

Please list colleges/universities and dates attended.

Dependant Status Information

*Do your parents or guardians live in Vermont?

Yes

No

How long have your parents or guardians continuously lived in Vermont?

*Do your parents or guardians own property in Vermont?

Yes

No

Date of Purchase

Was a Homestead Declaration filed?

Address of Property

Country

Street

City

Region

Postal Code

*Did your parent or guardian claim you as a dependant on their most recent Federal Tax Income return?

Yes

No

Please list the states where your parents or legal guardians have filed a state income tax return during the past three years, starting with the most recent tax year.

#1 Most Recent Tax Year

*Year taxes filed for

State

Date taxes were filed

Attach a copy of your parent or guardian's most recent income tax return to this application below.

#2 Tax Year

*Year taxes filed for

State

Date taxes were filed

My parent or guardian did not file taxes for this tax year

#3 Tax Year

*Year taxes filed for

State

Date taxes were filed

My parent or guardian did not file taxes for this tax year

Additional Comments

Please use this section to add any additional facts you think might be useful to determine your eligibility for in-state tuition status.

* Attach a PDF or image of the following documents to this application. If a document does not apply to you (for example, Property Tax Statement), you are not required to attach it. If no supporting documentation is received along with this form, this application will be considered incomplete and will not be reviewed.

Statement from Town Clerk or Town Registrar indicating original date(s) of voter registration. In cases where you have registered in more than one town, a statement from each clerk is required.
Copies of your most recent Federal and State Income Tax Returns.
Copies of your parent(s) most recent Federal and State Income Tax Returns (if you are 24 or under).
A copy of all Trusts, Support or Custody Decrees or Agreements affecting you.
A photocopy of any Vermont Driver’s License and/or vehicle registration.
Property Tax Statement.
Any additional information or documentation you feel relevant to your case.

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Add Another Document

By typing my name below, I understand that withholding information that was requested or giving false information in this application may make me ineligible for Vermont Resident Tuition at a Vermont State College institution. I certify that the statements in this application are correct and complete.

Please type full name