ASUO Spouse/Domestic Partner/Children Certification Form

Transcription

1 ASUO Spouse/Domestic Partner/Children Certification Form What is a Spousal Equivalency Card (C-Card)? The C-Card is a program offered by ASUO in collaboration with other campus departments that allows I-Fee paying students with dependents, spouses and/or domestic partners to extend a few of their student benefits to those dependents. How do students get a C-Card? Students must first read through the Terms and Conditions document (see "C-Card Terms & Conditions ") Student then must complete Spousal Equivalency Card Form online by selecting the green "Begin Form" button below Student then must visit the ASUO Office in person to present relationship proofs as well as their student ID (see "Acceptable Forms of Evidence" below) ASUO staff will verify that the student is currently enrolled in I-Fee paying course(s) and review the documents of evidence to approve and issue the student a C-Card. All C-Cards must be submitted before 4 pm in order to be processed. Each C-card is valid for one fiscal academic year and will expire July 31st of that year regardless of when it was obtained. Cardholders wishing to continue benefits must reapply each fiscal academic year (beginning in July). Re-Applying for C-Cards Provided that the previous year's application paperwork is still on file in the ASUO, we will waive the paperwork and proof of relationship(s) as long as the card is being re-issued for the same partner/spouse/dependent(s) and the student is still enrolled in UO incidental fee paying courses. A University of Oregon student ID must be presented for verification at time of re-application. Students must be enrolled in incidental fee paying courses for the term in which the partner/child is using the benefits or as otherwise stated in the specific benefit. If you have questions about these policies, please feel free to inquire with the ASUO. ASUO Office Assistants McArthur Court 1601 University St. University of Oregon Eugene, OR Acceptable Forms of Evidence: Declaration of Marriage: Marriage certificate IRS tax return showing marital status For non-us citizens whose county of residence does not issue a marriage certificate/license, a passport naming spouse will be sufficient. Declaration of Domestic Partnership (at least two (2) of the following): Federal/State/UO issued declaration of domestic partnership Joint mortgage, lease, or rental agreement. Evidence of joint savings or joint checking account. Title and/or registration of joint ownership of an automobile or real property. Evidence of joint use of and liability for credit cards. Certified copy of a life insurance policy naming partner as the beneficiary. Evidence that partner is a beneficiary under subscriber's deferred compensation or retirement plan. Evidence of durable powers of attorney for health care or financial management. Evidence of last will and testament listing partner as a major recipient of estate proceeds. Evidence of joint coverage under health insurance and/or auto insurance. Declaration of Dependent Child(ren) (at least one (1) of the following): Birth certificate of the child naming at least one of the parents on the C-card as a parent or guardian. School records of the child with the child's birth date naming at least one of the parents on the C-card as a parent or guardian. Medical records of the child with the child's birth date naming at least one of the parents on the C-card as a parent or guardian. IRS tax information stating the child is able to be claimed as a dependent naming at least one of the parents on the C-card as a parent or guardian (form must show date of birth and social security number). Valid passports with child's name and date of birth naming at least one of the parents on the c-cards as parent or guardian. Benefits C-card benefits for the Student Recreation Center, Craft Center, University Theatre, and athletic tickets can be found on the C-Card Terms & Conditions document below. C-Cards Terms & Conditions NOTE: By submitting this form you are not officially approved to access program benefits. ASUO Staff must verify that you have paid the I-Fee and seen physical proofs of evidence before spouse/domestic partner/children can access program benefits. Page 1 of 6 ASUO Spouse/Domestic Partner/Children Certification Form

2 Student Information [Required] [Required] [Required] UO Student ID - can not contain any punctuation. - can not contain any spaces. - must be between 9 and 9 characters. [Required] Phone Number - must be digits long and may include only numbers, hyphens, and spaces. [Required] Address - [email protected] [Required] Address [Required] City [Required] State [Required] Zip [Required] Do you attend the University of Oregon main campus in Eugene? - Select only one choice. [ ] Yes [ ] No Declaration of Domestic Partnership (non-marriage) - Click "Next" if you are not declaring a Domestic Partnership. Domestic Partnerships must meet ALL of the following criteria: Are 18 years of ago or older. Are competent to enter into a contract. Are not legally married to, nor the domestic partner of any other person/domestic partner for the prior six months. Are not related by marriage. Are not related by blood closer than permitted under marriage laws of the State of Oregon. Have entered into the domestic partnership voluntarily, willingly, and without reservation. Have entered into a relationship which is the functional equivalent of marriage, and which includes ALL of the following: Living together at the same residence as a couple and are each other's sole domestic partner Share a close personal relationship Page 2 of 6 ASUO Spouse/Domestic Partner/Children Certification Form

3 Mutual support for each other Mutual caring and commitment to each other Mutual fidelity Mutual responsibility for each other's common welfare Joint responsibility for the necessities of life Have been living together as a couple for at least six (6) months prior to the date of this affidavit Intend to contribute the domestic partner relationship indefinitely, with the understanding that the relationship is terminable at the will of either partner. In addition to this, Domestic Partnerships must be able to provide at least two (2) of the following as verification of our joint responsibility (information should be dated to confirm eligibility at time of enrollment): Joint mortgage, lease, or rental agreement. Evidence of joint savings or joint checking account that has been in effect for at least six (6) months. Title and/or registration of joint ownership of an automobile. Evidence of joint use of and liability for credit cards. Certified copy of a life insurance policy naming domestic partner as the beneficiary. Evidence that domestic partner is a beneficiary under subscriber's deferred compensation or retirement plan. Evidence of durable powers of attorney for health care or financial management. Evidence of last will and testament listing domestic partner as a major recipient of estate proceeds. Evidence of joint coverage under health insurance and/or auto insurance. Domestic Partner Certification By checking "I Agree", I certify that I: - Read the text above - Understand/meet the criteria to be considered a domestic partnership - Can provide at least two (2) pieces of evidence as list above [ ] I Agree Date of when domestic partnership was established Domestic Partner Information - Click "Next" if you do not have Domestic Partner Information to provide. Domestic Partner Identification Please provide one of the following: - Driver's License ID and state of issue (ex: XXXXXXXXX OR) - Passport ID - UO Student ID Declaration of Marriage - Click "Next" if you are not declaring a Marriage. Marriage Certification As a student of the University, I certify that my spouse and I are legally married. By checking "I Agree", I understand that I must provide physical proof of marriage via certificate in order to be approved for this program. (Note: For non-us citizens whose county of residence does not issue a marriage certificate/license, a passport naming spouse will be sufficient.) [ ] I Agree Page 3 of 6 ASUO Spouse/Domestic Partner/Children Certification Form

4 Date of Marriage Spouse Information - Click "Next" is you do not have Spouse Information to provide. Spouse Identification Please provide one of the following: - Driver's License ID and state of issue (ex: XXXXXXXXX OR) - Passport ID - UO Student ID Declaration of Dependent Child(ren) - Click "Next" is you do not have Child(ren) Information to provide. Dependent Children Certification By checking "I Agree", we certify that the following children reside permanently in our household, are eligible to claim as "depend" under IRS Regulation and/or Health Insurance Policies and are not University of Oregon incidental fee-paying student(s). In addition to this, we are aware that we must provide at least one (1) of the following pieces of verification for each dependent child: -Birth certificate of the child -School records of the child with the child's birth date -Medical records of the child with the child's birth date -IRS tax information stating the child is able to be claimed as a dependent (form must show date of birth and social security number). - Select only one choice. [ ] I Agree Dependent Child 1 Relationship to Student [ ] Daughter [ ] Son [ ] Niece [ ] Nephew [ ] Granddaughter [ ] Grandson [ ] Other Dependent Child 2 Page 4 of 6 ASUO Spouse/Domestic Partner/Children Certification Form

5 Relationship to Student [ ] Daughter [ ] Son [ ] Niece [ ] Nephew [ ] Granddaughter [ ] Grandson [ ] Other Dependent Child 3 Relationship to Student Dependent Child 4 Relationship to Student [ ] Daughter [ ] Son [ ] Niece [ ] Nephew [ ] Granddaughter [ ] Grandson [ ] Other Almost there! **PLEASE READ** By submitting this form you are not officially approved to access program benefits. ASUO Staff must verify that you have paid the I-Fee and seen physical proofs of evidence before spouse/domestic partner/children can access program benefits. To complete this process you'll need to do the following: 1. Collect all your physical proofs of evidence. See below for acceptable forms of evidence. -Declaration of Marriage: Marriage certificate IRS Tax return For non-us citizens whose county of residence does not issue a marriage certificate/license, a passport naming spouse will be sufficient. -Declaration of Domestic Partnership (at least two (2) of the following): Joint mortgage, lease, or rental agreement. Evidence of joint savings or joint checking account that has been in effect for at least six (6) months. Title and/or registration of joint ownership of an automobile. Evidence of joint use of and liability for credit cards. Certified copy of a life insurance policy naming domestic partner as the beneficiary. Evidence that domestic partner is a beneficiary under subscriber's deferred compensation or retirement plan. Page 5 of 6 ASUO Spouse/Domestic Partner/Children Certification Form

6 Evidence of durable powers of attorney for health care or financial management. Evidence of last will and testament listing domestic partner as a major recipient of estate proceeds. Evidence of joint coverage under health insurance and/or auto insurance. -Declaration of Dependent Child(ren) (at least one (1) of the following): Birth certificate of the child School records of the child with the child's birth date Medical records of the child with the child's birth date IRS tax information stating the child is able to be claimed as a dependent (form must show date of birth and social security number). 2. Bring physical proofs of evidence and UO Student ID to the ASUO Office, which is located in McArthur Court/EMU South. (Note: The UO Student must be present at the time C-Card is issued. Spouse/Domestic Partner/Child are not required to be present at the time the card issued.) Page 6 of 6 ASUO Spouse/Domestic Partner/Children Certification Form