OHIO RESIDENCY VERIFICATION APPLICATION PACKET

OHIO RESIDENCY VERIFICATION APPLICATION PACKET OFFICE OF THE REGISTRAR Columbus Campus, Madison Hall E-mail: residency@cscc.edu Voice Mail: 614-287-5533 Web: http://www.cscc.edu/services/recordsandregistration/residency.shtml Effective January 14, 2014 Revised October 22, 2015

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RESIDENCY GUIDELINES It is the intent of the Ohio Board of Regents in promulgating this rule to exclude from treatment as residents, as that term is applied here, those persons who are present in the State of Ohio primarily for the purpose of receiving the benefit of a state-supported education. This rule is adopted pursuant to Chapter 119 of the Ohio Revised Code, and under the authority conferred upon the Ohio Board of Regents by Section 3333.31 of the Ohio Revised Code. Ohio Residency Status for Tuition Surcharge Purposes All public, state-supported institutions are required to report enrollment data to the State of Ohio, according to Section (F)(4) of the Ohio Administrative Code, Section 3333-1-10. A student s residency status is initially determined by the information they provide about themselves at the point of their application for admission. Ohio Residency Verification reviews are conducted each semester to assist students in a redetermination of their current residency status with Columbus State Community College. According to the Residency Rule 3333-1-10, Section (F)(5), it is incumbent upon a student to apply for a change in residency, and her or his failure to do so as soon as she or he is entitled to a change shall preclude the granting of residency retroactive to that date. A change in residency shall be prospective only from the date such application is received. A change in residency status under this section is never automatic, and must be initiated by an application for such a change by the person seeking it. Please be advised that Retroactive Residency reclassifications are not allowed under the guidelines of the Residency Rule. If a student is designated as an out-of-state resident, he or she may qualify for in-state residency by meeting certain qualifications. A Residency Reclassification Application must be completed, important Verification Documentation submitted, and residency determination approved prior to the first day of the academic semester for which the student desires reclassification to be effective. Application materials and all appropriate documentation must be submitted to Columbus State Community College prior to the start of the semester of enrollment in order to be reviewed for the desired semester. Please note that students are expected to make full payment (including non-resident fees) by their appropriate payment due date. Payment deadlines cannot be waived or extended while a student s residency is being reviewed. If a student fails to apply for residency reclassification prior to the start of the semester of enrollment, their application will be given consideration for the next semester of enrollment. It is the student s responsibility to check his or her Columbus State Community College student e-mail account for communication regarding the status of his or her Ohio Residency Reclassification application and or status. Dates to submit application and supporting materials for Ohio Residency for Tuition Surcharge Purposes are: Term Review Process Begins Review Process Ends Spring Semester 2016 October 12, 2015 December 14, 2015 Summer Semester 2016 March 7, 2016 April 25, 2016 Autumn Semester 2016 June 1, 2016 August 22, 2016 Spring Semester 2017 October 12, 2016 December 14, 2016

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OHIO RESIDENCY REQUIRED DOCUMENTS CHECKLIST PRINT NAME: SIGNATURE: DATE: COUGAR ID : SEMESTER: My signature affirms my understanding of the classification being granted on the above date, along with any further action needed on my part including but not limited to returning with additional documents to renew the E(1) or C(3) status by the first day of the semester. The following is a checklist of items that you will need to provide via the Residency Drop Box before your request for residency reclassification can be approved. *Please note* this list is NOT all inclusive. Residency Officers are allowed by law to request additional documentation if needed to reach a determination. Please provide photocopies as documents will not be returned to you. IF YOU ARE CURRENTLY ACTIVE DUTY, A MEMBER OF THE OHIO NATIONAL GUARD OR A VETERAN, PLEASE SEE THE REQUIRED DOCUMENTS CHECKLIST FOR MILITARY STUDENTS C1: DEPENDENT ON AN OHIO RESIDENT Copy of Ohio Driver s License or State of Ohio ID card of BOTH Student and Parent, Spouse or Legal Guardian. Copies of current immigration or Visa status for BOTH Student and Parent, Spouse or Legal Guardian (if applicable) Student birth certificate or a copy of a marriage certificate (if residency is based on spouse). Parent, spouse, legal guardian Federal tax return transcript* for most recent tax year(s) showing the student was claimed as a dependent in the most recent tax year. Proof of Ohio Domicile showing 12 CONSECUTIVE MONTHS: Signed copies of Rental agreement, lease, and/or HUD settlement statement of property owned by parent/spouse/legal guardian. **If student is NOT listed, a notarized statement from the person whom he/she is residing with is ALSO REQUIRED. Proof of employment for Parent, Spouse or Legal Guardian (letter on company letterhead (see C3) and most recent pay stubs). C3: DEPENDENT OF A PERSON EMPLOYED FULL TIME IN OHIO Copy of Ohio Driver's License or State of Ohio ID card for BOTH Student and Parent, Spouse or Legal Guardian Copies of current immigration or Visa status for BOTH Student and Parent, Spouse or Legal Guardian (if applicable) Copy of Parent Federal tax return transcript* for most recent tax year(s) showing the student was claimed as a dependent in the most recent tax year Copy of a marriage certificate (if residency is based on spouse). Proof of Ohio Domicile: Signed copies of Rental agreement, lease, and/or HUD settlement statement of property owned by parent/spouse/legal guardian. **If student is NOT listed, a notarized statement from the person whom he/she is residing with is ALSO REQUIRED. Proof of Employment: A letter from the employer on company letterhead stating: A. Name of employed person B. Date the employment began C. Employee is full time and the annual salary Copies of most recent pay stubs (must be submitted EVERY semester) NOTARIZED STATEMENT: A written declaration made under oath in front of a notary public. This must be the original. WE DO NOT ACCEPT COPIES OR FAXES. Online: In person: *TO OBTAIN YOUR COPY OF THE FEDERAL TAX RETURN TRANSCRIPT: http://www.irs.gov John W. Bricker Federal Building; 200 N. High Street, Room 101 Columbus, OH 43215

OHIO RESIDENCY REQUIRED DOCUMENTS CHECKLIST C2: INDEPENDENT STUDENT Copy of Ohio Driver's License or State of Ohio ID card. Copy of current immigration or Visa status (if applicable) Proof of Ohio Domicile showing 12 CONSECUTIVE MONTHS: Signed copies of Rental agreement, lease, and/or HUD settlement statement of property owned. **If student is NOT listed, a notarized statement from the person whom he/she is residing with is ALSO REQUIRED. Student s Federal tax return transcript* for most recent tax year(s) Parent, spouse, legal guardian Federal tax return transcript* for most recent tax year(s) showing the student was NOT claimed as a dependent in the most recent tax year. (required if 25 or under) Student birth certificate (required if 25 or under) Proof of financial resources for the past twelve (12) months: income includes: employment, unemployment, Social Security/SSI, Retirement pay, State benefits (food stamps, WIC, cash benefits), savings, mutual funds, gifts of support from Ohio resident, financial aid Proof of employment (letter on company letterhead (see C3) and most recent pay stubs). Bank statements for the past twelve (12) consecutive months. Please be prepared to provide proof of all deposits over $100. E1: GAINFUL EMPLOYMENT IN OHIO PURSUING PART TIME PROGRAM Copy of Ohio Driver s License or State of Ohio ID card. Copy of current immigration or Visa status (if applicable) Proof of Ohio Domicile: Signed copies of Rental agreement, lease, and/or HUD settlement statement of property owned. **If student is NOT listed, a notarized statement from the person whom he/she is residing with is ALSO REQUIRED. Most recent pay stubs showing earnings of at least $300 per week (must be submitted EVERY semester) Letter from the student's employer on official company letterhead or a notarized statement that indicates: A. Student's name and CougarID B. Semester for which the student is applying for E(1) residency C. Date employment began D. Number of hours student is working per week E. Rate of pay per hour D1: FOREVER BUCKEYE Copy of Ohio Driver's License or State of Ohio ID card. Copies of current immigration or Visa status (if applicable) Proof of Ohio Domicile: Signed copies of Rental agreement, lease, and/or HUD settlement statement of property owned. **If student is NOT listed, a notarized statement from the person whom he/she is residing with is ALSO REQUIRED. Official Ohio high school transcript or a verification letter of your graduation on the high school's letterhead in a sealed envelope. (Note: a copy of your high school diploma is not sufficient proof of high school graduation)

OHIO RESIDENCY REQUIRED DOCUMENTS CHECKLIST E4: OHIO RESIDENTS TRANSFERRED OUT OF THE US BY THEIR EMPLOYER Copy of Ohio driver's license or State of Ohio ID card. Statement on employer's letterhead indicating the employee was an Ohio resident at the time of being transferred. Copy of employee's Ohio tax return for the previous year Dependents: (spouse or children) additionally, submit a notarized statement** from the spouse, parent, or legal guardian living in Ohio that includes the following information: a. Student's name and Cougar ID number b. Dates parent or spouse has lived in Ohio. c. Number of years parent or spouse has paid taxes in Ohio. d. Whether or not at least one parent or spouse has claimed the student as a dependent for tax purposes in the previous year. Substantiate by attaching a photocopy of Federal tax return transcript*. Copy of marriage certificate (for spouse only) E5: MIGRANT WORKERS Statement from the Ohio Department of Job and Family Services verifying the parent/student/spouse has been working in Ohio at least four months during each of the previous three years. (For Dependents Only): Submit a notarized statement** from the spouse, parent, or legal guardian living in Ohio that includes the following information: a. Student's name and Cougar ID number b. Dates parent or spouse has lived in Ohio. c. Number of years parent or spouse has paid taxes in Ohio. d. Whether or not at least one parent or spouse has claimed the student as a dependent for tax purposes in the previous year. Copy of marriage certificate (for spouse only) E6: OHIO RESIDENTS WHO ARE COMMUNITY SERVICE WORKERS Copy of Ohio driver's license or State of Ohio ID card. Copies of current immigration or Visa status (if applicable) A sworn statement from the community service group verifying Ohio home of record for the individual. A signed statement on letterhead verifying Ohio home of record for the individual. (For Dependents Only): Submit a notarized statement** from the spouse, parent, or legal guardian living in Ohio that includes the following information: a. Student's name and Cougar ID number b. Dates parent or spouse has lived in Ohio. c. Number of years parent or spouse has paid taxes in Ohio. (Attach Federal tax return transcripts* as proof) d. Whether or not at least one parent or spouse has claimed the student as a dependent for tax purposes in the previous year. Copy of marriage certificate (for spouse only) E7: MARITAL HARDSHIP Copy of Ohio driver's license or State of Ohio ID card. Copies of current immigration or Visa status (if applicable) Copy of court papers verifying the couple has taken legal steps to end the marriage Proof of Ohio Domicile: Signed copies of Rental agreement, lease, and/or HUD settlement statement of property owned by parent/legal guardian. **If student is NOT listed, a notarized statement from the person whom he/she is residing with is ALSO REQUIRED. A notarized statement* from the parents stating the following: a. The student's name and last four digits of social security number. b. Whether or not they are providing more than 50% of the financial support for the student. c. Length of time they have lived in Ohio and paid taxes. d. Whether they are U.S. Citizens or current immigration/visa status

OHIO RESIDENCY REQUIRED DOCUMENTS CHECKLIST PRINT NAME: SIGNATURE: DATE: / / COUGAR ID : SEMESTER: The following is a checklist of items that you will need to submit via the Residency Drop Box before your request for residency reclassification can be approved. Please provide photocopies as documents will not be returned to you. The lists below are examples of documentation. *Please note* this list is NOT all inclusive. Residency Officers are allowed by law to request additional documentation if needed to reach a determination. *FOR MILITARY STUDENTS ONLY* C4: VETERANS Copy of Ohio Driver s License or State of Ohio ID card Military DD 214 member 4 to prove Honorable Discharge or Medical Separation with 1 Year of Active Service Proof of Ohio Domicile as of the first day of a term of enrollment: Signed copies of Rental agreement, lease, and/or HUD settlement statement of property owned. If student is NOT listed, a notarized statement from the person whom he/she is residing with is ALSO REQUIRED. Additional documentation for dependents: a. SPOUSE: Marriage Certificate as proof of marriage. b. DEPENDENT CHILD: Veteran s Federal tax return transcript* for the previous year E2: OH RESIDENTS ON ACTIVE DUTY IN THE MILITARY Military LES (leave and earning statement) showing Ohio as home of Record Additional documentation for dependents: a. SPOUSE: Marriage Certificate as proof of marriage. b. DEPENDENT CHILD: Veteran s Federal tax return transcript* for the previous year Valid, government issued identification for student and spouse E3: ACTIVE DUTY MILITARY STATIONED IN OHIO Valid, government issued identification Military active duty orders verifying station in Ohio Proof of Ohio Domicile: Signed copies of Rental agreement, lease, and/or HUD settlement statement of property owned. If student is NOT listed, a notarized statement from the person whom he/she is residing with is ALSO REQUIRED. Dependents: (spouse or children) are eligible for in state tuition with above information and: a. SPOUSE: Provide copy of marriage certificate b. Dependent child: Provide copy of veteran s Federal tax return transcript* for the previous year E8: OHIO NATIONAL GUARD Valid, government issued identification for student and spouse A copy of enlistment papers (DD Form 4/1) or a letter from the base personnel officer verifying service in the Ohio National Guard. Additional documentation for dependents: a. SPOUSE: Marriage Certificate as proof of marriage. b. DEPENDENT CHILD: Veteran s Federal tax return transcript* for the previous year *NOTARIZED STATEMENT: A written declaration made under oath in front of a notary public. MUST BE ORIGINAL no copies will be accepted. All residency decisions must be finalized on or before the FIRST day of the Semester. RETROACTIVE RECLASSIFICATIONS WILL NOT BE GRANTED. *TO OBTAIN YOUR COPY OF THE FEDERAL TAX RETURN TRANSCRIPT: online: http://www.irs.gov in person: John W. Bricker Federal Building; 200 N. High Street, Room 101 Columbus, OH 43215 FOR ADDITIONAL INFORMATION: http://www.cscc.edu/services/recordsandregistration/residency.shtml CALL: 614 287 5533 or EMAIL: residency@cscc.edu

VERIFICATION OF DOMICILE AND SUPPORT FOR THE PURPOSE OF DOCUMENTING STATE RESIDENCY For Further Information Contact: Ohio Residency Officer Voice mail: 614-287-5533 E-mail: residency@cscc.edu PLEASE PRINT CLEARLY I Tenant Landlord (Please check one) Owner of this address: Street Name and Number Apartment Number City: State: ZIP Code: do certify that lives/lived with me Student Name (Please circle one) from / / to / /. I provide support for this person in the form of: Rent (amount per month): $ Room and Board All Living Expenses Educational Expenses Other (please explain): I Do Not Provide Financial Support Signature must be verified by a Notary Public and have the Notary Seal Signature: Date: / / The above signed has duly sworn that the information provided is true and accurate to his/her knowledge. Signed before me on this day of, 20 Notary Seal: Signature of Notary: Name (Please print): My commission expires on: / /

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Validation of Ohio Residency Status PLACE IN OHIO RESIDENCY DROP BOX: Columbus State Community College Madison Hall, Lower Level 550 East Spring Street FOR INFORMATION, CALL: 614-287-5533 Columbus OH 43215 OR EMAIL: residency@cscc.edu Ohio Residency Reclassification Application INSTRUCTIONS: Please read and carefully consider all of the questions before answering. This application must be submitted to an Ohio Residency Officer with supporting documents as outlined on the checklist, via the Ohio Residency Drop Box prior to the first day of the academic semester you desire reclassification to be effective. This is not to be used to appeal a decision for reclassification. Please use the Ohio Residency Reclassification Decision Appeal Request Form for that purpose. RETROACTIVE RESIDENCY DETERMINATIONS CANNOT BE MADE FOR TUITION SURCHARGE PURPOSES. PLEASE PRINT CLEARLY *NAME (Legal name required): *: INDICATES RESPONSE REQUIRED *Cougar ID LAST FIRST MI FORMER NAME *Social Security Number: *Date of Birth (mm/dd/yyyy): / / *Marital Status: Single Married: Month Year *Present Address: NUMBER AND STREET APT NUMBER CITY STATE ZIP CODE *Date present address was established (mm/dd/yyyy): / / *Date entered Ohio (mm/dd/yyyy): / / *Daytime Telephone Number:( ) *History of residence for 24-month period preceding above address: Evening Telephone Number:( ) Number and Street City and State From: Month/Year To: Month/Year *Please indicate the year of: *First term in attendance at CSCC Autumn Winter Spring Summer *Term for which residency is requested Autumn Spring Summer *Do you have an Ohio driver s license or state ID? Yes No *Do you have a driver s license or state ID from any other state? Yes No *If Yes, where? *Do you own or have use of a car? Yes No *Is it currently registered in Ohio? Yes No Are you a citizen of the United States? Yes No *If No, what type of visa do you hold? Permanent Resident Alien Student Other: PROVIDE PROOF OF CURRENT LEGAL STATUS TO REMAIN IN THE UNITED STATES Permanent Resident Alien visa number: A- Date issued: / / *Male 18 yrs - 26 yrs Indicate Your Selective Service Number: Not applicable *In what state are you registered to vote? *Have you registered to vote outside Ohio within the past 12 months? Yes No *If Yes, which state? PAGE 1

PLEASE PRINT CLEARLY *List all sources of financial support received during the 12-month period preceding enrollment (e.g. employment, spouse s employment, parents loans, savings, financial aid, etc.). Please be prepared to substantiate with documents, including complete bank statements with proof of deposits over $100 that are not directly deposited from an Ohio employer: *Have you filed an Ohio personal income tax statement for the past 12 months? Yes No *Who claimed you as an exemption on the past year s federal income tax return? Self Other *If Other : Name: Relationship: Year: ADDRESS CITY STATE ZIP CODE *Will this person claim you on the next year s tax return? Yes No *Substantiate by attaching a photocopy of the latest IRS Tax Return Transcript available at: http://www.irs.gov/individuals/get-transcript Also, substantiate residency of the person declaring you as an exemption by verifying he or she has lived in Ohio the past twelve (12) months. Use this space for any comments you wish to make to support your validation of Ohio residency: *Cite the specific section of the regulations from the Ohio Revised Code under which you qualify for residency and briefly explain why: (Include and/or attach any official documents you feel are pertinent) With the signing and submission of this document, I hereby verify my status as a bona fide resident of the State of Ohio as defined by the Ohio Board of Regents for the purposes of assessing tuition and fees. *Student signature (Required): Date: / / FOR OFFICE USE ONLY Residency is granted denied If denied, why: Residency is permanent conditional C1 C2 C3 C4 D1 E1 E2 E3 E4 E5 E6 E7 E8 Residency determination processed by: Date: / / Comments (if needed): Signature: Date: / / RLR:prc/Residency Application/10-22-2015 PAGE 2