Application for Classification As a Reciprocity Student

Application for Classification As a Reciprocity Student

APPLICATION FOR CLASSIFICATION AS A RECIPROCITY STUDENT

AT INDIANAUNIVERSITY SOUTHEAST

Residents of Jefferson, Oldham, Bullitt, Trimble and Meade counties Kentucky are eligible

for INDIANA RESIDENT TUITION RATES at Indiana University Southeast SUBJECT TO THE CONDITIONS list on the back of this application.

PLEASE FILL OUT THE INFORMATION REQUESTED BELOW

FALL SPRING SUMMER YEAR:

NAME:

Last First Middle

PHONE #: ( ) E-MAIL:

UNIVERSITY ID #:

DATE OF BIRTH: PLACE OF BIRTH:

If you are under 21, who is your parent or legal guardian?

What is the State and County of residence of your parent or legal guardian?

CHECK KY COUNTY OF RESIDENCE: Bullitt Jefferson Oldham Trimble Meade

ADDRESSES WHERE YOU HAVE RESIDED FOR THE PAST THREE (3) YEARS
Dates (month/year)
From To / Street / City / State / Zip Code
EMPLOYMENT INFORMATION FOR THE PAST THREE (3) YEARS
Dates (month/year)
From To / Company Name &
Street / City / State / Zip Code
COLLEGE OR UNIVERSITY YOU ATTENDED DURING THE PAST THREE (3) YEARS
Dates (month/year)
From To / Institution / City / State / Zip Code

I certify that to the best of my knowledge the information provided above is complete and correct.

Student (petitioner’s) Signature Date

REGISTRAR/ADMISSIONS USE ONLY: RECIPROCITY STATUS GRANTED YES NO

SIGNED: DATE:

SEE BACK OF FORM FOR RULES. 12/09 Office of the Registrar, IUSEA

RULES FOR DETERMINING CLASSIFICATION FOR RECIPROCITY STUDENT STATUS

IU SOUTHEAST ONLY

1. “RESIDENCE” means the place where an individual has his/her permanent home and has voluntarily fixed as a permanent habitation when not called elsewhere for labor, studies or other special or temporary purposes.

2. A person may be classified as a “Reciprocity Student” for fee purposes at Indiana University Southeast only when he/she has maintained a permanent residence in Jefferson, Oldham, Bullitt, Trimble or Meade counties in Kentucky for twelve (12) consecutive months immediately preceding the first scheduled day of classes of the academic session in which he/she plans to enroll.

3. The residence of an unemancipated person under 21 years of age follows that of his/her parents or legal guardian. In the event of a divorce or separation, if either parent meets the reciprocity resident requirement, such a person will be considered a RECIPROCITY STUDENT.

4. The foreign citizenship of a person shall not be a factor in determining reciprocity student status if such a person has legal capacity to remain permanently in the United States – Permanent Resident Status (Holds a Green Card).

5. DETERMINATION OF RECIPROCITY STUDENT STATUS WILL BE MADE BY THE IUS REGISTRAR.

If the applicant is dissatisfied with the Registrar’s determination, he/she may appeal the IUS Registrar’s decision to the Indiana University Standing Committee on Residence. Note: In order to file an appeal with the Indiana University Standing Committee on Residence, the petitioner will be asked to complete an additional form obtained at the IUS Registrar’s Office, LB-100, Phone: (812)941-2454.

ADDITIONAL COMMENTS, FOR REGISTRAR/ADMISSIONS USE ONLY:

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