______XXX –XX-______(Last Four Numbers)___
PRINT NAME (Last, First, Middle Initial) Social Security Number
AFFIDAVIT AND APPLICATION FOR CERTIFICATE OF RESIDENCE
PURSUANT TO SECTION 6301 AND 6305* OF THE EDUCATION LAW,
IN CONNECTION WITH ATTENDANCE AT A COMMUNITY COLLEGE
STATE OF NEW YORK
COUNTY OF
I (NAME) ______do hereby swear (or affirm) that I reside at (STREET ADDRESS) ______in the City, Village, Town of (NAME OF TOWN/ZIP) ______, County of ______, State of New York.
Have you been a legal resident of New York State for AT LEAST ONE YEAR immediately prior to the date of this affidavit? YES ______NO______
Have you been a resident of your current county for AT LEAST SIX MONTHS immediately prior to the date of this affidavit? YES ______NO ______
List your address for the past year below – do not include previous school address.
ADDRESSES INCLUDE: DATES:
Current (Same As Above) ______/______/______to PRESENT
______/______/______to ______/______/______
______/______/______to ______/______/______
I further state that I plan to enroll in Clinton Community College and that this affidavit (or affirmation) and application is made for the purpose of securing from the Chief Fiscal Officer of the County of ______a certificate of residence pursuant to the requirements of Article 126 of the Education Law.
______
Signature of Applicant
Sworn to (or affirmed) before me this
______day of ______20______
______
Notary Public
*SEE REVERSE SIDE FOR INSTRUCTIONS
Certificate of Residency Instructions
How to Obtain a Certificate of Residence
To qualify for the resident tuition fee, a student is required by law to present a residency certificate once each academic year, on or before registration, indicating that he or she has been a legal resident of the State of New York for one year, and of a county for six months. Residence, for purposes of tuition, refers to a student’s principal or permanent home.
Residents of Clinton County
1. Complete the Residency Application available in the student portal, on the college website, or obtained from the Bursar’s Office; it must be dated within sixty days of the start of the semester you wish to attend
2. Have your signature notarized;
3. Submit the Residency Application with your tuition payment.
Residents of Other New York State Counties
If you have been a permanent legal resident of New York State for the past year, but you have lived outside of Clinton County, you must:
1. Complete the Residency Application available in the student portal, on the college website, or obtained from the Bursar’s Office; it must be dated within sixty days of the start of the semester you wish to attend
2. Have your signature notarized;
3. Take or mail the application to your County Treasurer or Chief Fiscal Officer. The Treasurer will keep the application and issue you a Certificate of Residency;
4. Submit the original Certificate with your tuition payment. (A faxed copy cannot be accepted.)
SECTION 6301 AND 6305 OF THE EDUCATION LAW
IN CONNECTION WITH ATTENDANCE AT A COMMUNITY COLLEGE*
*Education Law, Section 6305, provides: “The Chief Fiscal Officer of each county, as defined in Section 2.00 of the local finance law, shall, upon application and submission to him/her of satisfactory evidence, issue to any person desiring to enroll in a community college as a non-resident student, a certificate of residence showing that said person is a resident of said county. Such person shall, upon his/her registration for each college year, file with the college such a certificate of residence issued not earlier than two months prior thereto, and such certificate of residence shall be valid for a period of one year from the date of issuance.” Education Law, section 6301, paragraph 4, defines: “Resident.” A person who has resided in the state for a period of at least one year and in the county, city, town, intermediate school district or school district, as the case may be, for a period of at least six months, both immediately preceding the date of such person’s registration in a community college, for purpose of section sixty-three hundred five of this chapter.
**In the event that a person qualified as above for state residence, but has been a resident of two or more counties in the state during the six months immediately preceding his/her application for a certificate of residence pursuant to section sixty-three hundred five of this chapter, the charges to the counties of residence shall be allocated among the several counties proportional to the number of months, or major fraction thereof, of residence in each county.