PETITONTOCHANGERESIDENCYSTATUS

ADMISSIONSANDREGISTRATION

(928) 344-7550FAX (928)344-7543

  • Failure tofileacompletepetitionbythe deadlinewill beconsidereda waiver oftheright tofilefor thesemester.Changes to astudent’sresidencystatuswill not be madeuntil thefollowingsemester.
  • Normal processing timefor completedpetitions isthree (3)workingdays. Ifadditionalinformation isneeded,theprocessmaybedelayed. It isthestudent’sresponsibilitytoprove,through documentation, in-state resident status.
  • Clear andconvincingdocumentationmustbesubmittedto support responses given in thispetition.

INSTRUCTIONS

1.Respond toall questionsandstatements

2.Attach aminimumofthree (3) supportingdocuments (dating backat least12months).Failure to providesupportingdocumentationwill beinterpretedas evidenceofnon-residency.Documentsthatshould be includedare: state incometaxreturn, voterregistration,automobileregistration,Arizonadriver’s license, placeofgraduationfrom highschool,sourceof financial support,dependencyas indicatedonfederal incometaxreturn,ownershipofrealproperty,signedleaseor rentalagreement,bankaccounts,andotherrelevantinformation.

Submitthispetitionandsupportingdocumentationtothe Admissions and RegistrationOffice

Check one:

□DependentStudent(for studentswhoaredependentonparents whoaredomiciledinArizona)

□IndependentStudent (for studentswho areemancipated)

PartII:StudentInformation

StudentName:SS#/StudentId

Last First Middle

Date ofBirth://PlaceofBirth:

MonthDayYearCityStateCountry

US Citizen: □ Yes □No PhoneNumber:( )

PermanentResident: □Yes □NoDateofIssuanceof Status:

CurrentAddress:

PermanentAddress:

Whatdate did yourpresentstay(i.e. currentstay) in Arizonabegin?//

MonthDay Year

PartIII:DomicileInformation

A.High School and Employment History

NameofhighschoollastattendedState

Location/CityMonth/YearGraduated

DATE
(From –To) / EMPLOYMENT
(IncludeEmployer,City,andState)

B.Personal Data–All studentsclaimingArizonaResidentStatus(if dependent of parent/guardian the following questions must apply based on parent/guardian information)

1)Whatareyourpresentsourcesofincome? (Pleaseselect onlyone)

□ Self-supporting(Self/Spouse) □ Parent orGuardian

If parentor guardian,home address:

City State ZipCode

2)Howlonghaveyoucontinuouslylived in Arizona?MonthsYears

3)Are you a registeredvoter? □Yes□NoCity/stateDate registered

4)IndicatewhatyearsyoufiledArizonastateincometaxfor?

5)CurrentDriver’s License Number

Issuing State DateIssued Renewal? □ Yes□No

6)Are youamemberofthearmedforces? □Yes□No(Ifyes,provide Military ID)

7)Is yourParentor Spouse in theMilitary? □Yes □No

StateClaimedforTaxPurposes (listedonthemonthlyLES)

8)Are you aresidentmemberof an Indiantribewhosereservationland lies in thisstateandextendsintoanotherstate?

□Yes □No Ifyes,whichreservation?

Student signature Date