THE ALABAMA COLLEGE SYSTEM CERTIFICATION …

1 In Order to be eligible for In-State Tuition, you MUST complete this form THE ALABAMA COLLEGE SYSTEM CERTIFICATION OF eligibility FOR IN-STATE TUITION In order to be eligible for in-state tuition, you MUST complete this form and fall into ONE or more of the following categories: Resident of the State of ALABAMA o I (or my non-estranged spouse) have lived in the state of ALABAMA for at least 12 continuous months immediately preceding my application for admission. o I am a dependent student and my parent/legal guardian has lived in the state of ALABAMA for at least 12 continuous months immediately preceding my application for admission. o I graduated from an ALABAMA High School or obtained a GED in the State of ALABAMA within three years of the date of my application for admissions.

2 O I have more substantial connections with the State of ALABAMA than any other state. Check all that apply: o Location of high school graduation. o Payment of ALABAMA State income tax as a resident. o Ownership of residence or other real property in the state and payment of ad valorem taxes on the residence or property. o Full-time employment in the state. o Residency in-state of spouse, parents, or children. o Previous periods of residency in the state for one year or more. o Voter registration and voting in the state. o Possession of state or local licenses to do business or practice a profession in the state. o Ownership of personal property in the state, payment of state taxes on property, and possession of state licenses plates. o Continuous physical presence in the state for a purpose other than attending school, excluding temporary absences for travel, military service, and temporary employment.

3 O Membership in religious, professional, business, civic, or other social organizations in the state. o Maintenance in the state of checking and savings accounts, safe deposit boxes, or investment accounts. o In-state address shown on selective service registration, driver s license, automobile title registration, hunting and fishing licenses, insurance policies, stock and bond registrations, last will and testament, annuities, or retirement plans. II. Be a Non-Resident who meets the Qualifications for In-State Tuition o I (or my supporting spouse or parent) am a member of the military on full-time active duty and stationed in ALABAMA under orders for duties other than attending school. o I (or my supporting spouse or parent) am an accredited member of a consular staff assigned to duties in ALABAMA .

4 O I (or my supporting spouse or parent) have full-time employment in ALABAMA and will start said employment within 90 days of my registration. o I (or my supporting spouse or parent) am a full-time permanent employee of this institution. o I (or my supporting spouse or parent) reside in a county of a state which is within the 50-mile radius of the designated campus of this institution. III. Non- Resident o Based on the residency guidelines above, I DO NOT meet the guidelines for ALABAMA resident tuition but am aware that I can reapply once I have met the guidelines. A request for change of residency status can only be made prior to registration; however, it will not be retroactive. I certify that in order to be eligible for resident tuition rates, the burden of proof lies with me, and that I may be asked to provide documentation for items checked.

5 I agree to notify the COLLEGE if there are any changes in the information submitted with this form. I understand that an out-of-state student cannot attain residency status simply by attending school for 12 months in the state of ALABAMA . I understand that any outstanding balance incurred, from my actions, on my student account will be turned over for collections to a 3rd party debt collection agency after 90 days if not paid and will result in my personal liability of all fees and costs associated with the collection of this debt. I understand that withholding required information requested on this application or giving false information could make me ineligible for admission to or continuation at Coastal ALABAMA Community COLLEGE . I agree to abide by the rules, policies, and regulations of the COLLEGE as stated in the COLLEGE Catalog.

6 I attest that the information given is accurate and complete to the best of my knowledge. I understand that Coastal ALABAMA Community COLLEGE owns all photographs of students and participants taken at Coastal ALABAMA events, and that Coastal ALABAMA reserves the right to use these photographs for COLLEGE promotional materials, both digital and print. If I do not wish to have my photographs used, I understand that I must file a Do Not Use Photograph form with the Coastal ALABAMA COLLEGE Relations Office. _____ Signature of Student / Date Social Security No: _____ Equal Opportunity in Education and Employment: In accordance with the official policy of the ALABAMA Community COLLEGE SYSTEM Board of Trustees, Coastal ALABAMA Community COLLEGE is committed to equal opportunity in employment and education.

7 No person is excluded from participation in, denied the benefits of, or subjected to discrimination under any program, activity, or employment on the grounds of race, color, disability, sex, religion, creed, national origin, or age. Revised 7/24/2017