Admissions, Registration & Records Campus Box 201 P.O. Box 173363 Denver, CO 80217-3363 Tel 303.556.

.2420 Fax 303.556.2431 South Classroom 133 www.ccd.edu

Amended Application Form

Your initial tuition classification was determined by the information provided on your Application for Admission. If you feel the decision was based on incomplete information, please complete the following questions in their entirety. This form is to be completed in full and returned to Admissions, Registration, & Records NO LATER THAN THE EARLIEST DROP (CENSUS) DATE FOR YOUR COURSES. Failure to do so may result in non-resident tuition classification for the semester without the right to appeal. Feel free to provide any documentation that shows your continuous presence in Colorado for one full year prior to the first day of class. These documents may include: Apartment lease or warranty deed, school records, utility bills, financial/bank statements, etc. They must clearly show your name, Colorado address, and be dated one year back. In addition, tuition classification is not based on physical presence alone. It is your responsibility to provide sufficient proof of your intent to make this state your permanent home at the time of your arrival in CO. Active-duty members of the armed forces, their spouse, and dependent children whose permanent duty station is in Colorado will be charged in-state tuition, even if the permanent duty station changes, as long as the student (armed forces member, their spouse, or dependent child) is continually enrolled in classes. Contact your military base Education Office for documentation. Do not complete this form: If you attended and paid non-resident tuition during the past three semesters see Petition for In-State Tuition. If you are an individual who was emancipated prior to turning 23 years of age see Petition for In-State Tuition. Part I to be completed by the student Name: ___________________________________ Student ID: S________________ Phone Number: (_______) _______ - __________ Please indicate which term you are applying for: Spring 20___ Birth Date: ____/____/_______ Summer 20___ E-Mail Address: _________________________________________ Fall 20___

Are you a U.S. citizen? Yes No If no, you must provide a copy of Form 1-551 (Permanent Resident Card) or immigrant visa. Proceed to Part II. If yes, proceed to answer the questions below and proceed to Part II. Questions for GED recipients: 1. Did you earn a GED in Colorado? 2. Have you resided in Colorado for the last 3 years continuously? Yes Yes No No No No N/A N/A N/A N/A

Questions for CO high school students: 1. For the last 3 years, were you enrolled in a Colorado public or private high school? Yes 2. Did you or will you graduate before you enroll in the above term? Yes Please indicate your age: _____

If you will be at least 23 years of age on or before the first day of class, proceed to Part II and answer the questions below as they apply to you. Are you under 23 years of age and have been married for at least one year? Yes
Month

No
Day Year

If yes, provide your marriage date. Proceed to Part II and provide only your information. ______/______/_______ If you answer No to the question above, proceed to Part II and answer the questions pertaining to your parent or court-appointed legal guardian. If your parent/court-appointed legal guardian is NOT a U.S Citizen, you must provide a copy of their Form 1-551 (Permanent Resident Card) or immigrant visa.

See back side for Part II

Name of person whose information is provided below_________________________________________________________

First Last

Relationship to Student:

Self

Parent

Court-Appointed Legal Guardian

Part II to be completed by person named above

1. 2. 3. 4.

List the date the person above has most recently resided in Colorado. _____/_____/_______ to _____/_____/_______ List any dates of extended absences from Colorado in the last two years. _____/_____/_______ to _____/_____/_______ N/A Yes No N/A N/A Did the person named above accept employment in Colorado prior to moving here?

List the most recent and previous COLORADO employer or income source for the person named above: ________________________________________ ____/____/______ to ____/____/______
Name of Employer or income source

________________________________________
Name of Employer or income source

____/____/______ to ____/____/______

5. 6.

List the past two years of Colorado state income tax return filed for the person named above: _______ and _______ N/A Does the person named above have a valid drivers license or state identification card? Date of issue: ____/____/______ Number: _______________ In what state was it issued? _______________ New Renewal Yes No

7.

List the last two years of Colorado motor vehicle registration for the person named above. _______/_______ and _______/_______
Month Year Month Year

N/A

8.

Provide date of Colorado voter registration for the person named above. _______/_______
Month Year

N/A Yes Yes Yes No No No

9.

Does the person above own property in Colorado? If yes, is that property their principle residence?

10. Does the person above maintain a home in another state?

I hereby swear/affirm that the answers given are accurate and complete, and that all the documents, attached hereto, are true and unaltered. If my circumstances change, affecting my tuition status, I agree to notify Admissions, Registration & Records in writing, within 15 days of such change. I understand that if false information or falsified supporting documentation is provided, any resultant in-state classification action based upon this document becomes voided and will be retroactively nullified. Student Signature: Parent Signature: ________________________________________________ ________________________________________________
(Required if parent/legal guardians information was provided)

Date: ____/____/______ Date: ____/____/______

FOR OFFICE USE ONLY

Received by: __________ Date: ___/___/_____ Decision by: __________ Date: ___/___/_____ Reason (if disapproved): _____________________________________________________________________

RES
Rev. 10/10