Franklin & Essex Residency

Franklin & Essex County Residency Form

Please complete this form to make sure everything is in place for a successful start at North Country!
Name *

First Name Last Name
Date of Birth

Month Day Year
Date
Email *
example@example.com
Phone Number *
Please enter a valid phone number.
Permanent Address

Street Address (PO Box not acceptable)

Street Address Line 2

City State / Province

Postal / Zip Code
Please select your county

Franklin County Essex County
How long have you lived at the address above?

Less than 12 months 12 months or more
If less than 12 months, please include your previous address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
The following are considered acceptable documentation to verify residency (select one):

NYS Driver’s License NYS Identification Card NYS Voter Registration Card NYS Motor Vehicle Registration Other NYS issued Identification NYS Income tax return Page 1 Residential Lease Agreement Proof of ownership of Franklin/Essex Co. Property Employment Paystub/W2 Bank Statement Page 1
Please upload your supporting documentation here. *

Document(s) must have a date showing one year’s legal residence in NYS and at least 6 months residence in Franklin and/or Essex County. Must show your name and physical address. You can provide more than one document to meet the one year requirement.
Cancel of
Please enter additional questions/concerns here:
STUDENT AFFIRMATION: I, the undersigned, in signing this document swear that my legal residence now is, and has for a period of at least one year prior to the date listed above been a resident of the state of New York. I affirm I have for a period of at least six months prior to the above date have lived in the above listed County. I swear all documentation provided are true and unaltered. I understand that further proof of residency may be required upon review and that residency must be updated every 12 months. I understand that failure to complete my Residency Requirement within the first 30 days of classes will result in the Non-Resident Tuition Rate being added to my account.
Please verify that you are human *
Signature

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Franklin & Essex County Residency Form