Primary Information
Applicant Name*

Last NameFirst Name
Applicant's Date of Birth*

MonthDayYear
Applicant's Phone Number*
Please enter a valid phone number.
Applicant's Email*
example@example.com
Program*
Are you a first time student at Haney?*

YesNo

Florida Residency for Tuition Purposes
A Florida "resident for tuition purposes" is a person who has, or a dependent person whose parent or legal guardian has, established and maintained legal residency in Florida for at least twelve (12) consecutive months preceding the first day of classes of the enrollment period for which Florida residency is sought.
1. Residence in Florida must be a bona fide domicile rather than for the purpose of maintaining a residence incident to enrollment at an institution of higher education.
2. To qualify as a Florida resident for tuition purposes, you must be a U.S. citizen, a foreign national in a nonimmigrant visa classification that grants you the legal ability to establish a bona fide domicile in the United States, a permanent resident alien, or legal alien granted indefinite stay by the U.S. Citizenship and Immigration Services. Other persons not meeting the twelve-month legal residence requirements may be classified as Florida residents for tuition purposes only if they fall within one of the limited special categories authorized by the Florida Legislature pursuant to section 1009.21, Florida Statutes. All other persons are ineligible for classification as a Florida "resident for tuition purposes."
3. Living in or attending school in Florida will not, in itself, establish legal residence. Students who depend upon out-of-state parents for support are presumed to be legal residents of the same state as their parents.
4. Residency for tuition purposes requires the establishment of legal ties to the state of Florida. Students must verify that they have broken ties to other states if the student or, in the case for dependent students, his or her parent has moved from another state.
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Citizenship:*

U.S. CitizenNon-U.S. CitizenPermanent ResidentOther
Do you live with your parents?*

YesNo
Social Security Number
Alien Registration Number
Issue Date

MonthDayYear

Florida Residency for Tuition Purposes

Continued

PROOFS OF RESIDENCY:

SECTION A:
▪ Florida Voter's Registration Card	▪ Florida Driver's License
▪ Florida Vehicle Registration	▪ State of Florida Identification Card
▪ Official Transcript from Florida Highschool REQUIRED: Earned within the last 12 months AND* show 2 or more years of Attendance.
▪ Proof of primary residency in Florida occupied for 12 consecutive months PRIOR to the student's enrollment Homeowner’s policy Title insurance policy Deed or Property Title Property tax payment or lease of multiple years
▪ Proof of a homestead exemption in Florida *REQUIRED: Document from the county tax collector demonstrating the application of a homestead exemption to the claimant's primary residence
▪ Proof of permanent full-time employment in Florida (at least 30 hours per week) *AND* provide 12 consecutive months of pay stubs

Can you provide any TWO of the documents listed above?*

YesNo
Can you provide at least ONE of the documents listed above?*

YesNo

Can you provide at least ONE proof listed above?

YesNo

Florida Residency for Tuition Purposes

Qualification by Exception
As provided in s. 1009.21, Florida Statutes, I qualify for residency based on the following permitted exception (documentation required):

VALID DOCUMENTATION:

▪ Qualified beneficiary under (s. 1009.98, Florida Statutes) Florida Prepaid College Program.

*REQUIRED: Copy of Florida Prepaid Recipient card

▪ Married to a person who has maintained legal residence in Florida for the past 12 consecutive months, established legal residence and intend to make Florida my permanent home.

*REQUIRED: Copy of marriage certificate and/or other documents required to establish residency.

▪ Active duty member of the Armed Services of the United States,or active drilling members of the Florida National Guard residing in this state.

*REQUIRED: Copy of military orders or DD2058 showing home of record.

▪ Active duty member of the Armed Services of the United States, attending a Florida College System institution or state university within 50 miles of the stationed military establishment, if such military establishment is within a county contiguous to Florida.

*REQUIRED: Copy of military orders

▪ United States citizens living on the Isthmus of Panama, and completed 12 consecutive months of college work at the Florida State University Panama Canal Branch.

*REQUIRED: Copy of marriage certificate or proof of dependency.

▪ Students from Latin America and the Caribbean who receive scholarships from the federal or state government.

*REQUIRED: Proof of scholarship and Latin America or Caribbean residency.

▪ Southern Regional Education Board’s Academic Common Market graduate students attending Florida’s state universities.

*REQUIRED: Certification letter from State Academic Common Market Coordinator.

▪ McKnight Doctoral Fellows and Finalists who are United States citizens.

*REQUIRED: Verification from graduate studies.

▪ United States citizens living outside the United States who teach at a Department of Defense Dependent School or who enroll in a graduate level education program in an American International School which leads to a Florida teaching certificate.

*REQUIRED: Copy of military orders or DD2058 showing home of record.

▪ Active duty members of the Canadian military residing or stationed in this state under the North American Air Defense (NORAD) agreement,and attending a Florida College System institution or state university within 50 miles of the military establishment where they are stationed.

*REQUIRED: Proof of active duty membership for specified purpose.

▪ Active duty members of a foreign nation’s military who are serving as liaison officers residing or stationed in this state, attending a Florida College System or state university within 50 miles of the military establishment where foreign liaison officer is stationed.

*REQUIRED: Proof of active duty membership for specified purpose

▪ Previously enrolled at a Florida state post secondary institution, classified as a Florida resident for tuition purposes, transferring to another Florida state post secondary institution within 12 months of the previous enrollment.

▪ Previously enrolled at a Florida state post secondary institution, classified as a Florida resident for tuition purposes, abandoned Florida domicile less than 12 months ago and re-establishing Florida legal residence.

▪ Full-time instructional or administrative personnel employed by state public schools or institutions of higher education

▪ Full-time employees of state agencies or political subdivisions of the state when the student fees are paid by the state agency or political subdivision for the purpose of job-related law enforcement or corrections training.

Can you provide at least ONE of the documents listed above?*

YesNo
Document Upload

Cancelof

Florida Residency for Tuition Purposes

Non-Florida Resident
I do not qualify as a Florida resident for tuition purposes for the term for which this application is submitted. I understand that should I qualify for a future term, it will be necessary for me to submit an updated Residency Declaration while providing prescribed,supporting documentation to substantiate as “reclassification” of my status. Submission of this required document must occur prior to the beginning of the term for which residency is sought. I do not have to complete any further portion of this form except for the signing below.
Signature*

First NameLast Name
Date

MonthDayYear
Date
High School Start Date*

MonthDayYear
Graduation Date*

MonthDayYear
Transcript Upload

Cancelof

Florida Residency for Tuition Purposes

Continued- Student Seeking Florida Residency for Tuition Purposes
as defined by s.1009.21, Florida Statutes, for the term for which this application is submitted. I understand that it will be necessary for me to provide copies of the required documentation upon admission, in order to be considered as a Florida resident for tuition purposes. I have read the residency information on qualifying as a dependent or independent student, and declare that:

I qualify as a resident for tuition purposes

Dependent^*

Independent^**

Student is 23 and Under
Eligible to be claimed on taxes
One/Both parents or Legal guardian provide 51% or more of support

Student is 24 and Up
Provide 51% or more of own support
Married, a Veteran, Member of Armed Forces, Ward of the Court or Someone with Children

*as defined by s. 1009.21(1)(a), Florida Statutes, in that I am eligible to be claimed as a dependent under the federal income tax code by the claimant below. The claimant is my “parent” as defined by s. 1009.21(1)(f), Florida Statutes,(i.e., either or both parents of the student, any guardian of a student, or any person in a parental relationship to the student). My parent has maintained legal residence in Florida for at least the past 12 consecutive months. As defined by section 1009.21(1)(d), Florida Statutes, “‘legal resident’ or‘resident’ means a person who has maintained his or her residence in this state for the preceding year, has purchased a home which is occupied by him or her as his or her residence, or has established a domicile in this state pursuant to s. 222.17.” A copy of your parent’s tax return may be requested to establish dependence.

**as a independent person who has maintained legal residence in Florida for at least the past 12 consecutive months. I provide 51%or more of my own support. An independent student generally includes a person who is at least 24 years old, married, a graduate or professional student, a veteran, a member of the armed forces, award of the court, or someone with legal dependents other than a spouse,pursuant to the United States Department of Education for the purposes of federal financial aid eligibility. There may be limited cases where a person under the age of 24 years old may qualify as an independent student. Such students will be required to verify independence (including financial independence.) A copy your tax return may be requested to establish independence.

I qualify as:*

DependentIndependent

Florida Residency for Tuition Purposes

Residency Declaration
I, the undersigned, hereby declare that I have read the foregoing document and that the facts stated in it are true and further affirm the authenticity of the information provided on all pages of this Residency Declaration. I understand that any false or misleading information on this Residency Declaration, or provided in support of this Residency Declaration, will subject me to penalties pursuant to section 837.06, Florida Statutes, for making a false statement. I give permission for the institution to review or examine any and all documents and records, including those accessible electronically, which may assist in support of my status as a Florida resident for tuition purposes.
Signature*

First NameLast Name
Claimant's Signature

First NameLast Name
Date

MonthDayYear
Date

Submission Review
Please, review your submission to ensure all the information provided is correct and the proper documents are uploaded.

NOTE: Applications with improper document(s) will not be processed.
Should be Empty:


SECTION B:
Declaration of domicile in Florida	Florida professional or occupational license
Florida incorporation	Document evidencing family ties in Florida.
Proof of membership in a Florida-based charitable or professional organization.	Utility bills *AND* 12 consecutive months of payments
Lease agreement *AND* 12 consecutive months of payments	Official state, federal, or court document evidencing legal ties to Florida

Primary Information

Authorization to Release Information

Contact 1:

Contact 2:

Florida Residency for Tuition Purposes

Florida Residency for Tuition Purposes

PROOFS OF RESIDENCY:

Florida Residency for Tuition Purposes

VALID DOCUMENTATION:

Florida Residency for Tuition Purposes

Florida Residency for Tuition Purposes

Florida Residency for Tuition Purposes

Florida Residency for Tuition Purposes

Submission Review