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Application for Virginia's In-state Tuition Privileges Attention Virginia Residents: Complete and sign this form to claim in-state tuition privileges, pursuant to Section 23-7.4 Code of Virginia.
 

Summary: Application for Virginia's In-state Tuition Privileges
Attention Virginia Residents: Complete and sign this form to claim in-state tuition privileges, pursuant to Section 23-7.4 Code of Virginia.
Section I (To be completed by student.)
APPLICANT'S INFORMATION (Please print.)
FULL NAME
SOCIAL SECURITY NUMBER
HOW LONG HAVE YOU LIVED IN VIRGINIA? _______________ YEARS _______________ MONTHS
CITIZENSHIP U.S. CITIZEN BY BIRTH PERMANENT RESIDENT (Please attach copy of both sides of Form I-551 [Green Card].)
NON-U.S. CITIZEN VISA TYPE ___________________________________________ DATE OF VISA ISSUANCE _______ /_______ /_______ DATE OF VISA EXPIRATION _______ /_______ /_______
WHERE YOU HAVE LIVED FOR THE PAST TWO YEARS? (List current address first; physical address--not P.O. box.)
CURRENT ADDRESS CITY/STATE ZIP CODE
FROM (Month/Year) TO (Month/Year)
PREVIOUS ADDRESS CITY/STATE ZIP CODE
FROM (Month/Year) TO (Month/Year)
STUDENT EMPLOYMENT INFORMATION FOR ONE YEAR PRIOR TO THE DATE OF APPLICATION
EMPLOYER CITY/STATE HOURS PER WEEK
FROM (Month/Year) TO (Month/Year)
EMPLOYER CITY/STATE HOURS PER WEEK
FROM (Month/Year) TO (Month/Year)
DO YOUR PARENTS, SPOUSE, OR LEGAL GUARDIAN PROVIDE OVER HALF OF YOUR FINANCIAL SUPPORT? YES NO

  

Source: Acton, Scott - Department of Electrical and Computer Engineering, University of Virginia

 

Collections: Computer Technologies and Information Sciences