STATE OF TEXAS §
COUNTY OF ___________________ §
Before me, the undersigned Notary Public, on this day personally appeared
known to me, who being by me duly sworn upon his/her oath, deposed and said:
1. My name is ______________________________________________________. I am
________ years of age and have personal knowledge of the facts stated herein and
they are all true and correct.
2. I graduated or will graduate from a Texas high school or received my GED certificate
3. I resided in Texas for three years leading up to graduation from high school or
receiving my GED certificate.
Please submit an official high school transcript or GED certificate (with date and scores).
4. I have resided or will have resided in Texas for the 12 months prior to the census date
of the semester in which I will enroll in ______________________________
5. I have filed or will file an application to become a permanent resident at the earliest
opportunity that I am eligible to do so.