CNU's Application for In-State Tuition Rates

IF YOU ARE A VIRGINIA RESIDENT, YOU MUST COMPLETE THE APPLICATION FOR IN-STATE TUITION IN ORDER TO RECEIVE IN-STATE TUITION RATES

This form should be completed if you are claiming entitlement to Virginia in-state tuition pursuant to section 23-7.4, Code of Virginia. Supporting documents and additional information may be requested.

* INDICATES A FIELD THAT IS REQUIRED FOR THE SUBMISSION OF THIS FORM
Part I
*Term for which you are applying for Virginia Status: Fall Spring Summer, *Year:

Last Name:
 First Name:
 Middle Name:

*Social Security Number:
- - 		*Date of Birth:(mmddyy)
 *E-Mail:
Please note that we need a vaild e-mail address to verify your on-line application.

*Citizenship: U.S. Citizen
Permanent Resident Alien
Non-Resident Alien		 If non-resident Alien list country, visa type, and visa number:
, ,
NOTE: A copy of your U.S. Immigration & Naturalization Service (INS) identification card (Green Card)is required to be forwarded to the CNU Admissions Office before consideration for admission can be made.

*Marital Status:Single
Married Divorced		 Name of Parent/Legal Guardian or Spouse:

Permanent Address of Parent/Legal Guardian or Spouse:
Address: City: State: Zip:
Part II Section A
Where have you lived in the past two years? (List current address first. Include dates)
Address City State Zip Code From To

*2. Do your parents/legal guardian provide 50% or more of your financial support or claim you as a tax dependent?
Yes No

3A. If you are married, do you wish to claim eligibility for in-state tuition rates based on your spouse's domicile?
Yes No NA

3B. If "Yes" in 3A, does your spouse provide over 50% of your financial support?
Yes No NA

*4. Do any of the following characteristics apply to you? Select all that apply.
Age 24 or Older as of the first day of the term in which you intend to enroll
Veteran or active duty member of the US Armed Forces
Graduate or first-professional student
Ward of the court or was ward of the court until age 18
If both legal parents are deceased, no adoptive or legal guardian
Legal dependents other than spouse
None of the above characteristics apply to me

*Directions for Completing the Remainder of This Application

Section B: Domicile Information
For the parent/legal guardian or spouse portion of this application, answer the questions about the parent upon whom you are dependent. The parent/legal guardian must certify and date this application. If you are claiming eligibility for in-state rates based on your spouse's domicile, you must answer the parent/legal guardian or spouse portion of this application about your spouse. Your spouse must certify and date this application.
The shaded areas on this form are the questions to be answered by your parent/legal guardian or spouse. Whether or not these questions are required is based upon the criteria listed above.


*5. Are you completing the blue shaded areas for your:
Father Mother Legal Guardian Spouse N/A

For questions 6-10 you must answer the "B" questions if your response to the "A" question is "No."


Student Answer *Parent/Guardian or Spouse Answer

6A. Have you ever been employed in Virginia for the past year? Yes No Yes No
6B. If NO were you employed in:
Student: Another State Not Employed
*Parent/Guardian or Spouse:
Another State Not Employed

7A. Was a tax return filed or income taxes paid to Virginia as a full or part year resident on all earned income last year? Yes No Yes No
7B. If NO were taxes paid to:
Student: Another State Did Not File
*Parent/Guardian or Spouse:
Another State Did Not File

8A. Are you a registered voter in Virginia? Yes No Yes No
8B. If NO are you registered to vote in:
Student: Another State Not Registered
*Parent/Guardian or Spouse:
Another State Not Registered

9A. Do you hold a Virginia driver's license? Yes No Yes No
9B. If NO do you hold license in:
Student: Another State Not Licensed
*Parent/Guardian or Spouse:
Another State Not Licensed

10A. Did you operate a motor vehicle registered in Virginia during the last year? Yes No Yes No
10B. If NO is it registered in:
Student: Another State Not Registered
*Parent/Guardian or Spouse:
Another State Not Registered

11A. Are you a member of the US Armed Forces? If "No" go to question #12. Yes No
11B. Have income taxes been paid to Virginia on all military income for the past year? Yes No NA
If "no." have income taxes been paid to another state? Yes No NA
11C. Does the current Leave/Earnings Statement reflect Virginia witholding? Yes No NA
If "Yes" effective date of change to Virginia:(mmddyy)

*Parent/Guardian or Spouse:
*12A. Is your parent/legal guardian a member of the US Armed Forces? If "No" go to question #13. Yes No
*12B. Have income taxes been paid to Virginia on all military income for the past year? Yes No NA
If "no." have income taxes been paid to another state? Yes No NA
*12C. Does the current Leave/Earnings Statement reflect Virginia witholding? Yes No NA
If "Yes" effective date of change to Virginia:(mmddyy)

Section C: Additional Information
13. If your spouse is in the military, will you have: Question 13 is not applicable
A. Resided in Virginia for the past year? Yes No
B. Been employed and earned at least $10,300 during the past year? Yes No
C. Paid income taxes to Virginia on all earned income? Yes No

14. If you have lived outside Virginia for the past year, will you have: Question 14 is not applicable
A. Been employed in Virginia and earned at least $10,300 during the past year? Yes No
B. Paid Virginia income taxes on all taxable income earned in Virginia during the past year? Yes No

15. If your parent/legal guardian is in the military, will your parent/legal guardian have: Question 15 is not applicable
A. Resided in Virginia for the past year? Yes No
B. Been employed and earned at least $10,300 during the last year? Yes No
C. Paid income taxes to Virginia on all earned income? Yes No
D. Claimed you as a dependent for federal an Virginia income purposes? Yes No

16. If your parent/legal quardian has lived outside Virginia for the past year, will the parent/legal guardian have: Question 16 is not applicable
A. Been employed in Virginia and earned at least $10,300 during the past year? Yes No
B. Paid Virginia income taxes on all taxable income earned in Virginia during the past year? Yes No
C. Claimed you as a dependent for federal and Virginia income tax purposes? Yes No

Section D: Parent/ Legal Guardian or Spouse Information
*17. Where have you lived in the past two years? (List current address first. Include dates)
Address City State Zip From To

Section E: Certification
I certify that all of the information provided in this application is true and accurate. I understand that this application is a legally-binding document and that if I provide fraudulent information, I may be subject to repayment or dismissal. I agree to furnish the University with supporting documentation related to my application, if I am requested to do so.
Full Legal Name of Applicant: Date
*Full Legal Name of Parent/Legal Guardian or Spouse: Date

Before you submit this form, please double check to make sure it is filled out fully and correctly.

By submitting this application, I certify that all the information I have provided is true.

If you have any questions about this application please email gradques@cnu.edu.
If there are any technical problems with this form, please mail the webmaster.

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