Office of the Registrar

6000 16th Ave SW, Seattle, WA

98106-1499
Residence Questionnaire
Directions: Please print clearly and answer each question. Incomplete or illegible forms cannot be considered and will be returned. Falsification or
intentionally erroneous information is subject to perjury under the laws of the State of Washington, RCW 9A.72.085. All information will be kept
confidential in accordance with the Family Educational Rights and Privacy Act of 1974. Once a domicile is established in Washington, it must continue
for one year before you are eligible for resident tuition.

Applicants applying for residency should be prepared to submit individual questionnaires to each campus within the Seattle District if they are intending
to enroll at the college.
SECTION 1
Name (Last, First, MI) Day Phone Number
FOR OFFICE USE ONLY
( ) Type

Address (Street, State, Zip) Student ID Number Status

 DEP  INDEP
E-mail Address Birth City, State, Country Birth Date Age Today's Date

Effective Date
1. Last high school attended _________________________________________ State ___________ Year Graduated _____________
2. For what term are you now seeking  Resident  Non-Resident
residence classification? Year 20___  Fall  Winter  Spring  Summer
If you have previously applied at this institution for a change in residence status, indicate: Term __________ Year __________

3. Class Standing: Undergraduate Graduate Professional School: _______________________________________ ____________________________________

Residence Classification Officer

4. At this Institution, you are or will be enrolled as a:  New Student  Continuing Student  Returning Former Student
If continuing or former student, give number of credit hours for which you were registered during each of the last three terms and identify each term by session and year:

Credits ______ Term __________ Year __________ | Credits _______ Term __________ Year ___________ | Credits _______ Term __________ Year __________

5. Country of citizenship: 5a. Do you hold permanent or temporary resident immigration status?
 Yes  No
If not USA, answer 5a, 5b and 5c. 5b. Do you hold "Refugee-Parolee," "Conditional Entrant" or PRUCOL status?
 Yes  No
5c. Do you hold a visa classification of A, E, G, H-1, I, K, or L?
 Yes  No
Note: An immigrant refugee, and the spouse and dependent children of If yes to any of the above, you must attach a copy of both sides of Resident
such refugee, may be exempted from paying the nonresident tuition fees Alien Card, Form I-94, or other documentation. (If you are not a citizen of the
differential if the refugee (a) is on parole status, (b) has received an United States and do not hold permanent or temporary resident immigration
immigrant visa, or (c) has applied for U.S. citizenship. status, "Refugee-Parolee", "Conditional Entrant", PRUCOL status or an A, E,
G, H-1, I, K, or L visa, you cannot be classified as a resident.)
6. Have you received financial assistance from a state governmental unit or agency If yes, indicate state, agency, type of assistance, disbursement dates, etc.
during the past twelve months?
 Yes  No
7. Will you be receiving state financial assistance during the next twelve months? If yes, indicate state, agency, type of assistance, disbursement dates, etc.

 Yes  No

SECTION 2
1. Are you applying for resident status as a dependent If yes, your parent or legal guardian must complete SECTION 3 of this form, providing proof of his/her
student whose parent or court -appointed legal guardian Washington domicile and all requested supporting documentation. Verification of your dependent status
has maintained a bona fide domicile in the State of must be documented by submitting a true and correct copy of your parent's or legal guardian's state and
Washington for at least one year? federal income tax return for the most recent tax year. The extent of the disclosure required concerning
the parent's or legal guardian's state and federal tax returns is limited to the listing of dependents
 Yes  No claimed and the signature of the taxpayer and shall not require disclosure of financial information
contained in the returns.
2. Are you applying for resident status as a financially If yes, you must complete Section 3 of this form and provide all requested supporting documentation.
Independent student?
 Yes  No
2a. Student's Sworn Statement:
I have not been and will not be claimed as an exemption for federal Income tax purposes by any person except myself or my spouse for the current calendar year and for the
calendar year immediately prior to the year in which this application is made; and I have not received and will not receive financial assistance in cash or in kind of an amount
equal to or greater than that which would qualify me to be claimed as an exemption for income tax purposes by any person except myself or my spouse during the current
year and for the calendar year immediately prior to the year in which this application is made.

Signature _________________________________________________________________________________________________ Date ___________________________

2b. To further substantiate your financial Independence, you are required to submit appropriate documentation.
 A true and correct copy of your state and federal income tax return for the calendar year immediately prior to the year in which this application is made. If you did not file a state or federal
income tax return because of minimal or no taxable income, documented information concerning the receipt of such nontaxable income must be submitted.
 A true and correct copy of your W2 form filed for the previous calendar year.
 Other documented financial resources. Such other resources may include but are not limited to, the sale of personal or real property, trust fund, state or financial assistance, gifts, or earnings of
the spouse of a married student.
 If you are 24 or younger, provide a true and correct copy of the first and signature page of the state and federal tax return of your parents, legally appointed guardians, or person or persons who
have legal custody of you for the calendar year immediately prior to the year in which this application is made. The extent of the disclosure required concerning the parent's or legal guardian's
state and federal tax returns is limited to the listing of dependents claimed and the signature of the taxpayer and shall not require disclosure of financial information contained in the returns.

3. Are you on active duty military stationed in the state of Washington or the spouse or dependent of such a person?  Yes  No

4. Did you spend at least 75% of both your junior & senior years in a Washington state high school, and did you enroll in college within 6 months of leaving high school, and were
your parents/legal guardians domiciled in Washington for at least 1 year within the 5-year period before you graduated from high school?  Yes  No

Directions: Do not leave any questions blank. No decision can be made unless all questions are completed and all required documentation is
submitted.
AG Form #151 Revised 1/15/02; HECB revised 06/09; AG approved 6/10/09;Registration Forms – Revised 4/13/25 - G:/Registration/Residency/Residency Forms/Residency_Questionnaire
South Seattle College does not discriminate on the basis of race, color, creed, national origin, sex, disability, age, honorably discharged veteran or military status, or sexual orientation.
 Office of the Registrar
6000 16th Ave SW, Seattle, WA
98106-1499
SECTION 3
1. This section is being completed and signed by: Date of your arrival in Washington : Purpose of moving to Washington:

 Parent  Legal Guardian Student Month: ________ Day _______ Year ______

Date you took action to officially declare Washington as

your permanent, legal domicile:

Month: ________ Day _______ Year ______

2. List chronologically your employment and physical residence for the last two years giving exact information as requested below. If you were not employed, list your physical residence for
the last two years. Attach additional page if necessary.

DATES OF EMPLOYMENT LOCATION OCCUPATION HOME ADDRESS

Mo. Day Yr. Mo. Day Yr. City State Employer Hrs/wk Street City State

Note: You must provide proof of your physical presence in Washington the past 12 months (e.g. copies of rent receipts, lease or home purchase agreements, cancelled rent
checks, letter from landlord, letter from employer, etc.).

3. If you were out of Washington during the last 12 months, give dates, and reasons for your absence:
DATES OF ABSENCE LOCATION PURPOSE OF ABSENCE
Mo. Day Yr. Mo. Day Yr. City State

4. Have you ever If yes, attach a If yes, list date, city and state for your last two registrations.
registered to vote? copy of your
current voter's Date ____________ City __________________________ State ________ Date Voted ____________
 Yes  No card.
Date ____________ City __________________________ State ________ Date Voted ____________

5. Do you own or use any If yes, give type of vehicle, license number, state and dates of registry. You must attach a copy of vehicle registration (not the title).
motor vehicles, RV’s,
boats or mobile homes?
Type of vehicle ________________________ License Number __________________________ State __________ Date of Registry ___________

 Yes  No
Type of vehicle ________________________ License Number __________________________ State __________ Date of Registry ___________
6. Do you have a valid When did you first obtain a driver's license in that state?
If yes, you must If yes, in what state:
driver's license?
attach a copy of your
current driver's _________________________ Date ______________________________
license.
Previous driver's When did you first obtain a driver's license in that state?
If yes, in what state:
license?
 Yes  No
Yes No Date ______________________________
_________________________
7. Do you have a bank If yes, please attach If yes, since what date? Name of Bank _______________________ Branch _______________
account? documentation of
date you opened
 Yes  No account.
_________________________ City ________________________________ State ________________

8. Have you ever paid 8a. Have you ever attended a Washington college/university for more than 6
in-state tuition at any If yes, date of last term __________________________________________ hours per term? Yes No
public institution of If yes, where _________________________________________________
Name of Institution _____________________________________________
higher education?
Dates Attended: From _____________________ To __________________ Dates attended From____________________ To ___________________
 Yes  No
9. Are you a US Citizen?
If no, attach a copy of your Resident Alien Card, I-94 or other INS documentation.

 Yes  No
10. List business or
professional licenses ______________________________________________________________________________________________________________
(name & state of issue)
Additional Comments:

STATEMENT OF INTENT

I certify that I have declared

Washington as my true, fixed,
and permanent place of Signature of Parent (if completing SECTION 3) _____________________________ Date:___________________
habitation.

CERTIFICATION Parent Address (Street, City, State)

______________________________________________________________________________

______________________________________________________________________________
I certify under penalty of
perjury under the laws of the Signature of Student _________________________________________ Date: __________________
State of Washington, RCW
9A.72.085 that the foregoing
and all supporting
documentation are true and
correct.

AG Form #151 Revised 1/15/02; HECB revised 06/09; AG approved 6/10/09;Registration Forms – Revised 4/13/25 - G:/Registration/Residency/Residency Forms/Residency_Questionnaire
South Seattle College does not discriminate on the basis of race, color, creed, national origin, sex, disability, age, honorably discharged veteran or military status, or sexual orientation.