Application for Border State Waiver(Alabama, Florida, North Carolina, South Carolina & Tennessee ONLY)

Application for Border State Waiver

(Alabama, Florida, North Carolina, South Carolina & Tennessee ONLY)

TUITION DIFFERENTIAL WAIVER

Prior to submitting a Border State Residents out-of-state tuition waiver application, students are advised to review the University System of Georgia Border State Residents out-of-state tuition waiver policy found in Section 7.3.4.1 of the Board of Regents Policy Manual (www.usg.edu/policymanual). Please note that the Border State Residents out-of-state tuition waiver is available to qualifying undergraduate students only. Documentation must be provided with application.

Ram ID*

Student First Name*

Student Last Name*

Student Stree Address*

Student City*

Student State*

Select

Student Zip Code*

Student Email*

Student Phone Number*

Phone

Term applying for waiver*

Select

Will you be attending as an undergraduate student?*

Yes

Citizenship Status*

Select or enter value

If Other, please detail

This waiver application is based on your present and permanent home (domicile) in the following eligible state (Alabama, Florida, North Carolina, South Carolina, Tennessee) bordering Georgia:*

Will you have lived in the above state for at least 12 consecutive months immediately preceding the first day of classes for the term the waiver is requested?*

Yes

Have you graduated or will you graduate from a high school in the above state?*

Yes

Have you ever lived outside of the above state above?*

Yes

Please let us know the time frame in which the above state has been your state of domicile?*

(mm/yyyy)

If yes, you have ever lived outside of the state above:*

Briefly describe your reason for moving to the above state.

Do you hold a current driver’s license/state-issued ID?*

Yes

Which state issued your driver's license/ID?*

Select

Do you own a motor vehicle?

Yes

State Vehicle Registered?*

Select

Are you registered to vote?

Yes

If yes, which state are you registered to vote in?*

Select

Did you file a state income tax return for the most recent tax year?

Yes

If yes, which state did you file in?*

Select

Please list all employment for the past two years, including military service.

Employer 1

Start Date

End Date

Employer City

Employer State

Select or enter value

# of hours worked per week

Are you under the age of 24?*

Yes

Parent or Legal Guardian Domicile*

Do you have a parent or U.S. court-appointed legal guardian who has established and maintained domicile in an eligible state (AL, FL, NC, SC, & TN) bordering Georgia for at least 12 consecutive months immediately preceding the first day of classes for the term the waiver is requested?

Yes

Name of above individual*

Relationship*

Select or enter value

Has that individual ever lived outside of the above state?*

Yes

They have maintained domicile in the above state since:*

(mm/yyyy)

Briefly describe their reason for moving to the above state:*

Do they hold a current driver’s license/state-issued ID?*

Yes

What state was your parent or guardian's driver's license or ID issued from?*

Select

Do they own a motor vehicle?*

Yes

If yes, state registered?*

Select

Are they registered to vote? *

Yes

If yes, state registered?*

Select

Did they file a state income tax return for the most recent tax year?*

Yes

State filed?*

Select

Were you claimed as a dependent?*

Yes

Did they file a federal income tax return for the most recent tax year?*

Yes

Were you claimed as a dependent?*

Yes

Signature*

By typing my name below, I understand that any material false statement made knowingly and willingly by me on this application, or any documents attached hereto may, in accordance with O.C.G.A. 16-10-71, which provides that upon conviction, a person who knowingly commits the offense of false swearing shall be punished by a fine of not more than $1,000 or by imprisonment for not less than one nor more than five years, or both, subject me to prosecution in a court of law. Additionally, I further understand that any such false statement may subject me to immediate dismissal from the institution.

Further, I certify that, to the best of my knowledge, the information submitted on this application is true and complete.

Today's Date*

LAWFUL PRESENCE & DOCUMENTATION OF WAIVER ELIGIBILITY*

Only those students verified to be lawfully present in the United States may be considered for an out-of-state tuition waiver. Waiver applicants may be required to provide additional documentation to meet this requirement. One of the following must be submitted:

A certified US Birth Certificate showing the student was born in the U.S. or a U.S. Territory. (A photocopy or faxed copy is not acceptable)
A U.S. Certificate of Naturalization (USCIS form N-550 or N-570)
A U.S. Certificate of Citizenship (USCIS form N-560 or N-561)
A U.S. Certificate of Birth Abroad issued by the Department of State (DS-1350) or a Consular Report of Birth Abroad (FS-240).
A current military ID (service member only, not dependent)
A current, valid permanent resident card (USCIS form I-151 or I-551). Must have copy of the front and back of the card.
A current U.S. Passport

Also required: Please attach one of the following to confirm domicile in the border state:

Copy of driver’s license or state-issued ID
Copy of vehicle registration
Copy of state tax return filed for the most recent tax year
Copy of federal tax return filed for the most recent tax year
Copy of utility bills
Copy of lease agreement or warranty deed (dated 12+ months)

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