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[ ] I am a dependent student, as defined by s. 1009.21(1)(a), Florida Statutes, in that I am eligible to
be claimed as a dependent under the federal income tax code by the claimant below. The claimant is my
“parent” as defined by s. 1009.21(1)(f), Florida Statutes, (i.e., either or both parents of the student, any guardian
of a student, or any person in a parental relationship to the student). My parent has maintained legal residence
in Florida for at least the past 12 consecutive months. As defined by section 1009.21(1)(d), Florida Statutes,
“’legal resident’ or ‘resident’ means a person who has maintained his or her residence in this state for the
preceding year, has purchased a home which is occupied by him or her as his or her residence, or has
established a domicile in this state pursuant to s. 222.17.” A copy of your parent’s tax return may be requested
to establish dependence.
[ ] I am an independent person who has maintained legal residence in Florida for at least the past 12
consecutive months. I provide 51% or more of my own support. An independent student generally includes a
person who is at least 24 years old, married, a graduate or professional student, a veteran, a member of the
armed forces, a ward of the court, or someone with legal dependents other than a spouse, pursuant to the
United States Department of Education for the purposes of federal financial aid eligibility. There may be limited
cases where a person under the age of 24 years old may qualify as an independent student. Such students will
be required to verify independence (including financial independence.) A copy your tax return may be
requested to establish independence.
TERM OF APPLICATION: (check one): [ ] FALL [ ]SPRING [ ]SUMMER YEAR: 20 ______
TO BE COMPLETED BY THE CLAIMANT/PERSON CLAIMING FL RESIDENCY:
Note: If the student is a dependent, the parent is the claimant and will complete this section and provide
supporting documentation. If the student is independent, the student is the claimant and will complete this
section and provide supporting documentation. No single document shall be conclusive in establishing
residency. Additional documentation, other than what is prescribed, may be requested in some cases.
All documentation provided is subject to verification. Evidence of ties to another state may result in
denial of Florida residency for tuition purposes.
Claimant/Name of Person Claiming FL Residency: ___________________________________________
Claimant’s Relationship to Student: _______________________________________________________
Claimant’s Address: ___________________________________________________________________
____________________________________________ Telephone Number: ______________________
Date Claimant began establishing legal FL residence: _________________________________________
PROVISION OF DOCUMENTS TO SUPPORT CLAIM OF FLORIDA RESIDENCY
Per s. 1009.21(3)(c), Florida Statutes, the residency determination must be documented by the
submission of written or electronic verification that includes two or more of the documents identified
below. No single piece of evidence shall be conclusive.
A. Claimant must provide at least one of the following of his/her personal documentation:
[ ] Florida voter's registration card
Number:____________________ Issue Date:_____/_____/_____
[ ] Florida driver's license. Number:_________________________________ Original Issue Date:______/______/______
Current Issue Date: ____/_____/_____
[ ] State of Florida identification card.
Number:___________________ Original Issue Date:______/______/______
Current Issue Date: ____/_____/_____
[ ] Florida vehicle registration. Number:_______________ Original Issue Date:______/______/_______
Current Issue Date: ______/_______/_______
[ ] Proof of permanent home in Florida occupied as primary residence for 12 consecutive months
prior to the student’s enrollment. (Required: document such as a deed or other evidence of title to
property used as primary residence, a homeowner’s policy, a title insurance policy, evidence of a
property tax payment on the primary residence, or a lease of multiple years’ duration.)