APPEAL FROM NONRESIDENT CLASSIFICATION FOR UNIVERSITY FEE PURPOSES UNIVERSITY OF WISCONSIN - WHITEWATER

Return Form To: I wish to appeal my current classification of nonresident for Residency Coordinator tuition purposes for the following semester: University of Wisconsin - Whitewater Admissions Office, 2060 Roseman Building Fall 20_____ Whitewater, Wisconsin 53190 Spring 20_____ Summer 20_____

SECTION 1: GENERAL INFORMATION

Name (as it appears on University of Wisconsin - Whitewater records) Student ID Number

Last First Middle Date of Birth

Local Address (Since: month/year): Permanent Home Address (Since: month/year):

Street Street

City State Zip/Postal Code City City State Zip/Postal Code

Contact Information

Home Telephone # Cell Phone #: Email Address:

UW-Whitewater Classification (please circle one): Freshman / Sophomore / Junior / Senior / Graduate Student / Special Student

From what state or country Country of Citizenship: did you move:

Date files I-485 form for Date Permanent Resident Permanent Resident Status: Card Received:

*If not a US Citizen: attach a copy of both sides of your (and your parents) Permanent Resident Card or evidence of your visa status.

SECTION 2: HOUSING INFORMATION

Type of Current Housing (please circle one): House (I own/I rent) / Residence Hall / Apartment / Other: *For Renters (attach a copy of your lease)

SECTION 3: DATED MATERIAL

Date entered Wisconsin to Date purchased or began renting establish a permanent residence: living accommodations in Wisconsin:

Date registered to vote in Wisconsin. Date registered a motor vehicle in Wisconsin. (Attach statement from City Clerk verifying registration.) (Attach a copy of Certificate of registration.)

Date obtained a valid Wisconsin driver’s license. Date self-supporting status was established: (Attach a copy of license.) a statement concerning self-support must accompany the appeal, and it must identify the past year’s expenses and source(s) of income or support.

Date employer began to withhold Wisconsin state income taxes from salary: Submit a notarized copy of your most recent Wisconsin State Income Tax return. (Note: If a copy is not available, write to the department of Revenue, 4638 University Avenue, Madison, WI 53705, and request a statement verifying the years for which you have filed a Wisconsin State Income Tax return.) UW-Whitewater Residency Appeal Form, Page 2

SECTION 4: INCOME TAX AND FINANCIAL INFORMATION

Sources of Support (including tuition) for the 12 months prior to this appeal

Parent(s)______% Spouse______% Significant Other______% Relatives______%

Savings______% Loans______% Financial Aid______% Gifts______%

G.I. Bill______% Employment during school______% Employment during summer______%

Trust Fund______% If Supported by a Trust Fund, name of state Trust Fund pays Income Taxes to:______

Other______% Explain Other:

Claimed as a dependent for Income Taxes by (circle one): Self / Spouse / Partner / Parent(s) / Other (name/relationship)

Wisconsin state income taxes For which years did you file Wisconsin state income (not property) tax withheld since (mo/yr): returns as a resident for tax purposes?

Submit a notarized copy of your most recent Wisconsin State Income Tax return. (Note: If a copy is not available, write to the department of Revenue, 4638 University Avenue, Madison, WI 53705, and request a statement verifying the years for which you have filed a Wisconsin State Income Tax return.

SECTION 5: DRIVER AND VEHICLE INFORMATION

State on current Driver’s license held only in Wisconsin since State on prior driver’s license (mo/day/yr) driver’s license

Presently operate a vehicle (while in school) Yes No Date Vehicle Registered: (Attach a copy of Certificate of registration.) If Yes, state of vehicle registration:

Vehicle is owned by: Insurance for vehicle carried in state of: State in which owner resides:

Your relationship to owner:

Insurance

SECTION 6: FAMILY RESIDENCE INFORMATION

Parent/Guardian 1:

Name Address Country of Citizenship

Parent/Guardian 2:

Name Address Country of Citizenship

-If parent/guardians names or addresses differ, please explain briefly: - If not a US citizen, attach a copy of both sides of Permanent Resident Card, or other evidence of visa status. UW-Whitewater Residency Appeal Form, Page 3

SECTION 7: COMMUNITY INTERESTS

Organizations and Activities you participate in (political, religious, social, community, volunteer, etc.)*

Name of Organization/activity City/State Dates Involved

1.

2.

3.

4.

*Note: The purpose for this information is to indicate your community interests other than as a student for the year next preceding the term you are seeking exemption from nonresident tuition. Under the Family Education Rights & Privacy Act of 1974, this information will be protected from disclosure to the extent permitted by law.

SECTION 8: PERSONAL STATEMENT

Please read the extract from the Wisconsin Statute 36.27(2) on pages 5 & 6. on a separate 8½x11 sheet, provide any additional information that would clarify your residence status and/or help to rebut a possible presumption that, having entered and remained in Wisconsin principally for educational purposes, you are presumed to continue to be domiciled outside this state. Comment specifically on the following: A. Your purpose in coming or last returning to Wisconsin B. In chronological order, dates and events related to your coming to Wisconsin and your activities, employment, and places of residence from the time you were living at home and attending high school until the present; (an applicant who is still in dependent status should provide similar information concerning his or her parent or guardian.) C. Facts that, in your opinion, lend to establish your residence in the State of Wisconsin. D. Your immediate and long-range plans E. Any other findings that you believe are important to finding of residency for tuition purposes for you.

SECTION 9: REQUIRED SIGNATURES

The undersigned hereby swears to the information provided in this appeal and the attached personal statement. I understand that any false or misleading information on this appeal may jeopardize my admission or right to continue my education at the university. I also understand that completing this appeal or submitting additional information, requested or otherwise, does not guarantee me residency of the State of Wisconsin for tuition purposes. This information is merely provided as guidelines for the residency committee to use in determining my residency status.

Subscribed and sworn to before me

This ______day of ______in the year______Notary Public Signature of person making this appeal

Commission Expires ______EXTRACT FROM SECTION 36.27(2), WISCONSIN STATUTES OF 2011 RELATING TO EXEMPTION FROM NONRESIDENT TUITION AT TH E UNIVERSITY OF WISCONSIN - WHITEWATER

36.27(2)(a) Students qualifying under any of the following categories, while they continue to be residents of this state, are entitled to exemption from nonresident tuition but not from incidental or other fees: 1. Any adult student who has been a bona fide resident of the state for 12 months next preceding the beginning of any semester or session for which such student registers at an institution. 2. Any minor student, if one or both of the student's parents have been bona fide residents of this state for at least 12 months next preceding the beginning of any semester or session for which the student registers at an institution. 3. Any adult student who is a dependent of his or her parents under 26 USC 152(a), if one or both of the student's parents have been bona fide residents of this state for at least 12 months next preceding the beginning of any semester or session for which the student registers at an institution. 4. Any minor student who has resided substantially in this state during the years of minority and at least 12 months next preceding the beginning of any semester or session for which such student registers at an institution. 5. Any minor student under guardianship in this state whose legal guardian has been a bone fide resident of this state for at least 12 months next preceding the beginning of any semester or session for which such student registers at an institution. 6. Any adult student who has been employed as a migrant worker for at least 2 months each year for 3 of the 5 years next preceding the beginning of any semester or session for which the student registers at an institution, or for at least 3 months each year for 2 of the 5 years next preceding the beginning of any semester or session for which the student registers at an institution, any adult student whose parent or legal guardian has been so employed while the student was a minor and any minor student whose parent or legal guardian has been so employed. In this subdivision, "migrant worker" has the meaning specified in s. 103.90(5).

36.27(2)(am) Any person who is a refugee, as defined under 8 USC 1101(a)(42), who moved to this state immediately upon arrival in the United States and who has resided in this state continuously since then is entitled to the exemption under par. (a) if he or she demonstrates an intent to establish and maintain a permanent home in Wisconsin according to the criteria under par. (e).

36.27(2)(b) 1. Nonresident members of the armed forces and persons engaged in alternative service who are stationed in this state on active duty and their spouses and children are entitled to the exemption under par. (a) during the period that such persons are stationed in this state. 2. Members of the armed forces who reside in this state and are stationed at a federal military installation located within 90 m iles of the borders of this state, and their spouses and children, are entitled to the exemption under par. (a). 3. Nonresident persons who served in active duty in the U.S. armed forces for at least 10 years, who were honorably discharged from such service within 4 years before registering at an institution, and who filed state income tax returns for at least 8 of the last 10 years of active duty in the U.S. armed forces, and their spouses and children are entitled to the exemption under par. (a). 4. A person who was a resident of this state at the time of entry into active duty, who is a resident of and living in this state at the time of registering at an institution, and who is a veteran, as defined in s. 45.01(12), is entitled to the exemption under par. (a).

36.27(2) (c) Any student who is a graduate of a Wisconsin high school and whose parents are bona fide residents of this state for 12 months next preceding the beginning of any semester or session for which the student registers at an institution or whose last surviving parent was a bona fide resident of this state for the 12 months preceding death is entitled to the exemption under par. (a).

36.27(2) (cm) Any person continuously employed full time in this state, who was relocated to this state by his or her current employer or who moved to this state for employment purposes and accepted his or her current employment before applying for admission to an institution and before moving, and the spouse and dependents of any such person, are entitled to the exemption under par. (a) if the student demonstrates an intent to establish and maintain a permanent home in Wisconsin according to the criteria under par. (e). In this paragraph, "dependents" has the meaning given in 26 USC 152(a).

36.27(2) (d) Any person who has not been a bona fide resident of the state for 12 months next preceding the beginning of any semester or session for which such person registers at an institution, except as provided in this subsection, is not exempt from the payment of the nonresident tuition.

36.27(2) (e) In determining bona fide residence at the time of the beginning of any semester or session and for the preceding 12 months the intent of the person to establish and maintain a permanent home in Wisconsin is determinative. In addition to representations by the student, intent may be demonstrated or disproved by factors including, but not limited to, timely filing of a Wisconsin income tax return of a type that only full-year Wisconsin residents may file, voter registration in Wisconsin, motor vehicle registration in Wisconsin, possession of a Wisconsin operator's license, place of employment, self-support, involvement in community activities in Wisconsin, physical presence in Wisconsin for at least 12 months preceding the beginning of the semester or session for which the student registers, and, if the student is not a U.S. citizen, possession of a visa that permits indefinite residence in the United States. Notwithstanding par. (a), a student who enters and remains in this state principally to obtain an education is presumed to continue to reside outside this state and such presumption continues in effect until rebutted by clear and convincing evidence of bona fide residence.

(2m) APPEALS. Any body designated by the board to determine nonresident tuition exemptions under sub. (2) may require a student who has been granted such an exemption to submit information from which the body may determine the student's eligibility for the exemption, the student's eligibility for a different exemption or the student's residency status.

February 2013