This section must be completed if you are claiming entitlement to in-state tuition privileges pursuant to Section 23-7.4 of the Code of Virginia. Supporting documents and additional information may be requested. You must submit this form before the first day of the semester or term for which you are applying if you wish to be considered for in-state status.


Student Applicant Information

Student's Legal Name:*


Date of Birth:*


Address:*


1. Citizenship:*
4. Filed a tax return or paid income taxes to Virginia?*
5. Been a registered voter in Virginia?*
6. Held a valid Virginia driver's license?*
7. Owned or operated a motor vehicle?*

Note: Answer the following question ONLY if you worked in Virginia but currently reside outside of Virginia.

8. Did you file Virginia taxes on all taxable income earned in Virginia for the last year?
9. Will you be age 24 before the first day of classes?*
10. Are you a veteran of the U.S. Armed Forces or active duty military?*
a. If you are active duty military, are you currently assigned to a permanent duty station in Virginia?

You must also provide the University with copies of your official military orders assigning you to a permanent duty station in Virginia and official documentation of your residence in Virginia (deed, lease, or letter from landlord).


b. Does your Leave and Earnings Statement (LES) reflect Virginia as your current state of residence?
11. Are you married?*
12. Are you a ward of the court or were you a ward of the court until age 18?*
13. Do you have legal dependents other than a spouse?*
14. Do your parents/legal guardian/spouse provide 51% or more of your financial support OR claim you as a tax dependent?*

Signature(s)