Residency Reconsideration

6. When did you most recently move to Wisconsin?

7. Please provide the following information:

A. Father's Name

Father's Address

B. Mother's Name

Mother's Address

C. If Parents’ addresses differ, explain

D. Guardian's Name

Guardian's Address

E. If neither parent is living where are they buried?

8. What are the sources of your support? (If several, itemize amounts of percentages.)

9. What percent of your funds do you obtain from your parents?

10. On whose federal income tax return were you listed as a dependent last year?

11. On whose federal income tax return will you be listed as a dependent for the current tax year?

12. Date purchased or began renting living accommodations in Wisconsin. If rental, is your house/apartment rented furnished or unfurnished?

13. Date employer began to withhold Wisconsin state income taxes from your salary?

Name of Employer

Employer's Phone Number

14. Which state did you file your last income tax returns and for what tax year?

15. Date registered to vote in Wisconsin

16. Date registered a motor vehicle in Wisconsin

17. Date obtained a valid Wisconsin Driver’s License

18. Are you a Veteran?

Yes

N/A

19. Read the Statute 36.27 and below write a clear and complete a statement as you can covering the following: (Be specific and factual but be concise; use separate sheets if necessary. This statement should be supported with any appropriate documentary evidence.

a. Your purpose of coming or last returning to Wisconsin.

b. A chronology of dates and events related to your coming here, your activities, your employment, and places of residence from the time you were living at home and attending high school, until the present. Explain any absences from the state.

c. Facts that, in your opinion and in the light of the regulations, tend to establish your residence here. Indicate the semester for which you should qualify.

d. Your immediate and long range plans.

EXPLANATION

Supporting Docs

RECONSIDERATION REQUEST TO RESIDENCY STATUS FOR FEE PURPOSES
I have read the excerpt of Wisconsin Statute 36.27(2) relating to determination of non-resident students. With this in mind, I am petitioning for reconsideration of the initial residency determination. (See question 18 of the form requesting reconsideration.)

20. By typing your name below you are agreeing to the following statement:

I certify that the information on this form is true and complete to the best of my knowledge, and I understand that inaccurate information may affect my enrollment or fee assessment. I authorize the use of any University records which may have a bearing on this reconsideration.

Date