FERRIS STATE UNIVERSITY

PETITION FOR CHANGE IN RESIDENCE STATUS

Name:

Student_Number:

Date_of_Birth:

Marital_Status:

First_Semester_at_FSU:

Current_Address

Street:

City:

County:

State:

Zip:

Local_Telephone_No:

Previous_Address

Street:

City:

State:

Zip:

Telephone_No:

Permanent_Address

Street:

City:

State:

Zip:

Telephone_No:

 

Are you a dependent student?

 

Yes:

No:

 

1.  Give reason you believe you qualify as a Michigan resident for fee-paying purposes:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

2.  List all other addresses, including vacation addresses, since you first enrolled at Ferris State University:

Address (Street, City, State, Zip)                                                      Dates (from/to)

1.
2.
3.
4.

 

 

 

 

 

 

 

 

 

 

 

3.  Your employment history for the past two years.

        Employer                                          Address                        Dates Worked     Full/part time

1.
2.
3.
4.

 

4.  Other colleges and universities attended and residency status there.

Name                                                                             State      Year             Residency Status

1.
2.
3.
4.

 

5.  List your sources of financial support during the past four years (include loans, scholarships, aid from spouse, parents or other persons, etc.).

        Year                     Source of support

1.
2.
3.
4.

 

6.  Attach any continuation sheets and any supportive documents you feel would be helpful to us in making the residency decision.

 

 

I hereby certify that the information given in this application, and in all attachments thereto, is true, correct and complete to the best of my knowledge.  I authorized Ferris State University to verify all facts relevant to my claim to residence.

 

 

___________________________                           ______________

Signature of Applicant                                                 Date