Border State Waiver

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Office of the Registrar
800 GSW State University Drive
Americus, GA 31709-4379
gswreg@gsw.edu
229.931.2015

Application for Out-of-State Tuition Differential Waiver
Border State Residents

Prior to submitting a Border State Residents out-of-state tuition waiver application, students are advised to review the University System of Georgia Border State Residents out-of-state tuition waiver policy found in Section 7.3.4.1 of the Board of Regents Policy Manual (www.usg.edu/policymanual). Please note that the Border State Residents out-of-state tuition waiver is available to qualifying undergraduate students only.

Section I - Student Information

First Name:

Last Name:

Student ID:

Address:

City:

State:

Zip:

Country:

International Postal Code (non-US addresses):

Term Applying for Waiver:

Year:

Will you be attending as an undergraduate student?

Citizen Status:

Which bordering state is your present and permanent home (domicile)?

Will you have lived in the above state for at least 12 consecutive months immediately preceding the first day of classes for the term the waiver is requested?

Have you graduated or will you graduate from a high school in the above state?

Have you ever lived outside of your current domicile state?

Do you hold a current driver’s license/state-issued ID?

Do you own a vehicle?

Are you registered to vote?

Did you file a state income tax return for the most recent tax year?

Employment Information

Please list all employment for the past two years, including military service. Attach additional sheets if needed.

Employer:

City:

Employment State:

Start Date

End Date:

Number of Weekly Hours Worked:

Add another employer

Employer:

City:

Employment State:

Start Date:

End Date:

Number of Weekly Hours Worked:

Add another employer

Employer:

City:

Employment State:

Start Date:

End Date:

Number of Weekly Hours Worked:

Add another employer

Employer:

City:

Employment State:

Start Date:

End Date:

Number of Weekly Hours Worked:

Are you under the age of 24?

Do you have a parent or U.S. court-appointed legal guardian who has established and maintained domicile in an eligible state (Alabama, Florida, North Carolina, South Carolina, Tennessee) bordering Georgia for at least 12 consecutive months immediately preceding the first day of classes for the term the waiver is requested?

Yes

State:

Name of the above individual:

Relationship:

Parent

U.S. court-appointed legal guardian

Has that individual ever lived outside of the above state?

Yes

Do they hold a current driver’s license/state-issued ID?

Do they own a vehicle?

Are they registered to vote?

Did they file a state income tax return for the most recent tax year?

Did they file a federal income tax return for the most recent tax year?

Section II - Oath and Affirmation

I understand that any material false statement made knowingly and willingly by me on this application, or any documents attached hereto may, in accordance with O.C.G.A. 16-10-71, which provides that upon conviction, a person who knowingly commits the offense of false swearing shall be punished by a fine of not more than $1,000 or by imprisonment for not less than one nor more than five years, or both, subject me to prosecution in a court of law. Additionally, I further understand that any such false statement may subject me to immediate dismissal from the institution.

Further, I certify that, to the best of my knowledge, the information submitted on this application is true and complete.

Section III - Documentation Requirements

Lawful Presence in the United States

Only those students verified to be lawfully present in the United States may be considered for an out-of-state tuition waiver. Waiver applicants may be required to provide additional documentation to meet this requirement.

Documentation of Waiver Eligibility
Additional documentation may be required to confirm domicile in the border state such as the following:

• Copy of lease agreement or warranty deed
• Copy of driver’s license or state-issued ID
• Copy of vehicle registration
• Copy of state tax return filed for the most recent tax year
• Copy of federal tax return filed for the most recent tax year
• Copy of utility bills

All personal data and special categories of sensitive personal data collected or processed by Georgia Southwestern State University must comply with the University System of Georgia’s (USG) Cybersecurity Plan, as authorized by the Board of Regents Policy Manual Section 10.4 Cybersecurity: www.usg.edu/policies. Anyone suspecting their sensitive personal data has been exposed to unauthorized access, report your suspicion to techsupp@gsw.edu. Otherwise, questions concerning general data privacy can be sent to dataprivacy@gsw.edu. Signature (below) and submission of this form provides consent to and acknowledgement of the USG Data Privacy and Legal Notice and relative policies.

I agree.

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