Residency Questionnaire

PART A (All)

Residency Reclassification Questionnaire

Please make sure you read the information on the website to know why you were classified as a nonresident and what documents you will need to submit with this petition. Residency information: https://www.elcamino.edu/admissions/residency.aspx

Residency regulations are extremely complex. Please be aware that every residency case is different based on the individual's situation. Therefore, the ECC Admissions & Records Office maintain the right to request additional documentation than those listed be below.

El Camino College will be closed starting Friday, December 22, 2023 and will reopen for business on Tuesday, January 2 2024. Forms submitted during this time will not be processed until the office reopens. The standard processing time for your form will start from when we reopen. HAPPY HOLIDAYS

SEMESTER/YEAR*

Fall 2023 Residency Appeal is over. If you have a pending appeal please make sure to follow up with Brenda Peterson. Please select another term. We will not be processing new request for Fall 2023

All documents for Winter 2024 must be dated between January 3, 2022 - January 3, 2023. The exception being a State ID/Driver License or Passport. Those documents can have an issue date before January 3, 2022 as long as they are still valid. Deadline to submit Winter 2024 residency questionnaire and required documentation January 12, 2024.

All documents for Spring 2024 must be dated between February 09, 2022 - February 09, 2023. The exception being a State ID/Driver License or Passport. Those documents can have an issue date before February 09, 2022 as long as they are still valid. Deadline to submit Spring 2024 residency questionnaire and required documentation April 30, 2024.

All documents for Summer 2024 must be dated between June 16, 2022 - June 16, 2023. The exception being a State ID/Driver License or Passport. Those documents can have an issue date before June 16, 2022 as long as they are still valid. Deadline to submit Summer 2024 residency questionnaire and required documentation July 11, 2024.

All documents for Fall 2024 must be dated between August 25, 2022 and August 25, 2023. The exception being a State ID/Driver License or Passport. Those documents can have an issue date before 8/25/2022 as long as they are still valid. Deadline to submit Fall 2024 residency questionnaire and documentation is November 3, 2024.

ECC Student ID #*

Date of Birth *

Phone*

Name*

First Name

Initial (optional)

Last Name

ECC Email Address*

Confirm ECC Email Address *

USE ONLY ELCAMINO.EDU EMAIL ONLY

Are you currently homeless? *

Address (Permanent Street Address)*

Address Line 1

City

State

ZIP Code

Address (Mailing Address if you have one)

Address Line 1

Address Line 2

City

State

ZIP Code

Citizenship*

Issue Date and Expiration Date*

Further documentation may be requested

Please explain your status*

Further documentation may be requested

PART B

Part B Military Service or Dependent of Active Duty Personal

Military Service/Dependent of Active Duty*

Date (Date assigned to active duty)*

Will you be stationed in California at the start of the semester/term in question?*

Were you assigned to California for educational purposes?*

Home of Records CA*

City*

State*

PART C

PART C - Physical Presence and Intent (at least two proofs from list on https://www.elcamino.edu/admissions/residency.aspx must be upload at the end of this form)

Date California became your permanent home*

Do you have a valid drivers license or ID?*

STATE/US TERRITORY LICENSE/ID ISSUED*

ISSUE DATE - EXPIRATION DATE*

DATE LICENSE/ID WAS ISSUED AND WHEN DOES IT EXIPRE

REGISTERED MOTOR VEHICLE*

STATE/US TERRITORY OF REGISTERED VEHICLE*

ISSUE DATE - EXPIRATION DATE *

DATE LICENSE/ID WAS ISSUED AND WHEN DOES IT EXIPRE

Are you registered to vote? *

STATE YOU ARE REGISTERED TO VOTE*

Date/Time*

Have you worked in the last 2 years? *

State you worked*

Did you file a state tax return in the last 2 years?*

State you filed your taxex*

Will you be 19 or older at the start of the semester? *

Are you between the age of 19 - 23 at the start of the semester but are still dependents of your parent(s)*

PART D

PART D - STUDENTS UNDER THE AGE OF 19*

*Students up to the age of 23 may use this section if they are dependents and cannot prove residency on their own

Foster Youth/Former Foster Youth*

Foster Youth/Former Foster Youth Documentation You may have*

If you answered yes attached the supporting documentation below and skip to Part G.

Person most recently responsible for your support is your:*

Parent/Guardian Name*

First Name

Last Name

Parent/Guardian Address*

Address Line 1

City

State

ZIP Code

PART E

PART E - Parent/Guardian Legal Status:

Is your parent/guardian a United States citizen (born or naturalized)*

Does your Parent/Guardian have any of the following documents. Please only check one.*

A permanent resident card An employment authorization card A valid non-immigration visa None of the above

Date Issued - Expiration Date*

If other please contact bpeterson@elcamino.edu. In the subject line of the email please state Parent/Guardian Residency. In the body please put the following. My parent/guardian does not have the documentation regarding citizenship. I will need further assistance. Please send this email from your MyECC email account.

Example email:

PART F

PART F - Parent/Guardian Physical Presence: (2 proofs are needed to be submitted with your appeal)

An example list and chart are provided of types of documents that should be uploaded with your Residency Reclassification Appeal. Please make sure all information is filled out correctly for your parent/guardian in this section.

List of Possible Documentation that may be submitted. This is not an exhaustive list.

Submitted documents must include Name, A Physical California Address (no P.O. Boxes) and dated within the date rage on the RESIDENCY Web Page . Please do not highlight or write on your documents. Only one item from any one source will be accepted.

PRIMARY PROOFS

Valid California Driver License/ID or CA DMV Printout (Online printout not accepted) or CA car registration
California 540 tax form with California as the home address for the previous year including signature page (540NR form NOT acceptable) The Federal Tax Form 1040 cannot be used as proof of residency.
Voter’s registration card or proof of voter registration stamped by County Registrar’s Office (Receipts not accepted)

SECONDARY PROOFS

Utility bill (gas, telephone, cable, etc.) Only one bill type will be accepted as a proof
Apartment/home lease or rental agreement (one-year current) - the agreement must be official. Month-to-month only if you have been there for at least a year.
Proof of California car insurance (insurance card or policy). Student, or parent if student is under 19, must be Primary Insured Driver. Must be show that you had for over a year.
California bank account statement (Statement end date is the date that is used) - Credit card statements are not acceptable.
California health insurance—must include resident address and issue date.
California public library membership, if dated or, Printout of library account information w/ library address stamp
Pay stub or employment verification on company letterhead along with pay stub if pay stub does not have home address
Military discharge papers (DD 214) that includes Character of Service field if discharged within three years of start of semester or Leave and Earnings statement indicating California as home of record
Filed Marriage license or divorce decree issued in California (for the appropriate time period)
California State Aid, Social Welfare, California Court documents that have been filed with the court (for the appropriate time period)
Union membership in a California Local—must include resident address and a date
Licenses or certificates issued by the state of California with issue date - high school diplomas cannot be used in this area

Does your parent/guardian have a license/ID?

State License/ID Issued

ISSUE DATE - EXPIRATION DATE

(Example:07/27/2013 - 07/27/2018)

Does your parent/guardian have Car?

REGISTRATION DATE - EXPIRATION DATE

(Example:07/27/2018 - 07/27/2019)

State Car Registered

Did you parent/guardian file state tax return in the last two years?

State filed taxes

PART G (ALL)

PART G

To be read and signed by all students completing this form.

Per California Education Code, the burden of proof is on the student to clearly demonstrate legal status, physical presence, and intent to remain indefinitely in California. Students seeking reclassification of nonresident status must also demonstrate financial independence. You are required to present evidence in accordance with California Education Code and Title 5 of the California Code of Regulations.

I certify under penalty of perjury that the foregoing statements and documentation submitted by me in connection with the determination of my residence are true, complete, and accurate. I understand that my residence determination will be based on the facts stated in this questionnaire and the documents I provide. If I receive classification as a California resident or an exception or exemption, I promise to notify the residence specialist if any of the facts stated in this questionnaire change. I authorize release of any information submitted by me in connection with my application for admission and determination of residence, but only as necessary to verify or explain the information, to obtain pertinent records, or in connection with perjury proceedings.

I have completely read and understood the directions on Admissions & Records California Residency and AB 540/2000 web page

All documents for Spring 2024 must be dated between February 17, 2022 - February 17, 2023. The exception being a State ID/Driver License or Passport. Those documents can have an issue date before February 17, 2022 as long as they are still valid. Deadline to submit Spring 2023 residency questionnaire and required documentation April 30, 2024.

You will need to upload the supporting documents as one PDF file. If you do not have access to a scanner you can download a free scanner on Google play and/or at the Apple App Store. A good one to use is Microsoft Office Lens.

Submission of Documents File*

No File Chosen

File uploads may not work on some mobile devices.

Signature*

[clear]

Use your mouse or finger to draw your signature above

Date/Time

PART A (All)

PART B

PART C

PART D

PART E

PART F

PART G (ALL)

Residency Evaluation

A&R Specialists Final Response