Student Education Information Form

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

MM

DD

YYYY

Gender

Male

Female

Ethnicity *

Hispanic

Non-Hispanic

Veteran Status *

Veteran

Non-Veteran

Citizenship Status - Select one *

Citizen

Permanent Resident

Other

Residency Status - Select one *

I have been a Massachusetts resident for six (6) continuous months and intend to remain here.

I am a member of the armed forces (or spouse or unemancipated child) on active duty in Massachusetts.

I am not a Massachusetts resident.

If you checked option 1, Please check-off those documents you possess as proof of your intent to remain in Massachusetts *

I have been a Massachusetts resident for six (6) continuous months and intend to remain here. As proof of my intent to remain in Massachusetts, I possess at least 2 of the following documents, which I shall present to the institution upon request. These documents are dated within one (1) year of the start date of the academic semester for which I seek to enroll (except possibly for my high school diploma). The institution reserves the right to make any additional inquiries regarding the applicant’s status and to require submission of any additional documentation it deems necessary. Please check-off those documents you possess as proof of your intent to remain in Massachusetts.

Valid Massachusetts Driver’s License

Massachusetts High School Diploma

Employment Pay Stub from Massachusetts Employer

Valid Massachusetts Car Registration

Valid Massachusetts Voter Registration

State/Federal Tax Returns Showing Massachusetts Address

Utility Bills from a Massachusetts Address

Signed Lease or Rent Receipt from a Massachusetts Address

Military Home of Record

Record of Parent(s) Residency for an Unemancipated Person