Fillable Printable University of Michigan Application Form for In-state Students
Fillable Printable University of Michigan Application Form for In-state Students
University of Michigan Application Form for In-state Students
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University of Michigan Application for In-State Tuition by Residence
** FILING DEADLINES**
Fall Term . . September 30 Winter Term . . January 31 Spring, Spring/Summer, and Summer Terms . . July 31
Applications must be received in the Residency Classification Office by 5 p.m. on the deadline date or a $300 late fee will be assessed.
No applications will be accepted after the last day of classes of the term.
Return the completed application by mail, fax or in person to: Residency Classification Office, Office of the Registrar, 1210 LSA Building, 500 S. State St.,
Ann Arbor, MI 48109-1382 fax (734) 615-2432
If you have questions or need assistance, call the Residency Classification Office at (734)764-1400 or view the In-State Tuition Guidelines and forms at
http://ro.umich.edu/resreg.php.
1. Name: Mr / Ms (circle one) _________________________________________________________________________________________________________________________________________
(Last) (First) (Middle)
Prior names (if applicable): _______________________________________________________________________
2. Area Code/Phone Number (Home and Cell) _____________________________________________________________ Email Address: _____________________________________________
3. Date of Birth _________/ _________/ ________ City, State, Country of Birth ______________________________________________________________________________________________
4. Social Security Number________________________________________________________ UM Student I.D. Number__________________________________________________________
5. Military Status: Are you a veteran? Yes _________ No________ Are you currently on Active Duty? No________ Yes _________ Expected date of separation __________________________
6. Requesting resident classification effective (circle one term only): Year________________ Fall Winter Spring Sp/Su Summer
7. Campus currently attending/will attend: Ann Arbor __________ Dearborn __________ Flint __________
8. If current or former UM Student, list School or College: ______________________________________ Class Level ________________________ Graduation Date______________________
If prospective UM Student, list School or College applied to: _____________________________________Class Level_________________________ Date Degree Expected_____________
9. Have you previously submitted an Application for Resident Classification or In-State Tuition? No_________ Yes_________ If yes, term/year _________________________________
Has a parent, brother, sister, or spouse/partner ever applied for resident classification? No____ Yes____ If yes, provide name(s):____________________________________________________
10. Are you a U.S. Citizen? Yes________No_______ If “No”, are you a Permanent Resident Alien? No_________ Yes________ If yes, issue Date of P.R. Card _________/__________/__________
If you are not a U.S. Citizen or Permanent Resident Alien, indicate your current visa status: _____________________________________________________
11. Provide the following information relative to your spouse or partner:
a. Name_________________________________________________________________________________ Social Security Number______________________________________________________
(Last) (First) (Middle)
b. Employed by ___________________________________________________________________ City _________________________________________________State___________________________
Job Title _____________________________________________________ Full or Part-time_______________________________ Date Began __________/__________/__________
c. Enrolled at __________________________________________________________________ City __________________________________________________State____________________________
Date Began __________/__________/__________ Full or Part-time___________________________________ Residency Status___________________________________________
Are your Parents-in-law residents of Michigan? Yes_________ No_________
12. Starting with the most recent, list in sequence your current and all previous addresses, including short-term and temporary addresses, for the past five years.
Show addresses where you have physically resided, not “mailing” or “permanent” addresses. Also list any Michigan addresses prior to this period. (Continue
on back of page if necessary.)
Street Address City State or Country Date From (m/y) Date To (m/y)
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13. Regarding Parents:
a. Names of parents ________________________________________________________________ _______________________________________________________________________
(FATHER) (MOTHER)
b. Marital Status (relative to each other): Married_________ Never married _________ Divorced _________ Date of divorce (m/y) _______________________
c. Current address where they physically reside (indicate effective dates of addresses--from m//y to m/y)
Father: Mother:
d. If applicable, all previous Michigan addresses for parents (note the effective dates of each-- from m//y to m/y)
Father: Mother:
14. List in sequence all schools you have attended during the past six years, including UM and secondary schools. Start with the most recent.
ALWAYS LIST HIGH SCHOOL, REGARDLESS OF HOW LONG AGO YOU ATTENDED.
Full or Degree
College(s)/Post Secondary Location Dates Attended Part-time Earned
(from m/y to m/y)
High School(s)
15. List in sequence all employers you have had during the past four years. (Start with the most recent and include military service.)
Employer Location Dates Worked Full or Part-time Annual Salary/Hourly rate
(from m//y to m/y)
16. For the following years, indicate the source(s) of your TOTAL financial support, e.g., self, parents, other relative, etc:
Year Name of Source Address Relationship to you $ Amount or Percentage
9/12 to 9/13
9/11 to 9/12
9/10 to 9/11
For the year 9/13 to 9/14 list the expected source(s) of your TOTAL financial support, listing $ amounts or percentages:
17. Were you claimed as a dependent on any person's federal or state income tax return during either (or both) of the past two tax years?
No _________ Yes _________If “yes," list year(s):____________________________________________ and indicate the name and address and the relationship of that person to you:
________________________________________________________________________________________________________________________________________________________________
(Name) (Relationship)
________________________________________________________________________________________________________________________________________________________________
(Street Address) (City) (State) (Zip code)
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18. Applicant's Statement Write a brief statement explaining your and your family’s purpose in coming to the state of Michigan; if you were previously a resident, please provide the
reason for your absence from the state and the purpose of your return. Also include any facts relevant to your establishment of a permanent domicile in Michigan as defined by the
University’s In-State Tuition Guidelines.
19. Attestation: “I certify that the information given in this application and in all attachments is true, correct and complete to the best of my knowledge. I understand that this
information is subject to audit and that falsification of a University record may be grounds for legal or disciplinary action. I authorize the University of Michigan Residency Classification
Office to verify all facts relevant to my claim to resident status, including verification of employment, verification of enrollment, and verification of income tax information and records filed
with the Michigan Department of Treasury and the United States Internal Revenue Service."
I UNDERSTAND THAT SUBMITTING AN APPLICATION WITH INCOMPLETE OR INACCURATE INFORMATION OR WITHOUT THE DOCUMENTATION
LISTED BELOW WILL RESULT IN SIGNIFICANT DELAYS IN PROCESSING TIME.
Signature of Applicant___________________________________________________________________________________ Date ___________/___________/__________
20. Please print your name and the address at which you wish to receive notice of action taken on your application to be classified as a Michigan resident. IT IS YOUR
RESPONSIBILITY TO KEEP THIS ADDRESS CURRENT BY CONTACTING THE RESIDENCY CLASSIFICATION OFFICE DIRECTLY WITH ANY CHANGES.
_____________________________________________________________________________________
(Name)
_____________________________________________________________________________________
(Number) (Street)
_____________________________________________________________________________________
(City) (State) (Zip Code)
The following documentation MUST be submitted with the application. Additional documentation may also be requested. Failure to provide documentation
will delay the processing and review of the application.
For all applicants: Copies of your driver’s license and the license(s) of the person or persons upon whom you are basing your claim to
resident eligibility; copies of the front and signature pages of the most recent year’s federal and state income tax returns (forms 1040 and
MI 1040) and accompanying W-2 forms for you and the person or persons upon whom you are basing your claim to resident eligibility and
any other documentation that supports your claim to resident eligibility
For applicants born outside the U.S.seeking eligibility based on Michigan residence: verification of U.S. citizenship or lawful permanent
residence in the U.S.
For applicants who are dependents: Copies of the first and second pages of the parents’ most recent year’s federal and state income tax
returns (forms 1040 and MI-1040) with all accompanying W-2s (and Schedules C and E if self-employed), along with parents’ most recent
pay stubs showing Michigan taxes being withheld
For applicants whose claim to eligibility for resident classification is based on permanent, full-time employment for themselves, a parent,
spouse or domestic partner: a signed letter from the employer, written on letterhead (including phone number), stating the position, status
and dates of employment. The letter should be accompanied by a copy of the most recent pay stub showing Michigan taxes being withheld.
***TO BE COMPLETED BY THE RESIDENCY CLASSIFICATION OFFICE***
Effective_______________________(Term)________________________ (Year) Approved __________ Denied __________ Date ______________________________ # _______________
____________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________
c:___________________________________________________ career:_____________________________________________________________________
