Anticipated Academic Enroll Year

Anticipated Enrollment Term

Student Type

Major

First Name

Middle Name

Last Name

Suffix

Preferred Name

Birth/Maiden Name

Date of Birth

Gender

Birth Country

Birth State

Social Security Number

Ethnicity

Race

Did your mother/father ever attend KC?

Does your father/mother work at KC?

What is the highest level of education that your father received?

What is the highest level of education that your mother received?

Are you a United States Veteran?

Which branch

Are you receiving veteran's benefits?

Are you currently on active duty?

Active Duty Branch

Permanent Address

Permanent Address City

Permanent Address State

Permanent County

Permanent Zip Code

Permanent Address Country

Mobile Phone Number

Alternate Phone

Email

Emergency Contact Info (Other than self)

First Name

Last Name

Phone

Email

Street Address

City

State

Zip Code

Did you graduate from high school?

Were you homeschooled?

Where were you homeschooled?

What year did you graduate?

What state is your High School in?

What was the name of the High School that you graduated from?

What year did you graduate from High School?

Do you have a HiSET/GED?

What state did you test for your HiSET/GED?

Have you attended any previous colleges or universities?

Are you on academic probation or academic suspension at any other college?

Please explain the circumstances around your probation at the other school

Previous College/University information:

College/University Country

College/University State

College/University City

College/University Name

College/University Org Code

Additional Names on Transcripts

Part A

Are you a resident of Texas?

What Texas public institution did you last attend? (Give full name, not just initials)

In what term were you last enrolled? (example: Fall = FA, Spring = SP, Summer = SU. FA2015, SP2015, SU2015, please no spaces between term and year.)

During your last semester at a Texas public institution, did you pay resident (in-state) or nonresident (out-of-state)?

If you paid in-state tuition at your last institution, was it because you were classified as a resident or because you were a nonresident who received a waiver?

Part B

Did you graduate or will you graduate from high school or complete a GED in Texas prior to the term for which you are applying?

If you graduated or will graduate from a high school in Texas, what was the name and city of the school (ex: HS Name, City)?

Did you live or will you have lived in Texas the 36 months leading up to high school graduation or completion of the GED?

When you begin the semester for which you are applying, will you have lived in Texas for the previous 12 months?

When you begin the semester for which you are applying, will you have lived in Texas for the previous 12 months?

Are you a U.S. Citizen or Permanent Resident?

Are you a U.S. Citizen or Permanent Resident?

Are you a U.S. Citizen or Permanent Resident?

Are you a U.S. Citizen or Permanent Resident?

Part G

Based on your responses, you qualify for a Residency Affidavit. Please contact the Admissions Office at (903) 983-8209 or kcadmissions@kilgore.edu.

I understand that officials of my college/university will use the information submitted on this form to determine my status for residency eligibility. I authorize the college/ university to verify the information I have provided. I agree to notify the proper officials of the institution of any changes in the information provided. I certify that the information on this application is complete and correct and I understand that the submission of false information is grounds for rejection of my application, withdrawal of any offer of acceptance, cancellation of enrollment and/or appropriate disciplinary action.

Part C

Do you file your own federal income tax as an independent tax payer?

Are you claimed as a dependent or are you eligible to be claimed as a dependent by a parent or court-appointed legal guardian? (To be eligible to be claimed as a dependent, your parent or legal guardian must provide at least one half of your support. A step-parent does not qualify as a parent if she/she has not adopted the student.)

Are you claimed as a dependent or are you eligible to be claimed as a dependent by a parent or court-appointed legal guardian? (To be eligible to be claimed as a dependent, your parent or legal guardian must provide at least one half of your support. A step-parent does not qualify as a parent if she/she has not adopted the student.)

If you answered "No" to both questions above, who provides the majority of your support?

Part D

Are you a U.S. Citizen?

Are you a Permanent Resident of the U.S.?

Are you a foreign national who application for Permanent Resident Status has been preliminarily reviewed? (You should have received a fee/filing receipt or Notice of Action (I-197) from USCIS showing your I-485 has been reviewed and has not been rejected).

Are you a foreign national here with a visa or are you a Refugee, Asylee, Parolee or here under Temporary Protective Status? If so, indicate which.

Do you currently live in Texas? If you are out of state due to a temporary assignment by your employer or other temporary purpose, please explain in Part G.

If you currently live in Texas, how many months have you lived here?

If you currently live in Texas, how many years have you been living here?

What is your main purpose for being in the state? If for reasons other than those listed, give an explanation in Section G.

If you are a member of the U.S. military, is Texas your Home of Record?

If not Texas, what state is listed as your military legal residence for tax purposes on your Leave and Earnings Statement?

Do you hold the title to real property (home, land) in Texas? If yes, what date was it acquired? If no, please skip.

Do you own a business in Texas? If yes, what date was it acquired? If no, please skip.

Do you hold a state or local license to conduct a business or practice a profession in Texas? If yes, what date was it acquired? If no, please skip.

While living in Texas, have you been gainfully employed for a period of at least 12 consecutive months?

While living in Texas, have you received services from a social service agency that provides services to homeless persons for a period of at least 12 consecutive months?

Are you married to a person who could answer"yes" to any of the last few questions?

If you answered "yes" indicate which question could be answered "yes" by your spouse.

How long have you been married (months)?

How many years have you been married to the Texas resident?

Part G

I understand that officials of my college/university will use the information submitted on this form to determine my status for residency eligibility. I authorize the college/ university to verify the information I have provided. I agree to notify the proper officials of the institution of any changes in the information provided. I certify that the information on this application is complete and correct and I understand that the submission of false information is grounds for rejection of my application, withdrawal of any offer of acceptance, cancellation of enrollment and/or appropriate disciplinary action.

Part E

Is the parent or legal guardian upon whom you base your claim of residency a U.S. citizen?

Is the parent or legal guardian upon whom you base your claim of residency a Permanent Resident?

Is this parent or legal guardian a foreign national whose application for Permanent Resident Status has been preliminarily reviewed? (He or she should have received a fee/filing receipt or Notice of Action (I-797) from the USCIS showing his or her I-485 has been reviewed and has not been rejected)

Is this parent or legal guardian a foreign national here with a visa or a Refugee, Asylee, Parolee or here under Temporary Protective Status? If so, indicate which one.

Does this parent or legal guardian currently live in Texas? If he or she is out of state due to a temporary assignment by his/her employer or other temporary purpose, please explain in Part G.

If he or she is currently living in Texas, how many years has he or she been living here?

If he or she is currently living in Texas, how many months has he or she been living here?

What is your parent's or legal guardian's main purpose for being in the state? If for reasons other than those listed, give an explanation in Section G.

If he or she is a member of the U.S. military, is Texas his or her Home of Record?

If not Texas, what state is listed as his or her military legal residence for tax purposes on his or her Leave and Earnings Statement?

Does your parent/guardian hold the title to real property (home, land) in Texas? If yes, what date was it acquired? If no, please skip.

Does your parent/guardian own a business in Texas? If yes, what date was it acquired? If no, please skip.

Does your parent/guardian hold a state or local license to conduct a business or practice a profession in Texas? If yes, what date was it acquired. If no, please skip.

While living in Texas, has your parent/guardian been gainfully employed for a period of at least 12 consecutive months?

While living in Texas, has your parent/guardian received services from a social service agency that provides services to homeless persons for a period of at least 12 consecutive months?

Is your parent/guardian married to a person who could answer "yes to any of the last few questions?

If "yes," indicate which question could be answered "yes" by your parent/guardian's spouse.

How many months has your parent/guardian been married to a Texas resident?

How many years has you parent/guardian been married to the Texas resident?

Part F

Is there any additional information that you believe our college should know in evaluating your eligibility to be classified as a resident? If so, please provide it below:

Part G

I understand that officials of my college/university will use the information submitted on this form to determine my status for residency eligibility. I authorize the college/ university to verify the information I have provided. I agree to notify the proper officials of the institution of any changes in the information provided. I certify that the information on this application is complete and correct and I understand that the submission of false information is grounds for rejection of my application, withdrawal of any offer of acceptance, cancellation of enrollment and/or appropriate disciplinary action.

KC Tax District Residency

Select the school district in which you actually live school districts listed are in the Kilgore College tax district). If you do not live in one of the listed school districts, select #None of the above#. Please note that in most cases, if you are a dependent for income tax purposes, your address for tuition purposes is considered the address of the person claiming you as a dependent. Proof of in-district residence may be required.

Collection Statement

I understand that if I fail to pay any debt to Kilgore College and the debt is sent for collection, I must pay all costs of collection, including attorneys' fees and collection agency fees.

Temporary Student

Are you a temporary student enrolling for Christmas Mini only, or May Mini only, or summer only?

KC Email

Kilgore College assigns all new applicants a KC specific email account.  Once the applicant's admissions application is processed, KC will provide this email account and additional directions for its use.  The email account will serve as the primary and official mode of communication between KC and the student.  It is the responsibility of each KC student to check this email account on a regular basis.

Text Messaging

Kilgore College uses two distinct text messaging systems to communicate with applicants and students. One system, RAVE Alert, sends emergency messages to enrolled students. The other, Remind, sends important reminders, campus updates, and other information. By supplying your cell phone number and submitting this application, you will be enrolled into both of these messaging systems. You may opt-out of one or both by responding to any KC text message with the word STOP.