Application for Virginia Student Status

Current Applicant Information
Residence Information
Employment & Education Information
Taxes / Motor Vehicle / Voting Information
Financial Support
Military Service
In-State Educational Privileges
Signature
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Committee on Virginia Status • Office of Admission • P.O. Box 400160 • Charlottesville, VA 22904
Email • FAX: 434-982‐2663 • Phone: 434‐982‐3391 • Virginia Status

Instructions:

Submit this form before the first day of the semester for which you are applying for in-state tuition. If you cannot submit this form, Contact our office for more information.
Incomplete or late applications will not be reviewed. The office will contact you if your application is incomplete.
For an explanation of appeal process, see the Domicile Review Appeal Process.

Applicant Information

First Name

Middle Name

Last Name

Suffix

Preferred Pronouns

Current Address

City/Town

State/Province

ZIP/Postal Code

Country

Current Mailing Address Valid Until

MM/YYYY

Permanent Address Same as Current Address

Permanent Address

City/Town

State/Province

ZIP/Postal Code

Country

Email Address (UVA email preferred)

Please provide your University of Virginia email address if you are a current student or otherwise affiliated. If you are a current student or affiliated with the University, the Office of Virginia Status will only use your University address in communication. If you are not a current University of Virginia student or otherwise affiliated with the University please provide your current email address. Whether or not you provide a University of Virginia email address, it is your responsibility check this address for all communication from the Office of Virginia Status.

Work Telephone

Ex. 555-555-5555

Cell/Primary Phone

Ex. 555-555-5555

Date of Birth:

Citizenship

Country of Origin:

Type of Visa: