Free affidavit of domicile 15Free affidavit of domicile 15
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DOMICILE AFFIDAVIT
Residency Classification Office
Modern Languages Building, Room 347
P.O. Box 210067
Tucson, AZ 85721-0067
[email protected]
Phone: 520-621-3636
Fax: 520-621-3665

Office use only:
Classification

Revised 01/2014

By:

Date:

This form is ONLY for first time students during their first semester at UA or former students who are returning after an absence.
Student Name

Student ID Number

Semester for which domicile affidavit is intended:

Spring

Summer

Fall

20

Part 1: Personal History

A.

Age

B.

Home address

Date of birth
City

State

Zip

Phone

C.

Present address

City

State

Zip

Phone

D.

U.S. citizen

Yes

Permanent resident alien

State of birth

Country of birth

No (if no, in what country do you hold citizenship)
Yes No

Refugee/asylee

Deferred Action for Childhood Arrivals (DACA)

Yes No

Yes

No

Type & Number of Visa

Issuance date of permanent resident alien status

If yes, then attach a copy of your EAD card to this affidavit.

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