office of enrollment services undocumented students living in … · 2020-02-03 · degree and...

Return to Rob Giovino – [email protected] – 401-825-2288

CCRI Office of Enrollment Services Knight Campus, 400 East Avenue, Warwick, RI 02886-1807

Office of Enrollment Services

Undocumented Students Living in Rhode Island – Residency Application Checklist

If you are not a U.S. citizen, a permanent resident of the U.S., or do not have an eligible non-immigrant visa, you may qualify to attend CCRI as an in-state resident as an undocumented student living in Rhode Island.

Please submit this along with all required forms and documents. (Please use your legal last and first name)

Last Name___________________________________________________ First Name____________________________

CCRI ID ________________________________________ (if available) Phone_________________________________

CHECK ITEMS SUBMITTED

______Application for Enrollment/Paper (if not yet submitted an application)

______Transcripts for Undocumented Students (High School seniors submit unofficial high school transcript, which includes mid-year senior grades)

Final Official Transcript with Graduation Date Confirmed ______High School transcript (attended R.I.HS 3 years required) or (U.S. GED® Credentials, 3 years proof of RI residency is required)

______Student Application form (Eligibility for in-state tuition and fees based upon Rhode Island High School Attendance or GED)

______Affidavit form (To be completed by student, signed in the presence of a Notary Public)

______Residency Document for Undocumented Students form (High School Graduates – one current residency document within the last 90 days)

(GED Graduates – one current residency document – for the past 3 consecutive years)

ADDITIONAL ITEMS NEEDED

DACA STUDENT

______Copy of Employment Authorization Card with category C33 designation – (front and back) (Active non-expired date as of the first day of classes)

______Copy of Taxpayer ID Number (SSN or ITIN) and Signed Request for Student’s Taxpayer Identification Number (W9S) form.

NON-DACA STUDENT

______Copy of Passport/Visa or Employment Authorization Card – (front and back)

______Copy of Taxpayer ID Number (SSN or ITIN) and Signed Request for Student’s Taxpayer Identification Number (W9S) form.

______If has no SSN or ITIN - Signed Request for Student’s Taxpayer Identification Number (W9S) form.

IF Eligible

______Application for the RI Promise Scholarship ______RI Promise Appeal if over 18 years old _____Paper FAFSA

Apply online at www.ccri.edu/oes/admissions/learnhowtoapply.html or follow the instructions below to apply by mail.

In Lincoln: CCRI-Flanagan Campus Office of Enrollment Services 1762 Louisquisset Pike Lincoln, RI 02865-4585

Personal data section• Your Social Security number and date of birth are essential in processing your application. Your Social Security number is mandatory under federal law.

• If applying without a social security number, please see http://www.ccri.edu/oes/admissions/ applicantwithoutssnortin.html

• Please note that if you are not a U.S. citizen, you may be asked to submit immigration documentation as listed on the Application for Enrollment. Foreign students must contact the Office of Enrollment Services regarding visas and additional admissions documentation which is required for attendance at the college.

• Questions pertaining to ethnicity and race are optional; however, answering these questions is important in assisting the college in its affirmative action goals

Programs of interest section• For campus codes and program names, refer to pages 2 through 4 of this application packet.

High school history section• For high school codes, refer to page 5 of this packet. It is the applicant’s responsibility to provide the

Office of Enrollment Services with official transcripts. Contact your high school guidance department or GED® testing center to forward official transcripts or GED® scores to the college.

College history section• List ALL colleges and universities previously attended, whether or not you wish to receive transfer credit.

For your convenience, some college codes are listed on page 5 of this packet. If your institution is not listed, do not enter a college code on the application.

COMMUNITY COLLEGE OF RHODE ISLAND

Application for Enrollment and Instructions

In Warwick: CCRI-Knight Campus Office of Enrollment Services 400 East Ave. Warwick, RI 02886-1807

In Providence: CCRI-Liston Campus Office of Enrollment Services One Hilton St. Providence, RI 02905-2304

In Newport: CCRI-Newport County Campus Office of Enrollment Services One John H. Chafee Blvd. Newport, RI 02840

Degree and Certificate Programs*


CCRI APPLICATION INSTRUCTIONS / PAGE 2 OF 7 8/2013

KN=Knight CampusFL=Flanagan CampusPV=Providence CampusNE=Newport County Campus

A.A.=Associate in ArtA.S.=Associate in ScienceA.A.S.=Associate in Applied ScienceA.F.A.=Associate in Fine Arts

A.A.S.T.S.=Associate in Applied Science in Technical Studies^ Some, but not all, major courses offered

on this campus.

PROGRAM CODE DEGREE CAMPUS DAY EVENING

ADMINISTRATIVE OFFICE TECHNOLOGY Administrative Assistant/Secretary ADAD A.S. KN FL + +Basic Office Skills Certificate BOSC Certificate KN FL + + Customer Service Specialist Certificate CSPC Certificate KN FL + + Legal Administrative Assistant/Secretary LGAD A.S. FL + +Legal Office Assistant Certificate LOAC Certificate FL + +Medical Administrative Assistant/Secretary MDAD A.S. KN +Medical Insurance Billing Specialist Certificate MIBC Certificate KN + +Medical Transcription Certificate MEDT Certificate KN +Office Administration Certificate OFAC Certificate KN FL + +

BIOTECHNOLOGYBiotechnology Certificate BIOT Certificate KN + +

BUSINESS ADMINISTRATION Accounting ACCT A.S. KN FL + +Accounting Certificate ACTC Certificate KN FL + +Entrepreneurship Certificate ETRC Certificate KN FL + +Financial Services FNBK A.S. KN FL + +Financial Services Certificate FNSC Certificate KN FL + +General Business GBUS A.S. KN FL PV NE + +Management MNGT A.S. KN FL + +Management Certificate MGTC Certificate KN FL + +Marketing MARK A.S. KN FL + +Marketing Certificate MRKC Certificate KN FL + +

CHEMISTRYChemical Technology CHMT A.A.S. KN + +Chemical Technology Certificate CHMC Certificate KN + +

COMMUNICATIONNew Media Communication Certificate NMCC Certificate KN FL PV NE + +

COMPUTER STUDIES and INFORMATION PROCESSING Computer Programming CPRD A.S. KN + +Computer Programming Certificate CPCT Certificate KN + +Cybersecurity CYBR A.S. PV KN FL NE + + General Information Processing CMGD A.S. KN + +General Information Processing Certificate CMGC Certificate KN + +Information Technology Support Specialist CMSD A.S. KN + +Information Technology Support Specialist Certificate CMSC Certificate KN + +Networking CMND A.S. KN + +Networking Certificate CMNC Certificate KN + +Office Automation Certificate OFFA Certificate KN + +Web Technologies CWTD A.S. KN + +Web Technologies Certificate CWTC Certificate KN + +





ENGINEERING and TECHNOLOGYCNC Manufacturing and 3D-Modeling Certificate ETCA Certificate KN + +Introduction to CNC Manufacturing Certifcate ETCI Certificate KN + +Computer and Networking Technology CNTD A.A.S. KN + + Computer Desktop Technology Track CDTO A.A.S. KN + + Computer Networking Technology Track CNTO A.A.S. KN + +Computer Desktop Technician Certificate CDTC Certificate KN + +Networking Technician Certificate NWTC Certificate KN + +Advanced Networking Technician Certificate NWAC Certificate KN + +Energy Utility Technology Certificate ETUT Certificate KN + +Engineering Systems Technology ETST A.S. KN + + CNC Manufacturing Track ETCT A.S. KN + + Electrical Track ETET A.S. KN + + Energy Track ETPT A.S. KN + + Mechanical Track ETMT A.S. KN + +Engineering Transfer ENGN A.S. KN + + Biomedical Track ENBI A.S. KN + + Chemical Track ENCH A.S. KN + + Chem-Biology Track ENCB A.S. KN + + Civil Track ENCI A.S. KN + + Computer Track ENCM A.S. KN + + Electrical Track ENEL A.S. KN + + Industrial Track ENIN A.S. KN + + Mechanical Track ENME A.S. KN + + Ocean Track ENOC A.S. KN + +

FINE ARTSArt ARTS A.F.A. PV KN FL NE + +Theatre THEA Performance Track DRAM A.F.A. KN FL + Technical Track TDRA A.F.A. KN FL +Music Jazz Studies Track JAZZ A.F.A. KN + Music Track MUSC A.F.A. KN +

GENERAL STUDIES General Studies GENS A.A. PV KN FL NE + +

HEALTH SCIENCES

ALLIED HEALTH PROGRAMSDiagnostic Medical Sonography DMSD A.A.S. FL + +Histotechnician HSTO A.A.S. PV + +Magnetic Resonance Imaging Certificate MRIC Certificate FL + +Medical Laboratory Technology CLAB A.A.S. FL + Phlebotomy Certificate PHLE Certificate PV + +Radiography (X-ray) XRAY A.A.S. FL + Renal Dialysis Technology Certificate RENL Certificate PV +Respiratory Therapy RESP A.A.S. FL +

DENTAL HEALTH PROGRAMSDental Assisting Certificate DAST Certificate FL +Dental Hygiene DHYG A.A.S. FL +

EMERGENCY/DISASTER MANAGEMENT




*Programs are subject to change at any time.

Emergency Management/Homeland Security EMGD A.S. KN FL PV NE +Emergency/Disaster Management Certificate EMER Certificate KN FL PV NE +Fire Science/Emergency Medical Technician FIRE A.A.S. KN FL PV NE + +Homeland Security Certificate HMLS Certificate KN FL + +

NURSING PROGRAMSNursing (Previous curriculum for students enrolled prior to Fall 2016) NURS A.S. or Diploma KN PV FL NE + +Nursing (NEW curriculum for students enrolled in Fall 2016 and after) NURS A.S. or Diploma KN PV FL NE + +Health Care Interpreter Certificate INTC Certificate PV +

REHABILITATIVE HEALTH PROGRAMSOccupational Therapy Assistant OCTA A.A.S. NE +Opticianry OPTI A.A.S. DL/NE +Physical Therapist Assistant PHTA A.A.S. NE +Therapeutic Massage TMSG A.A.S. NE +Therapeutic Massage Certificate TMSC Certificate NE +

HOSPITALITY Culinary Arts Assistant Certificate CULN Certificate FL + + Hospitality Certificate HOSP Certificate KN, FL + + Travel and Tourism Certificate TRVL Certificate KN, FL + +

HUMAN SERVICES Early Childhood Education and Child Development CHLD A.A. PV KN FL +Developmental Disabilities Certificate 173 CDVD Certificate KN FL +Early Childhood Education Certificate 174 CHLC Certificate PV KN FL +Education/Special Education ESPE A.A. KN FL +Gerontology Certificate GERN Certificate KN PV FL NE + +Social Service Majors:

Gerontology GERN A.A. KN FL +Mental Health MNTL A.A. PV KN FL +Social Work SOWK A.A. PV KN FL +Substance Abuse SUBS A.A. KN FL +

Social Services Certificate CSOS Certificate PV KN FL +

LEGAL STUDIES Law Enforcement LENF A.S. PV KN FL NE^ + +Paralegal Studies PALG A.S. PV KN FL NE^ + +

LIBERAL ARTS Liberal Arts LIBA A.A. PV KN FL NE + +Liberal Arts – English LAEN A.A. KN FL + +Liberal Arts – Foreign Languages LAFL A.A. KN FL + +Liberal Arts – Mathematics LAMA A.A. KN FL + +

SCIENCE Science SCID A.S. KN FL + +

TECHNICAL STUDIES Technical Studies TECH A.A.S. -T.S. KN FL + +



High School and College Codes


High School CodesAcademy for Career Exploration .....................................................400146 (formerly Textron Chamber of Commerce Academy)Alternate Learning Project.................................................................400143Dr. Jorge Alvarez High School ..........................................................400001Apponaug Christian Academy ...........................................................400241 Aquidneck Island Christian Academy ..............................................400129Attleboro High School ........................................................................220073Barrington Christian Academy..........................................................400002Barrington High School ......................................................................400000Beacon Charter School ......................................................................400282Bellingham Memorial Jr.-Sr. High School ........................................220117Bishop Connolly Regional High School ...........................................220783Bishop Feehan High School ...............................................................220077Bishop Hendricken High School .......................................................400238Bishop Keough Regional High School .............................................400099Blackstone Academy Charter School ..............................................400100 Blackstone-Millville Regional High School ......................................220160Blackstone Valley Baptist Academy .................................................400038Blackstone Valley Reg. Voc. Tech. High School ............................222154Block Island High School ....................................................................400005Burrillville High School .......................................................................400055Case High School .................................................................................222105Central Falls High School ...................................................................400012Central High School ............................................................................400145Chariho High School ...........................................................................400270Classical High School ..........................................................................400150Convent of the Sacred Heart ............................................................409001Coventry High School.........................................................................400030Coyle-Cassidy Memorial High School ............................................222120Cranston High School East ................................................................400035Cranston High School West .............................................................400036Cumberland High School ...................................................................400037Davies Career and Technical High School .....................................400057Dighton-Rehoboth Regional High School .....................................221645Durfee High School ............................................................................220785E 3 Academy .........................................................................................400157East Greenwich High School ........................................................... 400040East Providence High School ........................................................... 400050Elmhurst Academy ............................................................................. 409003Exeter-West Greenwich Regional Jr.-Sr. High School .........................................................400252Feinstein High School ..........................................................................400154First Baptist Christian School ............................................................400242Fletcher Preparatory ..........................................................................409004Foxborough High School ..................................................................220840GED® credentials ..................................................................................409999Global Learning Public Charter School...........................................221488Greene School ......................................................................................400254Highlander Charter School ................................................................400243

Hope High School ..............................................................................400155Immaculate Conception Academy ...................................................400227 Johnston High School .........................................................................400058Killingly High School ............................................................................070135King Phillip Regional High School ....................................................222562La Salle Academy ................................................................................400160Lincoln High School ...........................................................................400059Lincoln School (Providence) ............................................................400165Mansfield High School .........................................................................221320Masters Regional Academy ................................................................400220The Metropolitan Regional Career and Technical Center .....................................................................400166Middletown High School ...................................................................400063Milton High School ..............................................................................221440Moses Brown School ..........................................................................400180Mount Hope High School (formerly Bristol High School) ...........................................................400010Mount Pleasant High School ..............................................................400185Mount St. Charles Academy ..............................................................400285Narragansett High School ..................................................................400064New England Academy of Torah (Hebrew Day)..........................400187New England Laborers’/Cranston Public School Construction Academy ..................................................................400034 North Attleboro High School ...........................................................221625

North Kingstown High School..........................................................400088 North Providence High School .......................................................400090North Smithfield High School ...........................................................400287Norton High School ............................................................................221670Ocean Tides School ............................................................................400066Our Lady of Fatima High School .....................................................400236Paul Cuffee High School .....................................................................400006Pilgrim High School .............................................................................400239Plainfield High School ..........................................................................070090Ponaganset High School .....................................................................400093Portsmouth Abbey School .................................................................400130Portsmouth High School ....................................................................400128Paul J. Primavera Educational Center ...............................................220116The Prout School .................................................................................400228Providence Career and Technical High School ............................400142 Providence Country Day School ....................................................400045Rhode Island Nurses Institute Middle College ............................400141Rhode Island School for the Deaf ....................................................400189Rocky Hill School .................................................................................400043Rogers High School .............................................................................400075Juanita Sanchez Complex ...................................................................400183 (formerly the Providence Academy of International Studies and

William Cooley Health, Science and Technology Academy) School One ............................................................................................400188Scituate Jr.-Sr. High School ................................................................400095Seekonk High School ..........................................................................221891Shea High School (Pawtucket West) ...............................................400125Smithfield High School ........................................................................400053South Kingstown High School...........................................................400230St. Andrew’s High School .................................................................400250St. Dunstan’s Day School ...................................................................400193St. George’s High School ...................................................................400085St. Mary Academy (Bay View) ...........................................................400215St. Raphael Academy ...........................................................................400110Taunton High School ..........................................................................222123Times 2 Academy.................................................................................400144Tiverton High School ..........................................................................400224Tri-County Reg. Voc. Technical High School ................................220864Trinity Academy for the Peforming Arts .........................................400210Trinity Christian Academy .................................................................400060Toll Gate High School.........................................................................400237Tolman Senior High School ...............................................................400115U.S. Naval Academy Prep School .....................................................400068Uxbridge High School .........................................................................222155Jacqueline M. Walsh School of Performing and Visual Arts ...........................................................400969 Warren High School ...........................................................................400235Warwick Veterans High School .......................................................400240West Warwick High School ..............................................................400265Westerly High School .........................................................................400255The Wheeler School ...........................................................................400170Woonsocket High School ..................................................................400295Other ......................................................................................................409666Out-of-Country ....................................................................................409777Out-of-State (if not listed above) ........................................................409888

COLLEGE CODES

Bridgewater State University ................................................................. 3517Bristol Community College .................................................................. 3110Bryant University ..................................................................................... 3095Community College of Rhode Island .................................................. 3733Dean College ............................................................................................ 3352Fisher College ........................................................................................... 3391Johnson & Wales University .................................................................. 3465New England Institute of Technology ................................................. 0339Providence College .................................................................................. 3693Rhode Island College .............................................................................. 3724Roger Williams University ..................................................................... 3729Salve Regina University .......................................................................... 3759University of Massachusetts-Dartmouth ............................................ 3786University of Rhode Island .................................................................... 3919


APPLICATION FOR ENROLLMENTTell us about your interest in CCRI. Please share this information with us so that we can better advise you on your best course of action at CCRI.

First time in college. I have not attended college previously. Returning. I previously attended CCRI. Nondegree. I am enrolled at another college or university, taking classes at CCRI, but not pursuing a degree at CCRI; or I am interested in taking

courses for personal or professional reasons. Transfer. I am entering CCRI and I have previous college-level coursework.

Personal data: Complete this form after you have reviewed our program listings. Please print clearly.

Previous name

Permanent home street address

Are you a U.S. citizen? Yes No

If you are not a U.S. citizen, do you have a Permanent Resident Card (Green Card)? Yes No If you are a permanent resident card holder, please provide your alien registration number.: _____________________________________________________

Have you lived continuously in Rhode Island for one or more years as of the first day of classes for this semester? Yes No

Is Rhode Island your legal and permanent state of residence? Yes NoIf you have a non-Rhode Island permanent home address and you are claiming Rhode Island residency, you must submit a CCRI Application for In-State Residency and all required documentation. This information is available at wwww.ccri.edu/oes/admissions/pdfs/resusperm.pdf

If you are not a legal and permanent resident of Rhode Island, please list your legal residence.Street _______________________________________________________City _________________________________________State _______ ZIP _____________ Country____________________________ Are you a recipient of the Supplemental Nutrition Assistance Program (SNAP)? Yes NoService members or dependents

Did you serve or are you serving in the U.S. armed forces? Yes No N/A

If you or your dependents are currently serving, are you stationed in Rhode Island on active duty? Yes No N/A

Will you be using VA education benefits at CCRI? Yes No N/A

Will you be using VA education benefits as a dependent at CCRI? Yes No N/A

Did you honorably serve in a combat zone? Yes No N/A

Please note: • Applicants in Refugee Status, Temporary Protected Status, or Political Asylum Status must mail a copy of the documentation of their status.• Other visa or immigration status: Please mail a copy of your Visa, I-797 or other documentation.Misrepresentation concerning residency and/or citizenship is grounds for immediate dismissal from the college, but you will remain liable for all tuition and fees.

Date of birth (mm/dd/yy)

Home telephone number

Social Security number

Gender:

Cell number Please text me important college information regarding enrollment, financial aid and other key milestones in my academic progress

Date of application

City

(as it appears on Social Security card or U.S. passport)

Email addressState/Zip

Last name First name Middle initial

Middle initial

The following information helps us comply with federal statistical reporting requirements only and will not, in any way, impact an admission decision on your application. Federal regulations require colleges to report enrollment data by racial, ethnic and gender categories.

Ethnicity: (Not used for admission. Please check one.)*

Not Hispanic Hispanic or Latino

Federal regulations require colleges to report enrollment data by racial, ethnic and gender categories

Race: (Not used for admission. You may check more than one race.)

American Indian or Native American Asian Black or African American

Important information: One or both parents (biological or adoptive) earned a four-year degree Yes NoSingle parent with custody of a child under 18 Yes NoSpeaker of English as a second language Yes NoDisplaced homemaker† Yes No

* Ethnicity/Race data reporting for federal purposes has changed. The selections that you see in this section are the choices as mandated by the federal government for higher education reporting purposes. Only statistical numbers are reported. No individual data appears on the federal reports.

†�The�term�displaced�homemaker�refers�to�women�or�men�who�have�worked�mainly�in�the�home�for�a�minimum�of�two�years�caring�for�home�and�family.�Due�to�loss�of�family�financial�support (usually through death, disability or divorce), these individuals must leave the home and seek to support themselves and their families.

For Office Use

CCRI ID Number: For�Office�Use

Native Hawaiian or Pacific Islander White

Social Security number is mandatory under federal law. If applying without a social security number see http://www.ccri.edu/oes/admissions/applicantwithoutssnortin.html

Yes No

College/University name Code City State Degree College/University name Code City State Degree

College/University name Code City State Degree

Programs of interest: Please indicate your program choices. Please print clearly.

What program of study are you interested in pursuing?I am interested in a degree program

1st choice ________________________ ______________________________________________________________________________

2nd choice ________________________ ______________________________________________________________________________

At this time, I am interested in applying as a nondegree student (Please note: Financial aid, including on-campus work programs, is not available to nondegree students.)

Are you interested in receiving information about the Joint Admissions Agreement (JAA) among the Community College of Rhode Island, Rhode Island College and the University of Rhode Island? Yes No, thank you

Campus Program of study name

Campus Program of study name

Year

High school history: Please complete as appropriate. Please print clearly.

I have or will have:

High school diploma

Institution name, city, state

GED® credential

State in which GED® credential was received

Home school diploma — Please submit documentation from your local school district approving your home schooling program.

Institution name, city, state

I do not hold any of the above.

Code

Please forward a copy of your final official high school transcript or GED® credential to the Office of Enrollment Services as soon as available.

Diploma Date

Month / Day / Year

College history: Please list ALL undergraduate colleges and universities attended. (Please submit official transcripts from each school to the Office of Enrollment Services, 1762 Louisquisset Pike, Lincoln, RI 02865.) Please print clearly.

COLLEGE 1:

COLLEGE 3:

COLLEGE 2:

_______________________________________________________________________________ ______________________________________________________ _________________ ________________________

Agreements:

I certify that the information that I have provided on this application is true and correct. Further, by signing this form, I agree to abide by the rules and regulations at, and fulfill all financial obligations to, the Community College of Rhode Island. Acceptance Checkbox I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.

For Office Use Only

NEBHE __________________

Code

Date Received

Month / Day / Year

Code

Date Received

Month / Day / Year

Intended Entry Date

January/Spring September/Fall Summer

CCRI APPLICATION 12/2018

Applicant's signature Application date

Do you have a bachelor’s degree from a U.S. college or its equivalent from a school in another country? Yes No

If yes, indicate the degree received below.

_______________________________________________________________________________ ______________________________________________________ _________________ ________________________

_______________________________________________________________________________ ______________________________________________________ _________________ ________________________

If under age 18, signature of parent/guardian Application date

Please type your First and Last Name

Flanagan Campus,1762 Louisquisset Pike, Lincoln, RI 02865-4585 P: 401-825-2003 F: 401-333-7122

Knight Campus, 400 East Ave., Warwick, RI 02886-1807 P: 401-825-2003 F: 401-825-2394

Liston Campus, One Hilton St., Providence, RI 02905-2304 P: 401-825-2003 F: 401-455-6181

Newport County Campus, One John H. Chafee Blvd. Newport, RI 02840 P: 401-825-2003 F: 401-851-1627


Transcripts for Undocumented Students

Last name______________________________________________ First name___________________________________

Address_________________________________City________________________State_______ZIP code_____________

Birth date: Month____________Day___________Year_____________

CCRI ID#_________________________________________ Phone number_____________________________________

Please check one:

_____High School seniors submit unofficial high school transcript, which includes mid-year senior grades.

_____Official sealed high school transcript with graduation date. (Rhode Island high school attendance, three years)

_____Official sealed GED® credentials (three years proof of Rhode Island residency is required.)

_____Official sealed transcript. National External Diploma Program (NEDP) (three years proof of Rhode Island residency is required.)

Community College of Rhode Island locations


Eligibility for In-State Tuition and Fees Based Upon Rhode Island High School Attendance

Student Application (To be completed by Student)

If you wish to apply for in-state tuition based upon Rhode Island high school attendance and graduation or a General Equivalency Diploma (GED), you must complete and submit this application and the attached affidavit. You must also collect and submit documentation to show that you meet the requirements for receiving in-state tuition and fees. Please read these materials carefully and consult the attached affidavit and the Guidance for Students and Families for further information. You must complete both sides of this form, the application and the affidavit. Prior to filing this application and affidavit, it is recommended that you seek legal guidance if you have any questions regarding your present immigration status; the possible legal and/or immigration ramifications that may arise from your filing of this application; and/or your execution of this affidavit. NAME: CCRI STUDENT ID # IF AVAILABLE: AGE: DATE OF BIRTH: Gender: Male Female PLACE OF BIRTH: CITY: STATE: COUNTRY: CURRENT STREET ADDRESS: CITY: STATE: ZIP CODE: TELEPHONE: CELL: EMAIL: HIGH SCHOOL OR GED INFORMATION (PROVIDE INFORMATION ON ALL SCHOOL[S] YOU ATTENDED IN GRADES 9-12)

SCHOOL NAME CITY STATE FROM (MONTH/YEAR) -- TO (MONTH/YEAR)

For office use only

CCRI STUDENT ID #: Comments:

Received:

Decision Date:

Year: Term Code:

Signature:


Eligibility for In-State Tuition and Fees Based Upon Rhode Island High School Attendance

Affidavit

(To be completed by student, signed in the presence of a Notary Public, and submitted to the Office of Enrollment Services – Knight Campus, Warwick )

I, the undersigned under oath, depose and say as follows:

(a) That I have personal knowledge of the facts stated herein, which are all true and correct; and

(b) That I currently live in the state of Rhode Island and have attached documents that demonstrate my residence, which include several forms of proof such as a rental agreement, property tax bill, car registration, utility bill, an official piece of mail, or an ID card that lists my address;

(c) That I have lived in Rhode Island for three (3) or more years, have attended an approved high school in the state of Rhode Island for three (3) or more years, and I hold an official high school diploma (or will hold at the time of my enrollment) OR that I have lived in Rhode Island for three (3) or more years and have earned a GED (senior high school equivalency diploma from the state of Rhode Island), or will have earned one by the time of my enrollment. I have submitted my official high school transcript or GED equivalency transcript as proof;

(d) That I have filed an application for lawful United States of America immigration status, evidence of which I have attached hereto and incorporated herein, OR that I will file an application for lawful immigration status as soon as I become eligible to do so. I understand that my failure to file an application for lawful immigration status as soon as I become eligible to do so will result in a forfeiture of in-state tuition rates for me in the future; and

(e) That I do not, and if I am unemancipated my parent(s) does not, hold a temporary immigration classification or other immigration status within the definition of “non-immigrant alien” as described in U.S.C §1101(a)(15). (Please see Guidance for Students and Families for further information on this clause.)

Name (please print your name)

Signature Date

CCRI Student Identification # Student Date of Birth

This Affidavit has been subscribed and sworn to before me on this _______day of ___________, 20

Notary Public of the State of Rhode Island My Commission Expires:

Flanagan Campus,1762 Louisquisset Pike, Lincoln, RI 02865-4585 P: 401-825-2003 F: 401-333-7122

Knight Campus, 400 East Ave., Warwick, RI 02886-1807 P: 401-825-2003 F: 401-825-2394

Liston Campus, One Hilton St., Providence, RI 02905-2304 P: 401-825-2003 F: 401-455-6181

Newport County Campus, One John H. Chafee Blvd. Newport, RI 02840 P: 401-825-2003 F: 401-851-1627


Residency Document for Undocumented Students

Last name______________________________________________ First name__________________________________

Address_________________________________City________________________State_______ZIP code_____________

Birth date: Month____________Day___________Year_____________

CCRI ID#_________________________________________ Phone number_____________________________________

Residency documents accepted

Please check one:

_____Rental agreement

_____Property tax bill

_____Car registration

_____Utility bill

_____Identification card with current address listed

_____Federal income tax return- most recent tax year or a copy of R.I. state income tax return for most recent year

_____Automobile insurance policy

____ An official piece of mail (with your name) that includes the address listed on your Application for Enrollment.

NOTE:

RI High School attendance three years–RI/HS Graduate – one current residency document within the last 90 days.

GED Graduates – one current residency document for the past 3 consecutive years

NEDP Graduates – one current residency document for the past 3 consecutive years

Community College of Rhode Island locations

Instructions Purpose. The Community College of Rhode Island (CCRI) must get your correct identifying number to file Form 1098-T, Tuition Statement, with the IRS and to furnish a statement to you. This will be your Social Security number (SSN) or, if you are not eligible to obtain an SSN, your individual taxpayer identification number (ITIN). Form 1098-T contains information about qualified tuition and related expenses to help determine whether you, or the person who can claim you as a dependent, may take either the tuition and fees deduction or claim an education credit to reduce Federal income tax. For more information, see IRS Pub. 970, Tax Benefits for Higher Education.

Under federal law, you are required to provide the requested formation.

Part I.

Enter your name and mailing address. The name should match that used by the Social

Security Administration or Internal Revenue Service.

Taxpayer identification number. Enter your SSN or ITIN. If you do not have an SSN or ITIN,

apply for one and fill out and return this form when you receive it.

Part II.

Sign your name in the space provided to confirm the information provided. The Office of

Enrollment Services cannot change your records without your signature.

Part III.

Please fill out this part only if you are unwilling or unable to provide a taxpayer identification

number. Check either the first or the second box and sign the statement. By law, CCRI must

ask you at least once a year for your taxpayer identification number in order to meet its

obligation to file Form 1098-T.

Deliver or mail the completed form to the address provided. Do not email the form. Email

is not a secure way to transmit personal information.

Penalties

Failure to furnish correct SSN. If you fail to furnish your correct SSN or ITIN to CCRI, the IRS

may impose a penalty of $50 unless your failure is due to reasonable cause and not to willful

neglect.

Misuse of SSNs. If CCRI discloses or uses your SSN in violation of Federal law, CCRI may be

subject to civil and criminal penalties.

Privacy Act Notice

Section 6109 of the Internal Revenue Code requires you to give your correct SSN or ITIN to

persons who must file information returns with the IRS to report certain information. The IRS

uses the numbers for identification purposes and to help verify the accuracy of your tax return.

The IRS may also provide this information to the Department of Justice for civil and criminal

litigation and to cities and states to carry out their tax laws.

October 2014 National Association of College and Business Officers

Return completed signed form, in person or by mail, to:

Community College of Rhode Island


400 East Avenue

Warwick, RI 02886

Name of Student

Address

PART I

I certify that the number shown on this form is my correct taxpayer identification number.

PART II

OR

I am a foreign national/nonresident alien and do not have a Social Security number or

individual taxpayer identification number.

I do not plan to file an income tax return in the U.S.

I do not wish to provide my taxpayer identification number to CCRI at this time.

PART III I understand that I may be subject to an IRS fine of $50 for failure to do so.

I further understand that the IRS will not be able to use the Form 1098‐T filed by CCRI

to confirm my eligibility for certain education tax benefits without my taxpayer

identification number.

Taxpayer Identification Number

Request for Student’s Taxpayer Identification Number(Substitute Form W‐9S)

Signature Date

DateSignature

(SSN or ITIN)

___ ___ ___ ‐ ___ ___ ‐ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

Do not submit

this form to the IRS

CCRI Banner ID


CCRI: Application for the Rhode Island Promise Scholarship for 2020 HS/GED graduates

CCRI ID_________________________________________________________

The Rhode Island Promise Scholarship allows 2020 Rhode Island high school graduates to pursue an associate degree at CCRI tuition free. It appears that you may be qualified to receive this scholarship. To verify your eligibility for the Rhode Island Promise and to ensure that you understand the criteria required to be part of this program, you must complete this form.

By my signature below, I attest that I have read and understand the information set out above and the criteria required to be awarded and to continue to receive the Rhode Island Promise Scholarship. ____________________________________________ ____________ Student’s Signature (Parent’s signature required if student is under 18 years of age) Date

____________________________________________ ____________ Parent’s Signature (Parent’s signature required if student is under 18 years of age) Date

I, (print your name here):_______________________________________, have applied to an associate degree program at the Community College of Rhode Island and I attest to meeting the following criteria to be considered for the Rhode Island Promise Scholarship (please initial each line below):

I am a Rhode Island resident, and believe I qualify for in-state tuition and fees pursuant to the Council on Postsecondary Education’s Residency Policy: https://www.riopc.edu/static/photos/2017/02/24/S5_residency_050615.pdf

I am, or will be, a 2020 high school graduate (public, private or homeschooled) or a 2020 GED recipient I was, or will be, younger than 19 years of age when I earn(ed) my high school diploma or GED

OR I was, or will be, 19, 20 or 21 years of age when I earn(ed) my high school diploma, but believe I should

be considered for this scholarship due to personal circumstances that delayed my HS graduation I understand that I must also fulfill the requirements below to be granted and receive this scholarship. If I choose to attend CCRI and receive this scholarship, I hereby understand and certify that I will (please initial each line below):

Enroll in a CCRI associate degree program in the semester immediately following high school graduation or the receipt of a high school equivalency diploma.

Complete the FAFSA and all financial aid requirements as applicable Submit a final official high school transcript or GED transcript

By initialing here, I authorize CCRI to request my transcript directly from my high school Enroll full-time each semester (fall and spring) for two consecutive years Earn 30 credits each year (fall, spring, summer). Scholarship guaranteed for fall and spring only. Maintain a minimum CCRI cumulative GPA of 2.5 Commit, and if I choose to enroll do hereby commit, to live, work, or continue my education in Rhode

Island after graduation from CCRI I also understand the following policies related to the Rhode Island Promise Scholarship. I understand that (please initial each line below):

This scholarship is a two-year scholarship. Students are strongly encouraged to enroll in 15 credits per semester in order to stay on track to earn

30 credits each year. Students may enroll in 12-14 credits per semester, but will then need to enroll in summer courses, which will not be funded by this scholarship.

Students who withdraw from all courses or stop attending classes during a semester will be subject to the Federal Financial Aid Title IV refund policy if applicable.

The RI Promise Scholarship will also be governed by the policies and procedures adopted by the Council on Postsecondary Education.

Disbursement of funds for initial and/or renewal scholarship awards is conditioned upon the state’s annual approval and appropriation of sufficient funding for the Rhode Island Promise Scholarship Program.

https://www.riopc.edu/static/photos/2017/02/24/S5_residency_050615.pdf

CCRI: Application for the Rhode Island Promise Scholarship for 2020 HS/GED graduates

Supplemental application form for 19, 20 and 21 year old high school graduates

CCRI ID_________________________________________________________

The Rhode Island Promise Scholarship allows 2020 Rhode Island high school graduates who are under age 19

at the time of graduation to pursue an associate degree at CCRI tuition free. This scholarship may also be

awarded to students who graduate from high school at age 19, 20 or 21 due to personal circumstances that

delayed their high school graduation. You noted on your Rhode Island Promise application that you were, or

will be age 19, 20 or 21 upon high school graduation. This supplemental application is required in order for

CCRI to determine your eligibility for the Rhode Island Promise scholarship.

CCRI will review the personal circumstances noted above and may request further documentation or details

to determine whether or not you are eligible for the Rhode Island Promise Scholarship.

Submitted by:

____________________________________________ Student’s Signature (Parent’s signature required if student is under 18 years of age)

____________ Date

I, (print your name here):_______________________________________, was or will

be 19, 20 or 21 years of age upon completion of my high school diploma, but believe I

should be considered for this scholarship due to personal circumstances that delayed my

high school graduation. Those circumstances were:

I started kindergarten later than other children

I repeated one or more grades of K-12 schooling

I had an IEP or other special education plan that extended my time to graduation

Other personal circumstances, please explain:

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

Financial Aid Office

FINANCIAL AID INFORMATION Undocumented students are not eligible for federal and most state financial aid programs. However, undocumented students may qualify for Rhode Island Promise if they meet all other eligibility requirements. Rhode Island Promise applicants are all required to file the Free Application for Federal Student Aid (FAFSA). If you meet the criteria of an “Undocumented Student Living in Rhode Island”, you should fill out a paper FAFSA. PLEASE NOTE If a student does not have a social security number:

The online FAFSA is no longer an option for submission of the FAFSA form.

Please fill out the paper FAFSA https://studentaid.ed.gov/sa/sites/default/files/2020-21-fafsa.pdf

When filling out the paper FAFSA, the section requiring a social security number should be left blank.

If available, please provide your CCRI student ID number at the top of the FAFSA form

Please do not complete the online version or mail the paper copy to the federal processor. Please submit completed form to the CCRI Financial Aid Office How to Submit

By Email [email protected] By Mail Community College of Rhode Island Financial Aid Office 400 East Ave Warwick, RI 02886 11/2019

https://studentaid.ed.gov/sa/sites/default/files/2020-21-fafsa.pdf

mailto:[email protected]

office of enrollment services undocumented students living in … · 2020-02-03 · degree and...

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