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Residency Affidavit Form

Name

This field is for validation purposes and should be left unchanged.

ALL applicants, regardless of residency, must submit this form with the application for admission.

1. Name:(Required)

Full name

2. LSAC Account Number:(Required)

3. Place of Birth:(Required)

4. U.S. Citizen/permanent resident alien?

Yes

Non-resident Alien?

Yes

Visa Type:

5. Permanent Mailing Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

(good until)

6. Parent 1 Name:

Parent 1 Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent 2 Name:

Parent 2 Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

7. Parent 1 Telephone:

Day:

Evening:

Parent 2 Telephone:

Day:

Evening:

8. Did or will your parents claim you as an income tax exemption in:(Required)

	Yes	No
2025
2026

9. Did either parent(s) or guardian(s) provide you with regular financial support for the past 12 months? Amount can be estimated.

If yes, please provide the amount or short narrative description.

10. Applicant address(es) for the past two years:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

From:

To:

Address(es) #2

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

From:

To:

11. If you are married and your spouse is a Connecticut resident, please provide spouse's name and address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

12. Did you attend and graduate from a Connecticut high school?(Required)

Yes

If so, please provide the name and graduation year:

13. Have you ever voted in the United States?(Required)

Yes

Please provide the state and year in which you last voted:

If no, please explain:

14. Do you hold a valid driver's license or state identification?(Required)

Yes

State Identification information:

State:

License/ID number:

Expires:

15. Did you file city, state and/or federal income tax returns within the past year?(Required)

Yes

Name each city(ies)/state(s) in which you filed:

Indicate address on your last federal income tax form:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

16. Please check the classification that you believe is applicable to you:(Required)

Connecticut Resident

New England Compact Student (Rhode Island or Vermont)

Out-of-State (United States citizen living in any state other than CT, RI, VT)

Foreign

17. Additional information that may be helpful in determining your legal residence:

Residency Affidavit Form

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