Residency Form | Quinsigamond

First

Middle Initial

Last

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Date of Birth

QCC ID Number (if known)

Are you a United States citizen?

Yes

Are you a Permanent Resident?

Yes

Alien Registration #

If you are not a U.S. Citizen or Permanent Resident, please state your Visa or immigration status in detail

Valid Work authorization (provide alien registration number in the box below)

Valid student visa (indicate kind in the box below)

Valid Work visa (indicate kind in the box below)

Granted Asylum (provide alien registration number in the box below)

Refugee

Other (explain below)

Immigration Details

In-state or Reduced Tuition Category

Please select the in-state or reduced tuition eligibility category that applies to you.

I have been a MA resident for six (6) continuous months and intend to remain here.

I am an eligible participant in the New England Board of Higher Education's Regional Student Program

I am a member of the armed forces (or spouse or unemancipated child) on active duty in Massachusetts.

I am not a MA resident.

Please select the state you are eligible in

If not a MA resident or have not lived in MA for 6 months as stated above, what state or country are you from?