Student AFFIDAVIT/DOCUMENT EVIDENCING FAMILY TIES IN FLORIDA

AFFIDAVIT/DOCUMENT EVIDENCING FAMILY TIES IN FLORIDA

RESIDENCY FOR TUITION PURPOSES (TIER 2 of FLORIDA STATUE 1009.21)
Your Name

First NameLast Name
Student ID
Your Email
username@my.pbsc.edu
Your Relative's Name

First NameLast Name
Your Relative's Email
example@example.com
I, {yourName} do hereby swear or affirm that I am related to {name4} by virtue of the following statement and attached documents. This must be a verifiable relative with documents to substantiate.
Explain exactly how you are related to the individual
Upload documents to substantiate the relationship (i.e., copy of marriage certificate, birth certificate(s), etc.)

The following file types are accepted: pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, jpg, jpeg, png, gif
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I have lived in the state of Florida for at least 12 months prior to the first day of classes for the following term.
Use the link for a list of acceptable documents for the following field. The documents can be found in Tier 1 or Tier 2: www.pbsc.edu/admissions/florida-residency.php
Please upload two forms of proof evidencing that your relative is a resident of the State of Florida (must be State of Florida issued documents, i.e., driver’s license, vehicle registration, voter i.d. card, etc., but cannot be hunting/fishing license, library card, birth certificate, passport, etc.). Documents must bear an issue date of at least 12 months prior to the first day of class for the term in which student is applying to attend.

The following file types are accepted: pdf, doc, docx, xls, xlsx, csv, txt, rtf, html, jpg, jpeg, png, gif
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By entering my name below, I confirm that all information provided in this form is accurate, complete, and truthful to the best of my knowledge.
Please submit the completed PDF of this form in Workday under the ‘Pay Less Fees’ inbox item as part of your proof of Florida residency for tuition purposes.
- Click Submit to receive a PDF of your completed form and attachments.
- Click Save to get an email link so you can finish this form later.
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