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Residency Appeals Form

Today's Date

Today's Date

First Name

Middle Name

Last Name

CWID

Email Address

Phone Number

Birthdate

Birthdate

Present Address

Present Address

Country

Street

City

Region

Postal Code

Permanent Address

Permanent Address

Country

Street

City

Region

Postal Code

High school from which you graduated

Date you first registered at Louisiana Tech University

Date you first registered at Louisiana Tech University

Date you last registered at Louisiana Tech University

Date you last registered at Louisiana Tech University

The number on the current RESIDENCY REGULATIONS list by which you feel you qualify for IN-STATE evaluation

A brief statement why you feel you now qualify as a resident:

Please attach the appropriate supporting documents to the appeals form for the residency regulation that you are appealing. You will be notified of the decision by email.

FOR ADMISSION USE ONLY

Signature

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