rev 05/2021
If you are under 24 years of age, please complete the remainder of this page. If not, continue to the next page.
Are you or is your spouse currently on active duty in the U.S. military?
If yes, where are you stationed at? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If you were stationed OUTSIDE of California, what is your
State of Legal Residence (not "home of record") on military Records?. . . .
Student (yourself) Spouse
YES
NO
YES
NO
From To
From To
Parent Information
1) Are your parents divorced or permanently separated?
YES
NO
If yes, with whom did you live with last?
Father Other
Mother
Dates of Residence with parent: . . . . . . . . . . . . . . . . . . . . . .
From To
From To
2) If your parent(s) are deceased, please provide the date and place of death, Otherwise provide all information required below.
(Place)
Father: (Date)
(Place)
Mother: (Date)
Is your father a citizen of the United States?
Has your father been awarded:
-- Permanent Residence?. . . . . . . . . . . . . . . . .
-- Employment Authorization?. . . . . . . . . . . .
-- Temporary Residence? . . . . . . . . . . . . . . . . .
-- United States Visa?. . . . . . . . . . . . . . . . . . . . .
First Awarded
First Awarded
First Awarded
First Awarded
Last Renewed
Last Renewed
Expiration Date
Visa Type
I94 Entry Date
If NO, complete the following questions regarding your legal status in the U.S.
3) Information on Student's Father:
Print full name (Last, First,Middle)
Present Mailing Address (Number,Street,Apt#)
State
ZIP Code
b) Legal Status
Date California became your father's permanent home . . . . . . . .
Have your father been absent from California for
more than six weeks during the past 12 months? . . . . . . . . . . .
Important: If yes, attach a written statement explaining his absence(s) (include specific dates).
YES NO
a) Physical Presence
Does your father claim to be a Resident of California?
f) Military Information
Is your father currently on active duty in the U.S. military?
If yes, where is your father station at? . . . . . . . .. . . . . . . . . . . . . .
If your father was stationed OUTSIDE of California, what is your
father's State of Legal Residence (not "home of record") on
military Records?. . . .
YES
NO
From
To
Does your father have a driver's license?
Date Issued
Last Renewed
Which State
c) Driver License & Motor Vehicle Information
Does your father have a motor vehicle?. . . .
If your father does not drive, does he
have a California identification card?
Date Issued
Which state is it registered with?
Date of Registration
d) Banking Information e) Tax Information
Did your father file a California
income tax return for:
NO
YES
NO
YES
Last Year
This Year
Military Information
City
//:
//:
//:
//:
//:
//:
//:
//:
//:
:
:
A#
: / /
//:
YES NO
: / /
YES NO
YES NO
: / /
a) Checking Account:
:
Bank Name
:
Acct Mailing Address (state only)
b) Savings Account:
:
Bank Name
Date established
: / /
Date established
: / /
:
Acct Mailing Address (state only)
4) Information on Student's Mother:
Print full name (Last, First,Middle)
Present Mailing Address (Number,Street,Apt#)
State
ZIP Code
Date California became your mother's permanent home . . . . . . . .
Have your mother been absent from California for
more than six weeks during the past 12 months? . . . . . . . . . . .
Important: If yes, attach a written statement explaining her absence(s) (include specific dates).
YES NO
a) Physical Presence
Does your mother claim to be a Resident of California?
f) Military Information
Is your mother currently on active duty in the U.S. military?
If yes, where is your mother station at? . . . . . . . .. . . . . . . . . . . . . .
If your mother was stationed OUTSIDE of California, what is your
mother's State of Legal Residence (not "home of record") on
military Records?. . . .
YES
NO
From
To
Does your mother have a driver's license?
Date Issued
Last Renewed
Which State
c) Driver License & Motor Vehicle Information
Does your mother have a motor vehicle?. . . .
If your mother does not drive, does he
have a California identification card?
Date Issued
Which state is it registered with?
Date of Registration
d) Banking Information e) Tax Information
Did your mother file a California
income tax return for:
NO
YES
NO
YES
Last Year
This Year
City
//:
: / /
//:
YES NO
: / /
YES NO
YES NO
: / /
a) Checking Account:
:
Bank Name
:
Acct Mailing Address (state only)
b) Savings Account:
:
Bank Name
Date established
: / /
Date established
: / /
:
Acct Mailing Address (state only)
NOYES
NOYES
NOYES
NOYES
NOYES
Is your mother a citizen of the United States?
Has your mother been awarded:
-- Permanent Residence?. . . . . . . . . . . . . . . . .
-- Employment Authorization?. . . . . . . . . . . .
-- Temporary Residence? . . . . . . . . . . . . . . . . .
-- United States Visa?. . . . . . . . . . . . . . . . . . . . .
First Awarded
First Awarded
First Awarded
First Awarded
Last Renewed
Last Renewed
Expiration Date
Visa Type
I94 Entry Date
If NO, complete the following questions regarding your legal status in the U.S.
b) Legal Status
//:
//:
//:
//:
//:
//:
//:
//:
:
:
A#
NOYES
NOYES
NOYES
NOYES
NOYES
YES NO
If no, skip to section #4
YES NO
If no, skip to the next page.