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HACC Certificate of Residency Form

Please complete the form below. Required fields marked with an asterisk *

Contact Information

Name*

Answer required for "Name"

Middle Initial

Answer required for "Middle Initial"

Last *

Answer required for "Last "

HACC ID*

Answer required for "HACC ID"

For which term are you applying for?

Answer required for "For which term are you applying for?"

Spring Term

Summer 1 Term

Summer 2 Term

Fall

Winter

Address

Street Address*

Answer required for "Street Address"

City

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

Date you moved to your current address

Answer required for "Date you moved to your current address"

Phone*

Number Required

Email*

Answer required for "Email"

Today's Date*

Answer required for "Today's Date"

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"