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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

Middle Initial

Answer Required

Last *

Answer Required

HACC ID*

Answer Required

For which term are you applying for?

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Spring Term

Summer 1 Term

Summer 2 Term

Fall

Winter

Address

Street Address*

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City

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Zip/Postal

Answer Required

Date you moved to your current address

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Phone*

Number Required

Email*

Answer Required

Date of Birth

Answer Required

Today's Date*

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Confirmation Email

Confirmation Email *

Email Required