Figure: 19 TAC §21.731(c)

Chart II
AFFIDAVIT

STATE OF TEXAS                                         §
                                                                         §
COUNTY OF ________________                 §

            Before me, the undersigned Notary Public, on this day personally appeared ___________________________________________________,
known to me, who being by me duly sworn upon his/her oath, deposed and said:

1.  My name is ________________________________________________________.  I am ___ years of age and have personal knowledge of the facts stated herein and they are all true and correct.

2.  I graduated or will graduate from a Texas high school or received my GED certificate in Texas.

3.  I resided in Texas for three years leading up to graduation from high school or receiving my GED certificate.

4.  I have resided or will have resided in Texas for the 12 months prior the census date of the semester in which I will enroll in ___________________________________ (college/university).

5. I have filed or will file an application to become a permanent resident at the earliest opportunity that I am eligible to do so.

In witness whereof, this ____________day of _______________________, _________.

___________________________________
                                                                        (Signature)

___________________________________
                                                                        (Printed Name)

___________________________________
                                                                        (Student I.D.#)

SUBCRIBED TO AND SWORN TO BEFORE ME, on the ___________________ day of ________________________________________, ___________________________, to certify which witness my hand and official seal.

__________________________________
                                                                        Notary Public in and for the State of Texas