This form contains 46 fields organized into 13 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
Address - One (1) Month (Row 3)
One (1) Month - Zip Code	Text	Enter the ZIP code for the address where you resided during the one (1) month period (e.g., 5-digit ZIP or ZIP+4). Fill only if 'One (1) Month - Same as Previous' is 'No'. Max length: 13 characters Depends on: One (1) Month - Same as Previous
One (1) Month - County	Text	Enter the county of the street address where you resided during the one (1) month period. Fill only if 'One (1) Month - Same as Previous' is 'No'. Max length: 18 characters Depends on: One (1) Month - Same as Previous
One (1) Month - City	Text	Enter the city for the street address where you resided during the one (1) month period. Fill only if 'One (1) Month - Same as Previous' is 'No'. Max length: 24 characters Depends on: One (1) Month - Same as Previous
One (1) Month - State	Text	Enter the state for that address, preferably using the two-letter state abbreviation. Fill only if 'One (1) Month - Same as Previous' is 'No'. Max length: 6 characters Depends on: One (1) Month - Same as Previous
One (1) Month - Street Address	Text	Enter the full street address (no P.O. Box) where you resided during the one (1) month period, including house number and apartment or unit if applicable. Fill only if 'One (1) Month - Same as Previous' is 'No'. Max length: 28 characters Depends on: One (1) Month - Same as Previous
One (1) Month - Same as Previous	Checkbox	Check this box if the One (1) Month address is the same as the previous address provided (i.e., you do not need to re-enter the street/city/state/zip/county for the one-month row).
Address - One (1) Year (Row 1)
One (1) Year - City	Text	Enter the city for the One (1) Year residence as it appears in the mailing address. Max length: 24 characters
One (1) Year - State	Text	Enter the U.S. state where the One (1) Year residence is located (use the two-letter abbreviation or the full state name). Max length: 6 characters
One (1) Year - Zip Code	Text	Enter the ZIP code for the One (1) Year address (5-digit or ZIP+4 format, if applicable). Max length: 13 characters
One (1) Year - County	Text	Enter the county name in which the One (1) Year residence is located. Max length: 18 characters
One (1) Year - Street Address	Text	Enter the full street address for the One (1) Year residence (no P.O. Boxes), including apartment or unit number if applicable. Max length: 28 characters
Address - Six (6) Months (Row 2)
Six (6) Months - State	Text	Enter the state for that address (use the two-letter state abbreviation or the full state name). Fill only if 'Six (6) Months (Row 2) - SAME AS PREVIOUS' is 'No'. Max length: 6 characters Depends on: Six (6) Months (Row 2) - SAME AS PREVIOUS
Six (6) Months - Zip Code	Text	Enter the ZIP code for that address (5-digit ZIP or ZIP+4; include the hyphen if using ZIP+4). Fill only if 'Six (6) Months (Row 2) - SAME AS PREVIOUS' is 'No'. Max length: 13 characters Depends on: Six (6) Months (Row 2) - SAME AS PREVIOUS
Six (6) Months - County	Text	Enter the county in which that address is located. Fill only if 'Six (6) Months (Row 2) - SAME AS PREVIOUS' is 'No'. Max length: 18 characters Depends on: Six (6) Months (Row 2) - SAME AS PREVIOUS
Six (6) Months - City	Text	Enter the city for the street address where you resided during the six-month period. Fill only if 'Six (6) Months (Row 2) - SAME AS PREVIOUS' is 'No'. Max length: 24 characters Depends on: Six (6) Months (Row 2) - SAME AS PREVIOUS
Six (6) Months - Street Address (No PO Box)	Text	Enter the full street address where you resided during the six-month period (do not use a P.O. Box; include apartment or unit number if applicable). Fill only if 'Six (6) Months (Row 2) - SAME AS PREVIOUS' is 'No'. Max length: 28 characters Depends on: Six (6) Months (Row 2) - SAME AS PREVIOUS
Six (6) Months (Row 2) - SAME AS PREVIOUS	Checkbox	Check this box if the Street Address for the Six (6) Months row (row 2) is the same as the previously provided address.
Application Submission Checklist
Signed Application	Checkbox	Check this box when you have completed and signed the Certificate of Residence application form.
Copy of the Student and Parent/Legal Guardian NYS ID	Checkbox	Check this box when you are submitting a copy of the student’s and, if applicable, the parent/legal guardian’s New York State ID (driver’s license, permit, or non-driver’s ID).
Copy of one document from List A, one from List B, and one from List C	Checkbox	Check this box when you are including one document from List A, one from List B, and one from List C as required to prove residency.
Citizenship Status (pick one checkboxes)
U.S. Citizen	Checkbox	Check this box if you are a United States citizen.
Permanent Resident (Green Card)	Checkbox	Check this box if you are a lawful permanent resident of the United States (provide a copy of your Green Card).
Visa	Checkbox	Check this box if you are in the United States on a visa (provide a copy of your visa).
Other	Checkbox	Check this box if your citizenship status is not listed above (select this option and specify your status if requested).
Enrollment - Semester checkboxes, Year, College Name
Starting Semester - Fall	Checkbox	Check this box if your starting semester for enrollment is Fall.
Starting Semester - Spring	Checkbox	Check this box if your starting semester for enrollment is Spring.
Starting Semester - Winter	Checkbox	Check this box if your starting semester for enrollment is Winter.
Starting Semester - Summer	Checkbox	Check this box if your starting semester for enrollment is Summer.
College or Institute Name	Text	Enter the full name of the college or institute you will be attending for the starting semester. Max length: 52 characters
text_eae2_eff3	Text	Max length: 1 characters
Year (Starting Semester)	Text	Enter the calendar year for the starting semester (e.g., 2026). Max length: 5 characters
For Office Use Only (internal ID fields)
ID	Checkbox	Check this box when office staff have entered or verified the internal "ID" value for this application.
12	Checkbox	Check this box when office staff have recorded or verified the internal "12" identifier/code associated with this application.
6	Checkbox	Check this box when office staff have recorded or verified the internal "6" identifier/code associated with this application.
C	Checkbox	Check this box when office staff have recorded or verified the internal "C" identifier/code for this application.
PID	Checkbox	Check this box when office staff have entered or verified the internal "PID" (parcel/person identifier) for this application.
General
text_14e2_8b55	Text	Max length: 1 characters
Right‑margin small field (4)
Right‑margin small field (4) - ID	Checkbox	Check this box when the office-use code 'ID' applies to this record.
Student Contact Info (Phone, Email)
Student Last Name	Text	Enter the student's family/last name exactly as it appears on official records. Max length: 51 characters
Student First Name	Text	Enter the student's given/first name exactly as it appears on official records. Max length: 62 characters
Student Name and Date of Birth
Student Last Name	Text	Enter the student's family/last name exactly as it appears on official records. Max length: 43 characters
Student First Name	Text	Enter the student's given/first name (include middle initial only if required). Max length: 51 characters
Date of Birth	Date	Enter the student's date of birth. Max length: 18 characters
Student Signature and Date
Student Signature	Text	Enter the student's full legal signature to certify that the information on this form is true and accurate. Max length: 44 characters
Signature Date	Date	Enter the date when the student signed this form. Max length: 20 characters
Top‑left small field (12)
checkbox_d7ac_cb0e	CheckBox

Orange County Department of Finance Certificate of Residence (Affirmation and Application) — SUNY B-80 (Rev. 06.04.2024) Instructions