The Residency Manual
APPENDIX D. Application for the Benefit of a Reduced Tuition Rate as a Member of the Armed Services or Dependent Relative Thereof
Under North Carolina General Statutes Section (G.S.) 116-143.3 certain members of the armed services and their dependent relatives may be eligible to be charged a tuition rate less than the out-of-state rate whether or not they qualify as residents for tuition purposes under G.S. 116-143 .1. The pertinent law and implementing regulations are available for inspection in the
and may be examined upon request. Included among the requirements are that the member of the armed services and a relative claiming the benefit through a member be living together in North Carolina incident to the supporting member's active military duty and that the applicant for the benefit qualify for academic admission at the pertinent institution. This application, in proper order, must be submitted prior to the first day of classes of the first term of enrollment in each academic year for which the reduced tuition benefit is claimed.
DIRECTIONS
1 Respond to all questions within the part of the form that you are to complete. If any question is not applicable to your situation, write "Not Applicable" or "N/A."
2. Print or type all responses. If necessary, write "see attached" in the space provided, and use separate additional sheets, numbering your responses the same as the corresponding question and stapling or taping these sheets to this application form.
3. Be completely accurate to the best of your knowledge and understanding. Knowing falsification of your responses may subject you to disciplinary action including dismissal from the institution. When "date" is requested, give day, month, and year.
4. Sign and date this application where indicated to make those acknowledgments and certifications necessary to render this a viable application.
5. Attach the required affidavit(s). (See Part I, items 10 and 11, or Part II, item 11, as appropriate.)
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PART I. FOR APPLICANTS WHO ARE THEMSELVES SERVICE MEMBERS.
(If you are not a member of the Armed Services, skip to Part II.)
1. Applicant's full name rank , serial number.
2. Social security number (voluntary).
3. Date of birth.
4. Check that one of the following armed services in which you are currently serving on active military duty:
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U. S. Air Force U. S. Marine Corps
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U. S. Army N.C. National Guard
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U. S. Coast Guard U. S. Navy
Is this a Reserve Component of the indicated service? Yes No.
5. What is your permanent duty station?
6. What is the street address or building location at which you are currently living?
7. Have you been academically admitted to this institution? Yes No .
8. Beginning with what academic term are you seeking the tuition benefit?
9. Do the orders by which you were assigned to active military duty in North Carolina establish a date on which that duty will cease? Yes No . If "Yes," what is that date?
10. Attach an affidavit from the appropriate military authority attesting to your duty status and location.
11. Attach an affidavit from the appropriate military authority identifying any amounts payable to this institution, or to you, from federal or state government that are military education assistance to pay tuition. This affidavit may express these amounts either as a percentage of eligible costs to be covered or as a dollar amount paid or to be paid, depending on how the authorizing regulation is worded.
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PART II. FOR APPLICANTS WHO CLAIM THE TUITION BENEFIT AS DEPENDENT RELATIVES OF SERVICE MEMBERS
1. Applicant's full name
2. Social Security number (voluntary)
3. Date of birth
4. What is the street address or building location at which you are currently living?
5. Have you been academically admitted to this institution? Yes____No____
6. Beginning with what academic term are you seeking the tuition benefit?
7. For the service member through whom you claim the tuition benefit, provide the following:
a. Full name
b. Rank
c. Seria l Number
d. Date of birth
e. Branch of armed service (check one):
- U. S. Air Force U. S. Marine Corps
- U. S. Army N. C. National Guard
- U. S. Coast Guard U. S. Navy
Is this a Reserve Component of the indicated service? Yes No.
f. Permanent duty station
g. Street address or building location at which the service member currently lives
8. Do the orders by which the service member was assigned to active military duty in North Carolina establish a date on which that duty will cease? Yes No. If "Yes," what is the date?
9. Is the service member through whom you claim the tuition benefit in receipt of orders for permanent assignment outside of North Carolina? Yes No. If "Yes," what is the beginning date of that assignment?
10. What is your relationship to the service member through whom you claim the tuition benefit?
11. Attach an affidavit from the appropriate military authority at testing to your military dependency status and the duty status and location of the service member whose dependent you are (your sponsor).
12. Are you currently registered with the Selective Service System? Yes No .
If "No" state why you are not so registered.
(Note. All male citizens born on or after January 1, 1960, who are 18 but not yet 26 years old must register with the Selective Service System.)
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- - I hereby acknowledge that completion of Item 2 of Part I or II (Social Security number) is voluntary, is requested by the Institution solely for administrative convenience and record-keeping accuracy, and is requested only to provide a personal identifier for the internal records of this institution.
- - I hereby certify that all information I have set forth herein is true to the best of my knowledge, pursuant to my reasonable inquiry where needed.
- - I hereby acknowledge that the institution may verify the information set forth herein from sources accessible under law to the institution but that the institution may divulge the contents of this application only as permitted under the Family Educational Rights and Privacy Act of 1974 if I am, or have been, in attendance at this institution.
Applicant's signature Date
Signature of parent or guardian (if applicant Date is under 18 years of age)
