North Carolina Residence & Tuition Status Application Form
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4NORTH CAROLINA RESIDENCE & TUITION STATUS APPLICATION
APPLICANT INFORMATION
1. Applicant Student’s Full Name ___________________________________________________
2. Social security number (voluntary) _____________________
Citizenship ___________________________
(If not a US citizen, attach completed Supplemental Form) If Supplemental Form attached, check here
3. Date of birth________________
Place of birth _______________________________________________
4. Address while attending institution (current) ___________________________________________________
5. Permanent home address____________________________________________________________________
Since _______________________
Telephone _______________________
6. Previous home address in NC: ________________________________________________________________
From: ______/_____/_____
To: _____/_____/_____
Last previous home address outside N.C._____________________________________________________
From: _____/_____/_____
To: _____/_____/_____
7. Are you currently enrolled in this institution? (Yes or No)_______ Are you applying for admission?_______
Circle earliest term and indicate year in which you want this decision to apply:
Year ________
Fall
Spring
Summer, First Sess.
Summer, Second Sess.
8. Why did you move your home to North Carolina:______________________________________________________
On what date did you move your home to North Carolina: _____/_____/_____
9. From what state or foreign country did you move your home and legal residence:____________________________
10. When do you claim your legal residence in NC began? ___________________________________________________
11. Has your residence status for tuition purposes been previously determined by a North Carolina public education
institution? (Yes or No)________ If yes, (A) Name of institution:___________________________________________
(B) Classification: Resident_____________ Nonresident _____________
(C) Last term and year your were so classified: _______________________
12. Secondary (high or preparatory) schools you attended in sequence:
Name
Address (place & state)
From (date)
To (date)
a) _________________________
____________________________
______________
______________
b) _________________________
____________________________
______________
______________
13. List ALL post-secondary schools (universities, colleges, junior colleges, community colleges, etc) you have attended, in
sequence (including this institution):
Institution
Address (place & state)
From (date)
To (date)
a) _________________________
____________________________
______________
______________
b) _________________________
____________________________
______________
______________
14. Father living? (Yes or No)_________ Name_________________________Occupation ___________________________
Permanent home address______________________________________
Since ________________________________
15. Mother living? (Yes or No)_________ Name_________________________Occupation __________________________
Permanent home address______________________________________
Since ________________________________
16. Parents separated or divorced? (Yes or No)________ Who has /had custody of you? ___________________________
17. Legal Guardian? (Yes or No)_________ Name_________________________Occupation ________________________
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