Application For Clasification As A Legal Resident (Domiciliary) Of North Carolina For Tuition Purposes (Long Form)

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NORTH CAROLINA STATE EDUCATION ASSISTANCE AUTHORITY
APPLICATION FOR CLASSIFICATION AS A LEGAL RESIDENT (DOMICILIARY)
OF NORTH CAROLINA FOR TUITION PURPOSES (Long Form)
Under North Carolina law, bona fide legal residents (domiciliaries) of North Carolina are eligible for certain state grants to
students attending private education institutions. In essence, the controlling North Carolina statute (G.S. 116-143.1)
requires: “To qualify as a resident for tuition purposes, a person must have established legal residence (domicile) in North
Carolina and maintained that legal residence for at least 12 months immediately prior to his or her classification as a
resident for tuition purposes.”
G.S. 116.143.1 also sets forth statutory definitions, rules and special provisions for
determining resident status for tuition purposes. To be classified a resident for tuition purposes, you must furnish such
evidence as the institution may require to enable it to make such classification. If you claim North Carolina residence for
tuition purposes, you must file this application promptly.
DIRECTIONS
1. Answer all Questions. Incomplete Forms Will Be Returned. If a question is not applicable to your own situation, write
“not applicable.”
2. Print or Type All Responses. If you need more space to answer, 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. When “Date” is Required, Give Month, Day
and Year.
4. Sign and Date this application where indicated to make those acknowledgements and certifications necessary to render
this an acceptable application.
TYPE ALL RESPONSES OR PRINT THEM IN BLACK INK OR DARK PENCIL
1. Applicant student’s full name (Mr., Mrs., Miss, Ms.)
__________________________________ _____
2. Social Security number (voluntary) ___________________ Citizenship__________________________________
(If not a U.S. citizen, indicate your Visa classification
3. Date of birth _______________ Place of birth __________
________ Sex____________ Age _______
4. Current mailing address _______________________________________________________________________
_____________________ Until __________________________ Telephone (_______) _____________________
5. Permanent home street address ________________________________________________________________
Lived at that address since (date) _____________________________ Telephone (_______) ________________
6. Last previous home street address in N.C. was _____________________________________________________
_______________________________from (date) ___________________ to (date)________________________
Last previous home street address outside N.C. was ________________________________________________
_______________________________from (date)___________________ to (date) ________________________
7. Secondary (high or preparatory) schools you attended in sequence:
Name
Address (place & state)
From (Date)
To (Date)
a) _____________________________ _________________________ _______________ _______________
b) _____________________________ _________________________ _______________ _______________
8. List ALL post-secondary schools (universities, colleges, junior colleges, community colleges, etc.) you have
attended, in sequence:
Institution
Address (place & state)
From (Date)
To (Date)
a) ________________________________ ________________________________ ____________ ___________
b) ________________________________ ________________________________ ____________ ___________
If married, also list all of the above educational information for your spouse:
Institution
Address (place & state)
From (Date)
To (Date)
a) _______________________________ ________________________________ ____________ ___________
b) _______________________________ ________________________________ ____________ ___________

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