Uncg - North Carolina Residency Questionnaire Form
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1
2
3
4• Return to:
UNCG - Undergraduate Admissions
UNCG
PO Box 26170
Greensboro, NC 27402
North Carolina Residency Questionnaire (Short Form)
• E-mail to
or
admissions@uncg.edu
• Upload it in Spartanlink
The following information is required for all NC Residents.
NOTE: Failure to complete this form in full will delay notification of an admission decision and will result in a
non-resident classification for tuition purposes (you will be charged the out-of-state tuition rate). If you have any
questions about your residency, please contact Undergraduate Admissions at (336) 334-5243.
Instructions:
Answer all questions completely. Print clearly in ink or type. Do not leave any spaces blank. If questions do not apply to you,
please write “N/A” – omitted information may result in a non-resident classification for tuition purposes. Please submit this form to
Undergraduate Admissions in one of the three ways described above. Faxed copies are not accepted.
Full Legal Name ___________________________________________________________________________________________________________
1.
Date of Birth ______/______/______ Place of Birth _________________________________ Citizenship ____________________ Sex ______
mo.
day
yr.
2.
Permanent Address
______________________________________________________________________________________________
(Street)
____________________________________________________________________________________ Since ___/_____/_____
(City, State, Zip)
mo.
day
yr.
.
3.
Current Mailing Address
_________________________________________________________________________________________
(Street)
(
)__________________________________________________________________________________ Since _____/_____/_____
City, State, Zip
mo.
day
yr.
4.
Current Telephone (______)_______________________
E-mail ____________________________________________________________
5.
Previous Address
________________________________________________________________________________________________
(Street)
(
)_________________________________________________________________
From ____/____/____ Until ____/____/____
City, State, Zip
mo.
day
yr.
mo.
day
yr.
6.
Last Address Outside NC
_________________________________________________________________________________________
(Street)
(
)__________________________________________________________________ From ____/____/____ Until ____/____/____
City, State, Zip
mo. day
yr.
mo.
day
yr.
Yes
No
8.
Do you claim to be a legal resident of North Carolina for the last 12 months for tuition purposes?
If “yes,” please complete the rest of the information below.
9. Driver’s license acquired: When______________(month/year) Where______________(state)
Driver’s license renewed: When______________(month/year) Where______________(state)
10. Have you been in active military service or have you been a military dependent in the past 12 months?
Yes
No
If “yes, ” attach to this application
copies of the “Leave and Earnings Statement” for the most recent pay period and for the pay period
12 months ago for each such person.
11. Have you ever worked outside of North Carolina?
Yes
No
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