Application For The Benefit Of A Reduced Tuition Rate As A Member Of The Armed Services Or Dependent Relative Form Page 2

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FOR OFFICE USE ONLY
APPLICANT INFORMATION
STATUS:
IN-STATE
OUT-OF-STATE
Type all responses
TERM _____________________________
DATE OF MEETING ______________________
Applicant’s full name _____________________________________________
Date of birth ________________
Student ID number (if applicable) ___________________________________
Local mailing address ________________________________________________________________________
City _________________________________
State _______
Zip _______________________
UNCW E-mail __________________________________________________________________
Major / Program of Study ___________________________________________________________
PART I. FOR APPLICANTS WHO ARE THEMSELVES SERVICE MEMBERS.
(If you are not a member of the Armed Services, skip to Part II.)
1. Rank _______________________________________________________________
2. Please select one of the following armed services in which you are currently serving on active duty:
Army ____ Navy ____ Marines ____ Air Force ____ Coast Guard ____
Is this a reserve Component of the indicated service?
Yes____ No ____
3. What is your permanent duty station? ________________________________________________
4. Have you been academically admitted to this institution or are currently enrolled?
Yes____ No ____
5. Indicate the term and year for which you want this decision to apply:
Semester/Term_________
Year ______
6. 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 the date? ___________________________
7. ATTACH an affidavit, ON PRE-PRINTED MILITARY LETTERHEAD, from the appropriate military authority
attesting to your duty status and location. For an example,
click
here: .
UNIVERSITY OF NORTH CAROLINA WILMINGTON 
2

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