Application For The Benefit Of A Reduced Tuition Rate As A Member Of The Armed Services Or Dependent Relative Form Page 3

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PART II. FOR APPLICANTS WHO CLAIM THE TUITION BENEFIT AS DEPENDENT RELATIVES OF ACTIVE
DUTY SERVICE MEMBERS.
1. Have you been academically admitted to this institution or are currently enrolled?
Yes____ No ____
2. Indicate the term and year for which you want this decision to apply:
Semester ___________________ Year ______________
3. For the service member through whom you claim the tuition benefit, provide the following:
A. Full Name _________________________________________________________
B. Rank _____________________________________________________________
C. Date of Birth _________________________
D. Branch of Service: Army ____ Navy ____ Marines ____ Air Force ____ Coast Guard ____
E. Is this a Reserve Component of the indicated service?
Yes____ No ____
F. Permanent duty station? ________________________________________________
4. 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? ___________________________
5. Is the service member through whom you claim the tuition benefit in receipt of orders of permanent assignment
outside of NC? Yes____ No ____
If “Yes”, what is the beginning date of the assignment? ___________________________
6. What is the relationship to the service member through whom you claim the tuition benefit?
_______________________________________________
7. ATTACH an affidavit, ON PRE-PRENTED MILITARY LETTERHEAD, from the appropriate military authority
attesting to your military dependency status and the duty status and location of the service member whose
depended you are (your sponsor). For an example,
click
here.
8. 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.)
____________________________________________________________________________________________
____________________________________________________________________________________________
UNIVERSITY OF NORTH CAROLINA WILMINGTON 
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