Application For The Benefit Of A Reduced Tuition Rate As A Member Of The Armed Services Or Dependent Relative Form Page 4

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STUDENT ATTESTATIONS:

By initialing and/or electronically signing this document below, you are acknowledging that you have read and

understand these statements. Failure to initial by each statement below will result in your application being

returned and will delay processing.

Print/Type Initials

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1) I have answered all questions. If any question were not applicable to my situation, I have written “N/A.”

Whenever “date” is requested, I have given month/day/year as accurately as possible. I understand that failure

to answer all questions may result in the application being returned to me thus delaying a decision relative to

my residence-and-tuition status.

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2) I have printed legibly or typed all responses. (If necessary, write “see attached” in the space provided and

use separate additional sheets, numbering your responses the same as the corresponding question and

stapling these sheets to the application form.)

Print/Type Initials

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3) I have been completely accurate to the best of my knowledge and understanding. Further, I understand

that knowing falsification of my responses may subject me to disciplinary action, including dismissal from the

institution.

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4) I have signed and dated this application where indicated. I understand that failure to make the necessary

acknowledgements and certifications renders this an invalid application.

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5) I understand that all applications and all supporting documents must be submitted to the appropriate

for the

department by the FIRST OFFICIAL DAY OF UNCW CLASS as listed in the

Registrar’s calendar

academic term in which I wish to be considered for a change in residence classification for tuition

purposes.

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6) I understand that within 5 working days of submission of this form that the review process will begin.

Print/Type Initials

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7) I understand that the burden of proof is on me, the applicant, to demonstrate that I qualify for the benefit of a

reduced tuition rate as a member of the armed services or a dependent relative.

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8) I have attached an AFFIDAVIT, on PRE-PRINTED MILITARY LETTERHEAD from the appropriate military

authority attesting to my duty status and location or, if a depended, attesting to the duty status and location of

the service member whose dependent I am.

I hereby certify that all information I have set forth herein is true to the best of my knowledge, pursuant to my reasonable inquiry where needed.

I hereby acknowledge that the institution may verify the information set forth herein from sources accessible under law to the institution but that the

institution may divulge the contents of this application only as permitted under the Family Educational Rights and Privacy Act of 1974 if I am, or have

been, in attendance at this institution.

PLEASE PRINT OR TYPE TO ELECTRONICALLY SIGN THIS DOCUMENT.

Signature of Applicant ________________________________________________ Date _______________________

UNIVERSITY OF NORTH CAROLINA WILMINGTON