------ For Office Use Only -----
Military Personnel
Including Spouses & Dependents
Authority:
Active duty personnel in the armed services and their dependent relatives may be eligible for in-state tuition. An active
duty member of the military who qualifies for admissions to an institution of higher education in the State may qualify
for in-state tuition in two ways: as a domiciliary of the State or pursuant to a statutory grant as defined in G.S.116143.3. If a non-resident member of the armed services is abiding in the State, incident to active military duty, then the
in-state tuition rate and applicable mandatory fees will apply to the service member stationed in North Carolina and to
his/her dependent relatives who are sharing his/her abode.
Any member of the North Carolina National Guard, regardless of whether the person is a legal resident of North
Carolina, is eligible for in-state tuition rate whether in a reserve or active status. However, this benefit does not apply to
dependents of non-resident Guard members unless the Guard member is serving in North Carolina on active duty.
[Section: IV. B. 2 page 16]
Directions for Completing the Application:
1. Print or type your response to each question. Important: Be completely accurate to the best of your knowledge and
understanding; knowingly falsifying your responses may subject you to disciplinary action including dismissal from
the institution.
2. Sign and date this application where indicated to those acknowledgements and certifications necessary to render
this a viable application. Important: If you do not sign the application, it will be returned to you.
3. Attach required affidavit on military letterhead.
4. Make a copy of your entire application to keep for your records.
Student Contact Information
Applicant’s Full Name:
,
Last Name
First Name
Middle Name
Previous or Maiden Name:
Student ID #:
Date of Birth:
SSN (last four):
Click to choose date.
###-##-
No SSN:
Age:
University Assigned Email Address:
Daytime Phone:
(
)
Is this a cell phone:
Yes
No
Evening Phone:
(
)
Is this a cell phone:
Yes
No
Applicant is:
Active Duty Military
Spouse of Active Duty Military
Dependent Son or Daughter
Current Mailing Address (If written communication is required concerning this petition, it will be sent to this address.)
Addr Line 1:
Addr Line 2:
City:
State:
Zip:
If non US Address
Providence/Country:
From:
Click to choose date.
To:
Permanent Address
Addr Line 1:
Addr Line 2:
City:
Click to choose date.
State:
Zip:
-
If non US Address
Providence/Country:
From:
Click to choose date.
To:
Click to choose date.
Application Term & Enrollment Information
This application applies to which term(semester & year):
Term which you began at this institution(semester & year):
Are you enrolled at this institution for the current or future term?
Service Member Information
Is Applicant also Service Member: Yes
,
Service Member’s Full Name:
Last Name
1.
2.
3.
4.
5.
6.
7.
8.
9.
Yes
First Name
No
No
Middle Name
Rank:
Serial Number
If Applicant is not the Service Member, is the applicant living in Service Member’s home?
Yes
Service member is currently serving on active duty in which branch of the armed services?
N.C. National Guard
U.S. Army
U.S. Marine Corps
U.S Air Force
U.S. Coast Guard
U.S. Navy
Is this a Reserve Component of the indicated service?
Yes
No
What is Service Member’s current Home of Record state?
What is Service Member’s permanent duty station?
Is the Service Member currently assigned to temporary duty in North Carolina?
Yes
No
If “Yes” provide dates.
Beginning: Click to choose date.
Ending: Click to choose date.
Are you being sponsored by the military?
Yes
No
If Yes, name the sponsor
Attach a letter on military letterhead from the appropriate military authority (i.e. commanding officer or
personnel officer) attesting to your active duty status and permanent duty station.
No
Selective Service
(applies only to dependents)
NOTE: All male citizens born on or after January 1, 1972, who are 18 but not yet 26 years old must register with the
Selective Service System.
Military Personnel; Spouses & Dependents
Page 2 of 3
11/22/2010
Are you currently registered with the Selective Service System?
If “No” state reason:
Yes
No
Statement of Claim
I attest that I am an active duty member of the Armed Services or NC National Guard, or the spouse/dependent of a
member an active duty member of the Armed Services; who is stationed in or a legal resident of North Carolina; and
(pursuant to the applicable laws and policies) meet the qualifications for the benefit of the in-state rate of tuition.
Acknowledgements and Certification:
I hereby certify that, to the best of my knowledge and belief, all information I have set forth herein is true and accurate.
I understand and agree that the institution may verify information with regard to this application.
I understand that the institution may divulge the contents of this application only as permitted under state laws and/or
under the Family Educational Rights and Privacy Act of 1974 if I am, or have been, in attendance at this institution.
I understand that knowing falsification of this application may result in revocation of my admission and/or a violation
under the institution’s code of conduct.
Applicant’s Signature
Date
Parent or Guardian Signature
if applicant is a minor
Date
Submit to:
New Undergraduate Students
Office of Admissions
102 Cordelia Camp Building
Cullowhee, NC 28723
admiss@wcu.edu
(828) 227-7317
Continuing Undergraduate
Students
Registrar's Office
206 Killian Annex
Cullowhee, NC 28723
registrar@wcu.edu
(828) 227-7216
Military Personnel; Spouses & Dependents
Page 3 of 3
New & Continuing Graduate
Students
Graduate School
110 Cordelia Camp Building
Cullowhee, NC 28723
grad@wcu.edu
(828) 227-7398
11/22/2010