Application for Classification as a Legal Resident (Domiciliary) of
North Carolina for Tuition Purposes
State law allows bona fide North Carolina legal residents (domiciliaries) to be eligible for a lower tuition rate than
non-residents. North Carolina law (G.S. 116-143.1) requires you to establish legal residence (domicile) in North
Carolina and maintain it for at least 12 months immediately prior to the beginning of the term for which you seek
classification as a resident for tuition purposes. The statute also contains definitions, rules and special provisions
for determining residence for tuition purposes. Copies of the law and the local institution's policies may be
obtained from each community college.
If you are admitted to the college (or readmitted after a lapse in enrollment) the law requires the community
college to classify you as a resident or non-resident for tuition purposes for your term of admission. If you claim
North Carolina residence for tuition purposes, you must file this application before the end of the term for
which you claim such residence. To be classified a resident for tuition purposes, you must give the college the
evidence it requires to enable it to make that classification.
Directions
1.
Please print (in black or blue ink) all responses. If the question is not applicable to your situation, write
"NA". When "date" is requested, provide month, day, and year.
2.
You may be asked to provide appropriate documents to substantiate your claim if we are unable to make a
determination solely from your application. Examples of such documentation may include tax returns, a
voter registration card, a birth certificate, a marriage license, utility bills, INS documents, and/or a
current VISA.
3.
Please answer all questions accurately and completely. You are encouraged to write on the back of the
application or attach additional sheets if you need more space to provide a complete answer. You are also
encouraged to provide detailed, supplemental information concerning your residency claim. By providing
complete answers initially, you help eliminate processing delays that occur when we must get in touch with
you to obtain additional information.
4.
If you and/or your spouse are not U.S. citizens, you will be required to supply immigration information on
a supplemental form by the community college. You will be expected to provide a current VISA.
5.
All forms are available at the Registration and Records Office, or online at www.waketech.edu, and must
be returned to the local community college where you are enrolled or intend to enroll for review.
Remember: The application must be completed entirely in order for it to be reviewed.
Thank you
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North Carolina Residence and Tuition Status Application
Application Information
1.
Applicant Student’s Full Name:
2.
Social Security Number (voluntary):
Citizenship:
(If not a U.S. citizen, attach completed Supplemental Form)) If Supplemental Form attached, check here
3.
Date of Birth:
4.
Address while attending institution (current):
5.
Permanent home address:
Since:
6.
Place of Birth:
Telephone:
Previous home address in N.C.:
From:
E-mail Address:
To:
Last previous home address outside N.C.:
From:
To:
7.
Are you currently enrolled in this institution?
Yes
No Are you applying for admission?
Circle earliest term and indicate year in which you want this decision to apply:
Fall
Spring
Summer, First Session
Summer, Second Session
8.
Why did you move your home to North Carolina?
On what date did you move your home to North Carolina?
9.
From what state or foreign country did you move you home and legal residence?
10.
When do you claim your legal residence in N.C. began?
11.
Has your residence status for tuition purposes been previously determined by the North Carolina public
educational institution?
Yes
No If yes,
(A) Name of institution:
(B) Classification: Resident
Non-resident
(C) Last term and year you were so classified:
12.
Secondary (high or preparatory) schools you attended in sequence:
Name
Address (place and state)
a.
From (date)
To (date)
b.
13.
List all post-secondary schools (universities, colleges, junior colleges, community colleges, etc.) you have attended,
in sequence (including this institution):
Name
Address (place and state)
From (date)
To (date)
a.
b.
14.
Father living? (Yes or No)
Permanent home address:
Name
Occupation:
Since:
15.
Mother living? (Yes or No)
Permanent home address:
Name
Occupation:
Since:
16.
Parents separated or divorce? (Yes or No)
17.
Legal guardian? (Yes or No)
Permanent home address:
Court appointed at (place):
Who has/had custody of you?
Name
Occupation:
Since:
(on date)
1
Form 427 R-9 (6-26-08) LW
18.
Who (including yourself) last claimed you as an exemption on state and/or federal income tax returns, for what tax
year, and in what state filed?
a. On state return for
tax year, filed in (state)
on (date)
Name:
Relationship to you:
b. On federal return for
tax year, filed in (state)
on (date)
Name:
Relationship to you:
c. Does anyone intend to claim you as a dependent on state and/or federal income tax returns for the current tax
year?
Yes
No
19.
List in chronological order to date of this application all places you have spent at least 7 consecutive days during
the past three years. Your response must include your current address, all other places lived, and vacations.
Place (city and state)
Occupation or Purpose
From (date)
To (date)
a.
b.
c.
20.
When and where (state or foreign country) did you do each of the following during the last 24 months? List each
time you did each such act (If not done in the last 24 months, list where and when such acts were done the last time
you did them; if never done at all, write “never”):
Where
Month/Day/Year
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
Registered to vote
Voted
Called to serve on jury duty
Acquired or renewed driver's
license
Acquired ownership of property for
use as your principal dwelling
Inclusive dates of such property
ownership
Filed state intangibles tax return
Listed personal property for
taxation in the county where you
live
Filed state income tax return
Did you file as a resident or nonresident?
Had state income tax withheld
during the current tax year?
Beginning (Month/Day/Year)
During the previous year?
k.
21.
from:
to:
Yes
Where
Month/Day/Year
from:
to:
No
Where
Month/Day/Year
from:
to:
State(s)
Yes
No State(s)
Beginning (Month/Day/Year)
Was all of the amount withheld
refunded to you?
Yes
No
Registered/licensed a motor vehicle (car, truck, or other requiring license)
Type of vehicle (list all)
Where registered/ licensed
The car(s) or other motor vehicles which you maintain and operate in N.C. are owned by:
Name:
Address:
Registered/licensed in (state or foreign country):
Insured in the name of:
Address:
2
(Month/Day/Year)
22.
List the addresses at which you own and maintain personal property (clothing, furniture, cars, boats, checking or
savings accounts, stocks, bonds, pets, jewelry, appliances, etc.) and give percentage of value (of total personal
property) maintained at each address:
Address
% at this address
a.
b.
23.
List your employment for wages in the last 24 months?
Job Title
Employer
Address
(place and state)
Dates
(from)
(to)
Hours per week
a
b.
c.
24.
Of the total money required to meet your expenses, what percentage came from each of the following sources and
what was it used for?
Source
Your earnings
Your savings
Parent(s) or
Guardian
Name
Other (specify)
Total
25.
a.
b.
Preceding Calendar Year (Jan-Dec
% of Total
Used For
100%
)
Current Calendar Year (Jan-Dec
)
% of Total
Used For
100%
Have you or either of your parents been in active military service within the past two years? (Yes of
No)
If so, for each such person, attach copies of the "Leave and Earnings Statements" for the most recent pay
period and for the pay period 12 months ago.
If you or either of your parents have been in active military service or other federal government employment
within the past two years, answer the following for each such person:
Name(s):
Relationship to you:
Home address upon entry:
Official “home or record”:
Official home address now:
Date this home address was declared:
Home address upon discharge:
Date of discharge:
Legal residence most recently claimed on DD Form 2058 (State of Legal Residence Certificate):
Date that DD Form 2058 was completed:
Place to which mileage was paid upon discharge:
State for which income tax withheld:
From what date?
26.
Answer the questions below for each of the following individuals:
Your parents (or legal guardian) if you now live with them or have lived with them in the past 24 months or if
they have claimed you as a dependent for tax purposes in the past 24 months. Answer this question for your
father unless you parents are separated or divorced. If your parents are separated or divorced, answer this
question for both parents.
Any other person who has claimed you as a dependent for tax purposes within the past 24 months.
a. Names(s):
Relationship to you:
Permanent home address:
Lived at this address since (date):
Last previous home address:
From (date):
To (date):
3
b.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
27.
Where (state or foreign country) and when did this person do each of the following during the last 24 months?
List each time he or she did each such act. (If not done in the last 24 months, where and when did he or she
do these acts last? If never done at all, write "never"):
Where
Where
Where
Month/Day/Year
Month/Day/Year
Month/Day/Year
Registered to vote
Voted
Called to serve on jury duty
Acquired or renewed driver's
license
Acquired ownership of property
for use as your principal
dwelling
Inclusive dates of such property
from:
from:
from:
ownership
to:
to:
to:
Filed state intangibles tax return
Listed personal property for
taxation in the county where you
live
Filed state income tax return
Did you file as a resident or nonresident?
Registered/licensed a motor
vehicle (car, truck, or other
requiring license)
Claimed you as an exemption on state income tax return for
Tax year, file in (state)
on (date)
; federal income tax return for
tax year, filed in (state)
If there are additional circumstances, events, or acts that you feel support your claim to North Carolina legal
residence (domicile) for tuition purposes, attach a description of each, specifying the place and date of its
occurrence.
Applicant’s Acknowledgement and Certification

I hereby acknowledge that completion of Item 2 (Social Security Number) is voluntary, is requested by the
institution solely for administrative convenience and record-keeping accuracy, and is requested only to provide a
personal identifier for the internal records of this institution.

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.
Applicant’s Signature
Date
Signature of parent or guardian (if applicant is under 18 years of age)
Date
For Office Use Only
Approved
Date:
Disapproved
Initials:
Updated
Date:
Initials:
4
Date:
Initials: