Student’s Name: _________________________________________________________________
Last First Middle Initial
Student ID#: ____________________ or Last 4 digits of Social Security #: ________
Application for the Benefit of the In-State Tuition Rate
as a Member of the Armed Services
Under North Carolina General Statutes Section (NC G.S. 116-143.3) certain members of the armed
services and their dependent family members may be eligible to be charged the in-state tuition rate
whether or not they qualify as residents for tuition purposes under NC G.S. 116-143.1. The pertinent
law and implementing regulations are available for inspection in the Student Services Office at
Coastal Carolina Community College, and may be examined upon request. Included among the
requirements are that the member of the armed services and a family member claiming the benefit
through a member, be living in North Carolina incident to the supporting member’s active military duty
and that the applicant for the benefit qualify for academic admission at the pertinent institution.
**This application must be submitted prior to initial enrollment in each academic year for
which the in-state rate benefit is claimed**
1. Respond to all questions and complete all the questions within the part of the form that apply to you.
2. Print or type all responses. If necessary, write “See Attached” in the space provided, and use an
additional sheet(s), numbering your responses the same as the corresponding question and stapling
these sheets to you application form.
3. Be completely accurate to the best of your knowledge and understanding.
Note: Knowing falsification of your responses may subject you to disciplinary action,
including dismissal from the institution.
4. When a date is requested, please give the day, month and the full year.
5. Sign and date this application where indicated to make those acknowledgements and certifications
necessary to render this a viable application.
Please note: The certifying Military Official must be a Staff Non-Commissioned Officer, or
higher ranking official.
6. Turn in complete application to the Admissions Office located in the Student Service Center.
7. If you have any questions, please contact the Admissions Office at (910) 938-6396.
1. Applicant’s full name: ___________________________________________________________
Student ID#/Social Security Number: _______________________ Rank: ________________
Date of Birth: _____/_____/________
2. Check one of the following armed services in which you are currently serving on active duty:
US Marine Corps
US Navy
US Coast Guard
US Air Force
US Army
NC National Guard
3. Please mark your current duty station in North Carolina:
Camp Lejeune MCAS New River Cherry Point Other ___________________________
4. If necessary, can you provide documentation of your current duty station if requested by the
college? YES NO (example: a copy of current orders, a current LES, a copy of your BIR, etc.)
5. Have you been academically admitted to Coastal Carolina Community College? YES NO
6. Beginning with which academic term are you seeking the tuition benefit? ____________________
Year Term
7. Service Member’s anticipated military separation date: _____/_______/_______
(Those with an indefinite military separation date should use expiration date on military id card) MONTH DAY YEAR
This is to attest that _________________________________________________ is on active duty at
Last First Middle Initial
Duty Station
_____________________________________ _____________________________________
Supervising Military Authority Name/Rank Supervising Military Authority Signature
***I hereby acknowledge that submission of my Student ID# or Social Security Number 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 the 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
***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 the application only as permitted under the Family Educational Rights and Privacy Act
(FERPA) of 1974 if I am, or have been, in attendance at the institution.
_____________________________________________________________________________ ________________________________________
Applicant’s Signature Date
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