Last First Middle Initial
Student ID#: or Last 4 Digits of Social Security #:
COASTAL CAROLINA COMMUNITY COLLEGE
Application for the Benet of the In-State Tuition Rate
as a Dependent Family Member
Under North Carolina General Statues 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 benet is claimed**
1. Respond to all questions and complete all the questions within the part of the form that applies 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 your application form.
3. Be completely accurate to the best of your knowledge and understanding.
Note: Knowing falsication 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 certications
necessary to render this a viable application.
Please note: The certifying Military Ofcial must be a Staff Non-Commissioned Ofcer, higher
ranking ofcial or designated Family Readiness Ofcer.
6. Turn in complete application to the Admissions Ofce located in the Student Service Center.
7. If you have any questions, please contact the Admissions Ofce at (910) 938-6396.