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Updated 07/01/15
Carrington-Scott Campus
STUDENT SUCCESS
PO Box 8000
Graham, NC 27253-8000
Deferred Action for Childhood Arrivals (DACA) - Business Sponsorship Form
Pursuant to N.C.G.S § 115D-39(a), North Carolina law provides a special benefit to employers choosing
to pay the full cost of an eligible student/employee’s community college tuition. The employer is
granted the in-state tuition rate, even when the student/employee does not meet the general
requirements for in-state tuition. The law requires the student/employee to work at the employer’s
North Carolina business location. The burden of proof is on the student/employee to establish that the
business is a legitimate North Carolina business approved by the North Carolina Department of the
Secretary of State.
PART I: To Be Completed By the Student
Full Name: ________________________________________________________________________
Date of Birth: _________________________
Student ID #: _________________________
Semester(s) in which student is requesting
the DACA business sponsorship: _________________________________________________________
In order to be considered for the DACA business sponsorship, the student must submit the required
documents below to the Admissions Office (Director of Enrollment Management). Once documentation
is received and reviewed, an email correspondence of approval status will be sent to the students My
ACCess email account.
Completed DACA business sponsorship form
Copy of the I-797 Notice of Action form indicating DACA approval
Copy of employment authorization card/document
Copy of most recent pay stub to verify employment
PART II: To Be Completed By Sponsoring Business
Business name: _________________________________________________________________
Business address: _________________________________________________________________
Business federal tax ID #: ___________________ Business phone #: _____________________
Name of ACC student/employee sponsored: _______________________________________________
Semester(s) in which the
business is paying tuition: __________________________________________________________
Printed name and title of
authorized business representative: ______________________________________________________
I have reviewed the business sponsorship description (listed on page 1) and I confirm that the student
above is my current employee, and that the business listed above takes responsibility for tuition and fees
for the semester(s) listed above at ACC. I also confirm that the business listed above is an incorporated
business approved by the N.C. Department of the Secretary of State.
Authorized Business
Representative Signature: _________________________________________ Date: _______________
PART III: To Be Completed By ACC
The student meets the requirements for the DACA business sponsorship exception pursuant to N.C.G.S §
115D-39(a).
_____ Yes
_____ No
Director of Enrollment
Management Signature: ___________________________________________ Date: _______________
Additional Comments: