3. U.S. Military Service—If you will be providing documentation of your status related to U.S. military service,
please check the appropriate category and provide the related documentation.
_____Stu
dent is a veteran (provide copy of DD214 or similar showing discharge)
_____Student is an active military member (Provide copy of current military orders or similar)
_____Student is a covered individual: spouse, dependent or individual using educational assistance (provide copy of
service member’s documentation AND documentation of student relationship to service member)
You are not required to complete the remaining questions. Please proceed to signature section; sign and return
form with documentation. Note: If you plan to use any GI Bill education benefits, you may want to contact the
NMU Financial Aid Office to discuss possible impacts of a residency change.
4. Are you living with a relative? Yes No
If so, please indicate the nature of the relationship (e.g., parent, aunt, brother, etc.).
_____________________________________________________________________________________
5. Please state the address of the place which you consider to be your permanent home. This address must match the
permanent address the University has for you.
_____________________________________________________________________________________
6. Please state the name(s) of your parent(s) or legal guardian (s), and list all addresses where they have resided for
the last three years. Also, please include the time periods during which they have resided at those addresses. If there
are more than three addresses, please provide the information in the comments section (item #13).
a.___________________________________________________________________________________
From (mm/dd/yy):________To (mm/dd/yy):_______
b.___________________________________________________________________________________
From (mm/dd/yy):________To (mm/dd/yy):_______
c.___________________________________________________________________________________
From (mm/dd/yy):________To (mm/dd/yy):_______
7. Please list the company/business names and addresses of your employers for the previous three years and the
dates during which you were employed. If you are presently employed, please state whether you consider the
employment temporary or permanent. If there are gaps in employment, please explain.
Company name:_________________________________________________________________________
Company
address:_______________________________________________________________________
Dates Employed -From (mm/dd/yy):________To (mm/dd/yy):________Temporary or Permanent
Company name:_________________________________________________________________________
Company address:_______________________________________________________________________
Dates Employed -From (mm/dd/yy):________To (mm/dd/yy):________ Temporary or Permanent
Company name:_________________________________________________________________________
Company address:_______________________________________________________________________
Dates Employed -From (mm/dd/yy):________To (mm/dd/yy):________ Temporary or Permanent