Military Residency Verification Form printable pdf download

Military Residency Verification Form

In compliance the Higher Education Opportunity Act, North Central Missouri College offers

Missouri residency benefits to military personnel and their spouses/dependents. To qualify,

parties must follow all required admissions procedures, complete the Military Residency

Verification Form and present required supporting documentation.

As the applicant, are you (please check one):

_____ the military person _____the spouse

_____the dependent of a military person

I am applying for the following year and term: ______________Year, and (please check one)

_____Fall

_____Spring

_____Summer

I am applying as: _____Military stationed in MO _____ Military re‐assigned to another state

(Missouri resident stationed elsewhere)

Applicant information:

Name:

Where Did You Live Before Your Present Stay in Missouri?

Address*:

Telephone:

City, State, Zip

Date Present Stay in MO Began:

*Correspondence will be mailed to the address currently on file with NCMC.

Military Person Information

Home of Record/State of Legal Residence:

Date Entered Service:

Current Duty Station (if applicable)

Date of Discharge (if applicable)

I certify that all statements, information, and evidence presented are true and complete. I understand that if I provide false

information, make a material misrepresentation or omission in connection with my petition, or, if I make any effort to

fraudulently claim resident status under one of the military exception categories, it may jeopardize my case for residency and

subject me to disciplinary action, dismissal from the College, repayment of tuition fraudulently waived, and/or repayment of

financial aid fraudulently obtained, and it may result in civil and criminal liability. I hereby grant permission for NCMC

representatives to verify any supporting evidence submitted with this form.

__________________________________________

_________________________

Signature of applicant

Date

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Please return to Registrar’s Office, Alexander Student Center

Military Residency Verification Form