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
Page 1 of 2
Please return to Registrar’s Office, Alexander Student Center