Application For The Benefit Of Paying In-State Tuition As A Veteran Or Spouse / Dependent Of A Veteran Or Former Service Member Or Other Covered Individuals Using Transfered Chapter 33 Page 3

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Student Attestations:  
You must sign your initials by each statement in the sections that are applicable to you to indicate that 
you have read and understand these statements.  Failure to initial by each statement in the applicable 
sections may result in your application being returned and will delay processing.  
  
SPOUSE/DEPENDENT OF VETERAN:  
 
             I have attached a copy of the veteran’s DD214 (official or working copy) or service member’s 
death certificate (for Fry Scholarship recipients)  
  
             I have attached VA verification of transfer of Post 9/11 GI Bill benefits (Transfer of Entitlement) or 
Fry Scholarship award.  
  
             I am currently living in North Carolina or will be living in North Carolina on the first day of the 
term.  I intend to establish residency in North Carolina and understand that this document 
serves as my letter of intent to establish residency.    
  
              I have attached proof of my abode in North Carolina.  Proof of abode includes, but is not limited 
to:  copy of lease, a letter from landlord, copy of utility bill, or verification of on campus housing.    
  
ALL STUDENTS:  
 
               I have answered all questions. If any question was not applicable to my situation, I have written 
“N/A.”  Whenever “date” is requested, I have given month/day/year as accurately as possible. I 
understand that failure to answer all questions may result in the application being returned to 
me thus delaying a decision relative to my tuition status.  
  
              I have been completely accurate to the best of my knowledge and understanding. Further, I 
understand that knowing falsification of my responses may subject me to disciplinary action, 
including dismissal from the institution.  
  
               I have signed and dated this application where indicated. I understand that failure to make the 
necessary acknowledgements and certifications renders this an invalid application.  
  
               I understand that all applications and all supporting documents should be submitted to the 
appropriate department by the published deadline for the academic term for which I wish to be 
considered.  
  
              I understand that the burden of proof is on me, the applicant, to demonstrate that I qualify for 
the benefit of a reduced tuition rate as the spouse or dependent relative of an active duty 
member of the armed services or as a recipient of the Fry Scholarship or transferred education 
benefits under Chapter 33 (Post‐9/11 Educational Assistance) U.S. Department of Veterans 
Affairs benefits.  I understand that if it is determined that I am not eligible for the in‐state tuition 
rate then I will be responsible for and charged at the out‐of‐state rate.  
  
  
Page 3  
  
July 31, 2015  
  

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