Request for Additional Residency Information (Classification Re-evaluation Form) - Fayetteville Technical Community College - North Carolina

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REQUEST FOR ADDITIONAL RESIDENCY INFORMATION
(CLASSIFICATION RE-EVALUATION FORM)
Date Submitted:
STUDENT NAME:
STUDENT ID/SSN (
):
Last Four
PLEASE PROVIDE COPIES ONLY!
Additional Documentation
NC Driver License
1040 Federal Tax Form
NC State Tax (
)
Form W2 (
)
Form D400
Wage and Tax Statement
Other
FOR OFFICIAL USE ONLY
APPEAL STATUS:
In-State
Out-of-State
REASON: _____________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________
Date: _____________________
Admissions Representative
FTCC Form A-31
Revised 03/12/2013
REQUEST FOR ADDITIONAL RESIDENCY INFORMATION
(CLASSIFICATION RE-EVALUATION FORM)
Date Submitted:
STUDENT NAME:
STUDENT ID/SSN (
):
Last Four
PLEASE PROVIDE COPIES ONLY!
Additional Documentation
NC Driver License
1040 Federal Tax Form
NC State Tax (
)
Form W2 (
)
Form D400
Wage and Tax Statement
Other
FOR OFFICIAL USE ONLY
APPEAL STATUS:
In-State
Out-of-State
REASON: _____________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________
Date: _____________________
Admissions Representative
FTCC Form A-31
Revised 03/12/2013

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