01 N.C. Admin. Code 26B .0104 - FORMS AND INSTRUCTIONS

The following forms and instructions are used by the Veterans Affairs Commission (the "Commission" for purposes of this Subchapter) to administer scholarships for children of war veterans, pursuant to G.S. Chapter 165, Article 4. Forms required of the applicant to complete the scholarship package are located at: http://www.nc4vets.com/nc-programs or may be obtained by contacting the North Carolina Division of Veterans Affairs (NCDVA) at 919-807-4250 or by writing to the NCDVA at 1315 Mail Service Center, Raleigh, NC 27699-1315.

(1) Instruction Sheet, NCDVA-16. To be considered for selection by the Commission, an application shall be received in the Assistant Secretary's Office (NCDVA) by deadlines referenced in this Rule. Applicants for scholarships classified as Class II or Class III shall submit scholarship application on or before February 14. Applicants for scholarships classified as IA, IB, or IV as determined by United States Department of Veterans Affairs (USDVA) Certification form (NCDVA-13 if living veteran, and NCDVA-14 if veteran is deceased) shall submit scholarship application by:

(a) June 1 in order to be awarded on the following July 1; or

(b) December 1 in order to awarded on the following January 1.

The application shall be mailed to the North Carolina Division of Veterans Affairs 1315 Mail Service

Center, Raleigh, NC 27699-1315, or emailed to: ncdva.scholarships@doa.nc.gov.

(2) The applicant shall submit the following documents to the Assistant Secretary's Office (NCDVA) for consideration:

(a) a completed application, NCDVA-17, together with a copy of the public record of applicant's birth;

(b) evidence of veteran's biological or adoptive relationship to applicant (which may be shown on birth certificate, court documents, payment of child support, or DNA test);

(c) a copy of veteran's discharge or notice of separation (DD 214, member copy 4) from the armed services (if available);

(d) a financial questionnaire, NCDVA-18;

(e) the most recent federal income tax return from applicant, applicant's veteran parent, and other parent;

(f) high school transcript through junior year of high school or, if already graduated, complete high school transcript and all college transcripts to date if applicable;

(g) the applicant's scholarship essay questionnaire, NCDVA-23B(2);

(h) two recommendations, NCDVA-23B(3); and

(i) a copy of any high school and college disciplinary record.

(3) The selected applicants (all classes) shall submit the following documents to the Assistant Secretary's Office (NCDVA) no later than June 30 for a scholarship to be awarded on the following July 1 (selected applicants submitting Class IA, Class IB, or Class IV application after June 1 shall submit the following documents on or before December 1 to be awarded the following January 1):

(a) a copy of Selective Service registration acknowledgement, if not age 18 by June 30, must be received within six months of attaining age 18 (male applicants only);

(b) proof of graduation from high school (high school diploma);

(c) final complete academic record which shall include a list of high school and college courses taken with corresponding grades earned, cumulative weighted and unweighted grade point average, and attendance and disciplinary records;

(d) NCDVA-11, Affidavit - School Declaration Form;

(e) a letter of acceptance from the school that the applicant shall attend; and

(f) NCDVA-17G, Permission form for access to student's academic records of the college, university, or community college he or she shall attend or attended if previously enrolled.

(4) Application Form, NCDVA-17. A person seeking a scholarship under G.S. Chapter 165, Article 4, (Scholarships for Children of War Veterans) shall submit a completed application form, NCDVA -17 to the NCDVA which provides:

(a) the applicant's first name, middle initial, last name, social security number, address, telephone number, email address, and county of residence;

(b) the first name, middle initial, last name, USDVA File number or social security number, and address of applicant's eligible veteran parent;

(c) the applicant's date of birth, place of birth (city, county, and state), mother's birth place, the applicant's length of residency in North Carolina, high school attended, and graduation date from high school;

(d) the college, university, community college, or technical institute that applicant plans to attend;

(e) the legal residence of applicant's eligible veteran parent at time such veteran parent entered the Armed Forces;

(f) the legal residence of applicant's eligible veteran parent at time of application;

(g) the degree of service connected or non-service connected disability of applicant's eligible veteran parent at time of scholarship application;

(h) answers to questions regarding the applicant's veteran parent's purple heart medal, if any, MIA or POW status, receipt of United States Department of Veterans Affairs (USDVA) disability compensation or pension, and whether veteran parent is deceased;

(i) signature and date of applicant and applicant's parent or guardian;

(j) answers to questions about applicant's accomplishments, special honors, or awards received during high school (and post high school if applicable), submitted in resume format as referenced on NCDVA-17;

(k) a copy of the public record of applicant's birth, evidence of veteran's biological or adoptive relationship to applicant (which may be shown on birth certificate, court documents, payment of child support or DNA test), and a copy of veteran's discharge or notice of separation, [DD 214, member copy 4] from the armed services, if available; and

(l) applicant's high school transcript through junior year, ACT or SAT score, a copy of all college transcripts, if applicable, and a copy of disciplinary and attendance records from high school and any other college or technical schools attended (if school does not maintain disciplinary records, then applicant shall attach a statement from high school guidance counselor or college advisor explaining that no such records exist).

(5) Financial Questionnaire, NCDVA-18, to accompany application for scholarship. A person seeking a Class II or Class III scholarship, as defined in G.S. 165-22, shall submit a completed Financial Questionnaire, NCDVA 18, to the NCDVA which provides:

(a) the applicant's veteran parent's first name, middle initial, and last name;

(b) USDVA file number or social security number of the applicant's veteran parent;

(c) the applicant's first name, middle initial, last name, and the last four digits of the social security number on Financial Questionnaire, NCDVA-18;

(d) the applicant, applicant's veteran parent, and other parent shall provide the amount of each of their:

(i) bonds, mutual funds, but not retirement plans, along with cash, savings, account balances including certificates of deposit;

(ii) liabilities (for the purpose of this sub-item, liabilities shall include education and medical expenses of applicant, veteran parent and other parent); and

(iii) annual income from wages, salary, USDVA disability compensation, pension, interest, dividends, military retirement, company pension, workman's compensation, net business income or loss from previous calendar year, and net farm income or loss from previous calendar year;

(e) the applicant's high school or college status, name of university, college, or community college attending, number of semesters completed, and source and amount of funding towards education (i.e. scholarship, grants, student loan, or no financial assistance);

(f) the relationship, age, and source of funding for any sibling of applicant who is a dependent of applicant's veteran parent while such sibling attends post high school training or college;

(g) the dated signature of applicant's veteran parent in the space designated on the form; and

(h) a copy of latest federal tax return of applicant, applicant's veteran parent, and other parent (if required to file taxes). If no return was filed, then applicant shall provide a statement as to the reason no federal tax return is attached.

(6) Essay Questionnaire, NCDVA-23B(2), to accompany scholarship application. A person seeking a Class II or Class III scholarship, as defined in G.S. 165-22, shall submit a completed Essay Questionnaire, NCDVA 23B(2), to the NCDVA which provides:

(a) the reasons applicant believes he or she should be selected and awarded a scholarship;

(b) the first name, middle initial, and last name of applicant's veteran parent;

(c) the applicant's first name, middle initial, last name, and the last four digits of the social security number;

(d) a list of all schools to which the applicant has both applied and been accepted;

(e) a list of schools to which applicant applied and is awaiting an acceptance decision;

(f) the applicant's desired major or area of study, if known;

(g) essays to provide insight into applicant's character, reputation, and accomplishments by describing:

(i) how the applicant has prepared for college;

(ii) why the applicant believes he or she should be selected;

(iii) a kind act accomplished by the applicant that few people know about;

(iv) a mistake made by the applicant and what the applicant learned from this mistake;

(v) any other information the applicant wishes the North Carolina Veterans Affairs Commission to consider, including but not limited to unusual special circumstances affecting grades, absences, outstanding achievements, special talents, or interest; and

(h) the applicant's dated signature.

(7) Recommendation Form NCDVA-23B(3), to accompany scholarship application. A person seeking a Class II or Class III scholarship, as defined in G.S. 165-22, shall submit two completed Recommendation Forms, NCDVA-23B(3), at least one from applicant's guidance counselor or teacher, to the NCDVA which provides:

(a) an assessment of applicant's scholastic achievements, disciplinary record, and comments on applicant's character;

(b) the first name, middle initial, and last name of applicant's veteran parent;

(c) the applicant's first name, middle initial, last name, and the last four digits of the social security number;

(d) the first name, middle initial, last name, and relationship to applicant of person submitting a recommendation for applicant;

(e) the length of time the recommender has known the applicant;

(f) if the recommender is a guidance counselor or designated teacher, then include class rank, cumulative grade point average (weighted and unweighted), and provide a disciplinary record or describe any disciplinary issues if no disciplinary record; and

(g) a written evaluation of applicant including comments and examples of the applicant's character (courage, honesty, kindness, dedication, work ethic).

(8) Affidavit-School Declaration, NCDVA-11, (All Classes). Upon receipt of a blank Affidavit-School Declaration form, NCDVA-11 from the NCDVA, the selected applicant shall return a completed NCDVA-11 form to the NCDVA no later than June 30 (to be awarded a scholarship the following July 1), to notify the NCDVA of which school the applicant would like the scholarship to apply (selected applicants classified as IA, IB, or IV after June 1 shall submit completed Affidavit-School Declaration NCDVA-11 by December 1 to be awarded a scholarship the following January 1). An additional NCDVA-11 may be requested by contacting the NCDVA at 919-807-4250. The selected applicant shall provide the following information on the NCDVA-11:

(a) the first name, middle initial, and last name of the selected applicant's veteran parent(s);

(b) the first name, middle initial and last name of the selected applicant;

(c) the last four digits of the social security number of the selected applicant;

(d) the name of the school that such selected applicant plans to attend;

(e) the semester date the selected applicant plans to begin his or her course of study; and

(f) the dated signature of the selected applicant.

(9) Permission for Access to Student Records, NCDVA-17G (All Classes). Upon receipt of a blank Permission for Access to Student Records form, NCDVA-17G from the NCDVA, the selected applicant shall return a completed NCDVA-17G form to the NCDVA no later than June 30 to be awarded a scholarship the following July 1 (selected applicants classified as IA, IB, or IV after June 1 shall submit completed Permission for Access to Student Records form, NCDVA-17G, by December 1 to be awarded a scholarship the following January 1), to permit the NCDVA access to the student's cumulative grade point average and information about the student's academic standing, including without limitation any probationary status. An additional NCDVA-17G may be requested by contacting the NCDVA at 919-807-4250. The selected applicant shall provide the following information on the NCDVA-17G:

(a) the first name, middle initial, and last name of the selected applicant;

(b) the last four digits of the selected applicant's social security number;

(c) the identification number assigned by the school to the selected applicant;

(d) the selected applicant's mailing address;

(e) the selected applicant's email address;

(f) the selected applicant's telephone number;

(g) a grant of permission by the selected applicant for the NCDVA to access the cumulative grade point average and academic standing records (including without limitation, any information concerning probationary status) of such selected applicant from the named school that selected applicant plans to attend;

(h) an acknowledgment that the permission granted by the selected applicant is made with the understanding that any records and information provided by the school attended by the selected applicant may not be made available by the NCDVA to any other agency other than the NCDVA and may only be used in the administration of the selected applicant's scholarship; and

(i) the dated signature of the selected applicant.

Notes

01 N.C. Admin. Code 26B .0104

Authority G.S. 143B-1220 through 143B-1222;
Eff. February 1, 1976;
Readopted Eff. February 27, 1979;
Amended Eff. October 1, 2015;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. February 2, 2016.

Authority G.S. 143B-252(4); 143B-399(4);
Eff. February 1, 1976;
Readopted Eff. February 27, 1979. Amended by North Carolina Register Volume 30, Issue 09, November 2, 2015 effective 10/1/2015.