NORTHCAROLINA DEPARTMENTOF THE SECRETARYOF STATECHARITABLESOLICITATIONLICENSINGDIVISION

EDUCATIONEXEMPTIONQUESTIONNAIRE N.C.G.S. 131 F 3(4)

OrganizationName

Date Completed

ContactPerson atOrganization

JobTitle

Phone Number

EmailAddress

MailingAddress

City

State

ZipCode

Directions:Beginning withSection 1below, pleaseCLEARLYmark“YES”or“NO”in response to eachquestion.SECTION 1: EDUCATIONALINSTITUTIONS AS DEFINEDBY STATUTE

Is thisorganization“an educationalinstitution,thecurriculum of which,inwhole or in part,isregistered,approved,oraccreditedbytheSouthernAssociationofCollegesandSchools,or accreditedbyan equivalentregionalaccreditingbody?“

YES

NO

If youchecked“YES”,pleaseprovidethenameandlocationoftheorganization’sregionalaccreditingbodyor copyoftheaccreditationdocument.

SECTION 2:INSTRUCTIONALUNITSASSOCIATEDWITH“EDUCATIONALINSTITUTIONS” AS DEFINEDBYRULE

Isthisorganization an instructionaluniti.e. “a departmentorschooloreducationalinstitution”?

YES

NO

Have trusteesof aneducationalinstitution asdefinedabovegrantedwrittenauthorizationforsolicitationbythisinstructionalunit?

YES

NO

Do the trusteesof aneducationalinstitutionas definedabovehavefinalauthorityoverthe financialaffairsof thisinstructionalunit?

YES

NO

Do the trusteesof aneducationalinstitutionas definedabovehavefinalauthorityoverthe disbursementofthecontributionssolicitedbythisinstructionalunit?

YES

NO

Have thetrustees ofan educationalinstitutionasdefinedaboveauthorizedtheincorporationof receiptsanddisbursementsof the contributionstotheinstructionalunitas partoftheinstitution’sfinancialstatement?

YES

NO

If thisorganizationisan “instructionalunit”i.e.departmentorschooloreducationalinstitution,do thetrusteesof aneducationalinstitution as definedabove grantacademiccreditfor instructionalprogramsofthisinstructionalunit?

YES

NO

IF YOUCHECKED“YES”IN RESPONSETOANYQUESTIONS INTHIS SECTION, YOUMUSTPROVIDEWRITTENDOCUMENTATION SUPPORTING THERESPONSE(S).

SECTION 3: FOUNDATIONSASSOCIATEDWITH“EDUCATIONALINSTITUTIONS”AS DEFINEDBY RULE

Isthisorganization afoundationthatmeetsthefollowingdefinition: “an incorporatedbodywhichholds statuswiththeIRS as a foundationandisauthorizedtoreceivefinancialsupportfrom,andrenderfinancialsupportto,otherpersonsfor charitablepurposes? “

YES

NO

Have trusteesof aneducationalinstitutiongrantedwrittenauthorization forsolicitationbythisfoundation?

YES

NO

Do the trusteesof aneducationalinstitutionhave finalauthority overthe financialaffairsof thisfoundation?

YES

NO

Do the trusteesof aneducationalinstitutionhave finalauthority overdisbursementofthe contributionssolicitedby thisfoundation?

YES

NO

Have thetrustees ofan educationalinstitutionauthorizedtheincorporationof receiptsanddisbursementsofthecontributions as partof the institution’sfinancialstatement?

YES

NO

IF YOUCHECKED“YES”IN RESPONSETOANYQUESTIONS INTHIS SECTION, YOUMUSTPROVIDEWRITTENDOCUMENTATION SUPPORTING THESERESPONSE(S) INCLUDING THE“EDUCATIONALINSTITUTION”WITHWHICHTHEORGANIZATION IS AFFILIATED.

SECTION 4:NON-PUBLIC SCHOOLS AS DEFINEDBYSTATUTE

Is thisorganization an“educationalinstitutionincompliancewithNorthCarolinaGeneralStatutesChapter115C,Article39?”Thisstatutory sectionappliestonon-publicschoolsbelow collegelevelsuch as privatechurch/religiousschools,

homeschools,etc.YES NO

SECTION 5:EDUCATIONALMEMBERSHIPORGANIZATION

Isthis anorganizationwitha membershipthatiscomposedsolely of20ormore educationalinstitutionsthatmeetthe

criteriasetforthinN. C. Gen.Stat. §131F-3(4)?YES

NO

YOUMUST PROVIDESUFFICIENTDOCUMENTATION SUPPORTING ANEXEMPTION.

WRITTENDOCUMENTATIONSUPPORTINGEXEMPTIONREQUESTS MAY INCLUDEARTICLES OFINCORPORATION,BYLAWS,RESOLUTIONS, LEGALMEMORANDUMS,FINANCIALRECORDS ORSTATEMENTS, TAXFILINGS,STATEMENTOFAUTHORITYOFBOARDS OFDIRECTORS, PROOFOFACCREDITATION, ETC.

THIS QUESTIONNAIREWILLBEPROCESSEDBYTHECHARITABLESOLICITATIONLICENSINGDIVISIONWITHIN 10DAYSOFRECEIPT.THEORGANIZATION WILLRECEIVEALETTERFROMTHEDEPARTMENTINDICATINGWHETHERTHEYQUALITY FOR THEEDUCATION EXEMPTION ORMUST OBTAIN ASEPARATEEXEMPTIONORFILEFOR A CHARITABLESOLICITATION LICENSETOCONTINUESOLICITING IN NORTHCAROLINA INCOMPLIANCEWITHSTATELAW.

PLEASEVISITTHEDEPARTMENT OFTHESECRETARY OFSTATECHARITABLESOLICITATION LICENSING WEBSITEAT

TOOBTAINADDITIONALINFORMATION

INCLUDING APPLICABLELAWS ANDADMINISTRATIVERULES.

IF YOUHAVEANYQUESTIONS REGARDINGCOMPLETIONOFTHIS QUESTIONNAIRE, PLEASECALLTHECHARITABLESOLICITATION LICENSINGDIVISION AT (919) 807-5400. MAILRESPONSESTO:N.C. DEPTOFTHESECRETARYOFSTATE, CHARITABLESOLICITATIONLICENSINGDIVISION, POBOX 29622, RALEIGH, NC 27626-0622.