NC LEAP Application
First Name *
Your application cannot be processed unless you provide both a first and last name.
Your answer
Last Name *
Your application cannot be processed unless you provide both a first and last name.
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Street Address or P.O. Box # *
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City *
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State *
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Zip Code *
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County *
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Preferred Phone Number *
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Alternate Phone Number
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Email Address *
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Race/Ethnicity
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Gender
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Number of Household Members *
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Yearly Household Income *
Please include income from all household members from all sources.
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Please list all sources of income *
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Assets *
Assets include cash, bank accounts, certificates of deposit or any asset which can be converted to cash. Please do not include the value of an IRA or 401(k).
Your answer
Are you prepared to submit documentation verifying financial eligibility for all applicants in your matter shortly after submitting your application? *
We ask that all NC LEAP applicants submit documentation of financial eligibility (e.g., most recent tax return, Social Security statement or other proof of income) via electronic upload. We cannot fully process any application without the ability to verify the applicant's financial status. If you are applying on behalf of more than one business partner or owner, we require verification of financial eligibility for each individual.
If you are unable to submit documentation of financial eligibility at this time, please explain why. *
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