North Carolina Guardianship FormNorth Carolina Guardianship Form
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North Carolina Guardianship Association
Post Office Box 17673
Phone: (919) 266-9204

Raleigh, North Carolina 27619
Fax: (919) 266-9207

Email: [email protected]

Website: nc-guardian.org

APPLICATION FOR CERTIFIED GUARDIAN
(Must be completed and notarized)

1. Full Name: ___________________________________________________________________________
(As you wish it to appear on your certificate)
2. Are you a member of the North Carolina Guardianship Association?

Yes _________

No _________

3. Business/Agency Name (if applicable): ____________________________________________________
4. Mailing Address: ______________________________________________________________________
City: ______________________ State: ______ Zip Code: ___________ County:___________________
5. Daytime Telephone Number: ________________________ Fax Number: _________________________
6. Evening Telephone Number: ________________________ E-mail Address: ______________________
7. Education:
High School Diploma (or GED) _