2018-2019 Inmate Verification Form
Student Name: GTCC ID:
You stated on your application for admissions that you were an inmate in a jail or prison. We need to
verify this information. Please mark one of the following below:
Yes, I am currently an inmate.
Name of Prison or Jail:
Address of Prison or Jail:
Expected release date:
No, I am not currently an inmate.
Student Signature Date
Please return this completed form to: GTCC Financial Aid Office, PO Box 309, Jamestown, NC 27282
or FAX to 336-217-8468.
Financial Aid Office P.O. Box 309 Jamestown, NC 27282
Phone: 336.334.4822 Option 3 Fax: 336.217-8468
Certification and Signatures
Signing this worksheet certifies that all of the information you reported on it
is complete and correct.
WARNING: If you purposely give false or
misleading information you may be fined,
be sentenced to jail, or both.