Financial Aid Office P.O. Box 309 Jamestown, NC 27282
Phone: 336.334.4822 Option 3 Fax: 336.217-8468
2019-2020 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.
Certification and Signatures
WARNING: If you purposely give false or
Signing this worksheet certifies that all of the information you reported on it
misleading information you may be fined,
be sentenced to jail, or both.
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.
click to sign
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