2020 - 2021
Inmate Worksheet
Student Name Student ID Phone Number
You were flagged as an inmate in a jail or prison. Verification of this information is required. 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.
Warning: According to the U.S. Department of Education, if you purposely give false or
misleading information, you may be subject to a fine of up to $20,000 or imprisonment
for up to 5 years, or BOTH.
Certification and Signatures:
I understand if I purposely give false or misleading information I may be fined, sentenced to jail, or both.
Student Signature Date
Parent Signature Date
Return completed worksheet(s) to:
Caldwell Community College and Technical Institute
Office of Financial Aid
E-mail – finaid@cccti.edu
Caldwell Campus – 2855 Hickory Blvd., Hudson, NC 28638 Watauga Campus – PO Box 3318, Boone, NC 28607
Fax: 828.726.2709 Fax: 828.297.1729
click to sign
signature
click to edit
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click to sign
signature
click to edit
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