Office of Financial Aid
Waycross Campus (912) 287-6584
Jesup (912) 427-5800
Alma (912) 632-0951
Camden (912) 510-3327
Hazlehurst (912) 379-0041
Baxley (912) 367-1700
Golden Isles (912) 262-4999
Website: www.coastalpines.edu
Declaration of
No Income -
Parent Form:
20PINC
Aid Year: 2020-2021
Pleas
e Type or Print clearly.
Student Information
_____________________________
Last Name
___________________________
First Name & Middle Initial
____________________________
CPTC – Student ID Number
Certification of Support
I __________________________________________
(Print Name of Parent)
hereby certify that I (nor my spouse) did not work in 2018 and therefore was not required to file a Tax Return
for 2018*. Provided below is the following financial support I (We) received for Calendar Year 2018.
1) ______________________________ $___________________
2) ______________________________ $___________________
3) ______________________________ $___________________
4) ______________________________ $___________________
5) ______________________________ $___________________
Total Calendar Year Amount of the above support: $___________________
___________________________________________ _______________________________________
Signature of Supporter Date
_______________________________________________
Relationship to the Student
___________________________________________ _______________________________________
Student's Signature Date
*You must provide documentation that you d
id not file taxes. Paper request form: IRS Form 4506-T available online at www.irs.gov or can be
obtained from your local Financial Aid Office. Mail or fax the completed form to the address provided. The student must return this form with the
Non-filing letter to the Office of Financial Aid at Coastal Pines Technical College once received. If you have any questions, please stop by your
local CPTC Financial Aid Office.
As set forth in the student catalog, Coastal Pines Technical College (CPTC) does not discriminate on the basis of race, color, creed, national
or ethnic origin, gender, religion, disability, age, political affiliation or belief, genetic information, veteran status, or citizenship status (except
in those special circumstances permitted or mandated by law). The following persons have been designated to coordinate the College’s
implementation of non-discrimination policies: Katrina Howard, Title IX Coordinator, Jesup Campus, Office 132, khoward@coastalpines.edu
,
912.427.5876; Cynthia Linder, Office 1439, Title IX Coordinator, Waycross Campus, clinder@coastalpines.edu , 912.287.4098; and Cathy
Montgomery, ADA/Section 504 Coordinator, Golden Isles Campus, Office 1141, cmontgomery@coastalpines.edu , 912.262.9995.
click to sign
signature
click to edit
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