Enter YEARLY Amounts
_____________________________ _________________________ ____________________________
___________________________________________ _______________________________________
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 -
Student
Form: 20INC
Aid Year: 2020-2021
Please T
ype or Print clearly.
Student Information
Last Name First Name & Middle Initial CPTC Student ID Number
did not work in 2018 and therefore had no income* because he/she was:
[ ] I
ncarcerated [ ] Lived with parents/relative
[ ] Lived with other party [ ] Other: ________________
Certification of Support
I __________________________________________
(Print Name of Supporter)
hereby certify that I provided the following support to the above student for Calendar Year 2018.
[ ] Free Room and Board [ ] Monthly Rent
[ ] Gas [ ] Car payment
[ ] Medical/Dental bills [ ] Food
[ ] Utility bills [ ] Other
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 did 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
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