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
Federal Work-Study
Application Request
Form: FWSR1819
Aid Year: 2018-2019
I am applying for the Federal Work-Study program at Coastal Pines Technical College. If eligible and offered a
position, I understand that I may work only the number of hours authorized to work each semester, without special
permission. I also understand that I may not work more than a maximum of 20 hours per week, if authorized, and
maintain Satisfactory Academic Progress in order to be eligible to continue in this program and must be enrolled in
at least 6 semester credit hours each semester. I also certify that I am a recipient of the Federal PELL Grant
program, do not have ANY criminal history and am not prevented from lawfully becoming employed in this country
because of visa or immigration status. Note: a criminal background check and proof of citizenship/immigration
status will be required prior to offer of Federal Work-Study Employment at CPTC.
900 _ _ _ _ _ _
Enter full name
Full Name (last, first, and middle initial)
Student ID Number
Enter address
Enter email
Street Address (include apt. no.)
CPTC Email Address
Enter city, state, zip
Enter phone #
City State
Enter program of study
Program of Study
Zip Code
Phone Number
Enter grad date
Anticipated Graduation Date
Position Desired:
Please note times available to work for the current semester:
Fall 2018
Spring 2019 Summer 2019
Monday
Tuesday
Wednesday
Thursday
Monday
Tuesday
Wednesday
Thursday
Monday
Tuesday
Wednesday
Thursday
Skills and abilities: (Check all that apply)
Typing (Speed/WPM) ______
Office Machines
Tutor (Math/Reading)
Filing/Imaging
Telephone
Adult Literacy
Computer
Switchboard
Office Work
Communication
Microsoft Office
Library
Student's Signature: Date:
TO BE COMPLETED BY OFFICE OF FINANCIAL AID
Student has Financial Need: Yes No If No, Reason for Ineligibility: ___________________
Maximum Hours Eligible to Work: _________________ Semester: ___________________
BANNER Program of Study: ____________________________________________________________
Financial Aid Officer Signature: _______________________________ Date: ___________________
Coastal Pines Technical College does not discriminate on the basis of race, color, national origin, gender, age or disability. Any violation of or questions related to Title IX should be directed to Karla Eubanks,
Vice President for Student Affairs, at (912) 427-5899 or keubanks@coastalpines.edu . Any violation of or questions related to Section 504 should be directed to Cathy Montgomery at (912) 427-6265 or
cmontgomery@coastalpines.edu.
Rev. 02/22/2018 1819 Federal Workstudy Application Request
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