_____________________________________
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Financial Aid Office
2019 - 2020 Inmate Worksheet
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 Signature
I certify that all of the information reported on this worksheet is complete and correct.
A parent’s signature is required for dependent students.
Student Signature ____________________________________________ Date ________________
Parent Signature _____________________________________________ Date ________________
Please return this completed form to:
Caldwell Campus
2855 Hickory Blvd.
Hudson, NC 28638
Fax: 828.726.2709
Email: finaid@cccti.edu
Watauga Campus
P.O. Box 3318
Boone, NC 28607
Fax: 828.297.1729
Email: finaid@cccti.edu
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