Yuba Community College District
Career and Technical Education Student Income Certification

PURPOSE: The purpose of the Student Income Certification form is to collect data that is not gathered during telephone and on-line registration. Career and Technical Education funding is allocated to each community college based on the number of career, vocational and technical students who meet certain financial criteria.

SECURITY: The data you enter on this form is kept confidential and will not be released to anyone. Once you submit your data, it will be transmitted to the Registrar's Office, Yuba Community College District.

INSTRUCTIONS: To complete the online form, simply type your answers in the corresponding fields or select your answers from the popup lists (where applicable). Once you have completed the form, click the 'SUBMIT' button at the bottom to submit your data.

Name:

Student ID Number:

Please answer the following questions:

1. Are you a SINGLE parent?

2. Are you a Displaced Homemaker?
(recently widowed/divorced/separated - now preparing to enter workforce)

3. Were your enrollment fees waived by Financial Aid?

4. TOTAL Family size in the household in which you live (include parents and children in the home):

6. FAMILY income for household in which you live: