FAXXSDNH
245 College Road, Smithfield, NC 27577
(919) 209-2036 |
www.JohnstonCC.edu
Dep # in HH/College
Number of Household Members and Number in College
(Dependent Student Parent Signature and PIN Number Verification)
Please note:
The supplied PIN number must match the number on file associated with the student's form to represent the parent signature.
Parent Signature
Student ID Number
Dependent Supplied
PIN Number
Date
By checking this box, I ratify the use of my typed name and attached PIN number as an electronic representation of my signature.
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