All Coastal Pines Technical College students who become or are already fully vaccinated (both doses of Pfizer or Moderna, or one dose of Johnson and Johnson) against COVID-19 will receive a one-time $100 incentive payment. All CURRENTLY ENROLLED full-time and part-time students, including Adult Education students, are eligible to receive the incentive payment.

Each student who submits his/her form and vaccine documentation by November 1, 2021, will have his/her name entered into a drawing for a chance to receive one of three additional, one-time $1,000 incentive payments. No student may receive more than one additional $1,000 incentive. So, in addition to receiving the one-time $100 incentive payment, three students will each receive an additional, one-time $1,000 incentive payment. The drawing will be held on November 9, 2021, during the CPTC Cabinet meeting scheduled for 9:00 a.m.

The form will include instructions and will have a space for the student to attach a copy of his/her COVID-19 Vaccination Record Card (front and back) that confirms he/she has been fully vaccinated. Forms must be completed and submitted by November 1, 2021. The incentive will be disbursed to students the week of November 29, 2021. Payments will be generated through the Banner Student Account system. Be sure to read and follow the instructions for submitting the form.

Covid-19 Student Incentive Form


  1. Take a photo of the front and back your Official CDC COVID-19 Vaccination Card and save as an image file type (.png or .jpg) on your computer -or-
    Scan the Official CDC COVID-19 Vaccination Card and save as a Adobe Acrobat file type (.pdf) on your computer.
  2. Open the attached Student Vaccination Incentive Documentation form in Adobe Reader (see below for link location to download at home).
  3. Click in and complete each field on the form with your personal information.
  4. Click inside of the COVID-19 Vaccination Record Card Copy field to upload the copy from step 1.
  5. Click browse to search your computer to locate the storage location of the card copy, click the file name once, then choose Open to review a copy of the file. If you have selected the correct file, click OK to upload the file image copy.
  6. Choose File, Save As, then select the location to store the Vaccination Incentive Form.
  7. Next open your CPTC Student Email Account, Copy and paste the following in the subject area of the email: Vaccination Incentive Form Encrypt, and Attach a copy of the saved Vaccination Incentive Form to the email.
  8. Send the email with the form attached to
  9. Deadline for submission is November 1, 2021 at 5:00pm.

Adobe Acrobat Reader (FREE):