2018-2019 Independent Verification Worksheet
Student Name
Student ID or SSN
Address
Phone
Number of Household Members and Number in College: Include in the space below information about any household
member who is, or will be, enrolled at least half time
in a degree, diploma, or certificate program at an eligible
postsecondary educational institution any time between July 1, 2018, and June 30, 2019, and include the name of the
college. If more space is needed, provide a separate page with the student’s name and ID number at the top
1. List below the people in the student’s household. Include:
The student.
Full Name
Age
Relationship
College
Self
Indian Hills Community College
The student’s spouse, if the student is married.
Full Name
Age
Relationship
College, If Will be Enrolled at Least Half Time
The student’s or spouse’s children if the student or spouse will provide more than half of the children’s support from July
1, 2018, through June 30, 2019, even if a child does not live with the student. You may include any unborn children if
they will be born during the school year with their expected due date.
Include other people (not your children or spouse) only if they now live with the student and the student or spouse
provides more than half of the other person’s support, and will continue to provide more than half of that person’s
support through June 30, 2019. Support includes money, housing, food, clothes, medical and dental care, gifts, loans,
payment of college costs, etc.
Full Name
Age
Relationship
College, If Will be Enrolled at Least Half Time
Yes
No
Yes
*No
*Submit a Student NonTax Filer Form available on the WebAdvisor. Be sure to submit all 2016 W-2 and 2016 1099 forms you received and
submit an IRS Verification of Non-filing Letter which you can request from the IRS at https://www.irs.gov/individuals/get-transcript.
4. If you are married, has your spouse filed or will he or she be required to file a 2016 U.S. federal income tax return?
Not Applicable
Yes
*No
*Submit a Student NonTax Filer Form available on the WebAdvisor. Be sure to submit all 2016 W-2 and 2016 1099 forms they received and
submit an IRS Verification of Non-filing Letter which you can request from the IRS at https://www.irs.gov/individuals/get-transcript.
5. Certification and Signature
I certify that all of the information reported is complete and correct.
A hand written signature, not typed, is required.
Student’s Signature (Required)
Date
Please return this completed form and all other required materials to:
Ottumwa Campus: Indian Hills Community College, Attn. Financial Aid, 525 Grandview Avenue, Ottumwa, Iowa 52501
Fax: 641-683-5741, Phone: 800-726-2585, ext. 5262 or 641-683-5262, Email: OneStop@indianhills.edu
Centerville Campus: Indian Hills Community College, 721 North First Street, Centerville, IA 52544
Fax: 641-856-3158, Phone: 800-670-3641, ext. 2200 or 641-856-2143, ext. 2200
To check the status of your documents, go to WebAdvisor and click the Financial Checklist, under the Financial Aid heading.
WARNING: If you purposely give false or
misleading information, you may be
fined, sent to prison, or both.
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