2019-20 INDEPENDENT VERIFICATION FORM
Please complete this form on a computer, or use black or blue ink.
STUDENT NAME ____________________________________ CCC ID# OR LAST 4# OF SSN ________________
A
DDRESS ______________________________________________ PHONE ___________________________
C
ITY _____________________________________ STATE _______________ ZIP CODE __________________
Your application was selected for review in a process called “Verification.” In this process, our office may be comparing
information from your application with copies of you (and your spouse’s) 2017 financial documents. We are legally
required to collect and review this information before awarding Federal aid. If there are differences between your
application information and your financial documents, the Financial Aid Office will make corrections to your Student Aid
Report (SAR).
Complete this verification form and submit it with any other requested documents to your financial aid office as soon as
possible. Failure to return the requested information will delay the processing of your financial aid.
HOUSEHOLD SIZE AND NUMBER IN COLLEGE
List the family members you will support between July 1, 2019 and June 30, 2020. Include yourself and your spouse, if
married. Also include your children if you will provide more than half their support. Include children if attending college
and are required to use your income information when applying for federal student aid.
L
IST
F
ULL
N
AME OF
A
LL
FAMILY MEMBERS LIVING IN
YOUR HOUSEHOLD IN 2019-20
AGE
R
ELATIONSHIP
TO
STUDENT
LIST COLLEGE ATTENDING AT LEAST
HALF-TIME IN 2019-20
Self
Central Community College
HOLD
CERTIFICATION STATEMENT
Signing below certifies that all of the information reported is complete and correct. An electronic signature is not valid.
____________________________________________________________
S
TUDENT SIGNATURE DATE
Please return this form to the Financial Aid Office at the location you plan to attend:
Central Community College Columbus PO Box 1027 Columbus, NE 68602-1027 Fax: 402-562-1290
Central Community College Grand Island PO Box 4903 Grand Island, NE 68802-4903 Fax: 308-398-7407
Central Community College – Hastings PO Box 1024 Hastings NE 68902-1024 Fax: 402-461-2447
Central Community College Kearney PO Box 310 Kearney, NE 68848-0310 Fax: 308-338-4041
WARNING: If you purposely give
false or misleading information,
you may be fined, sent to prison,
or both.
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