ICC-Financial Assistance Office
1 College Drive
East Peoria, IL 61635-0001
Phone: (309) 694-5311
Fax: (309) 694-5160
Rev. March 14, 2019
2019-2020 Bachelor, Graduate or Professional Degree Confirmation Form
According to your Student Aid Report or information provided to ICC, you may have a Bachelor’s Degree or are working
towards a graduate (beyond bachelor’s) or professional degree. We need to confirm or correct this information. Please
place a checkmark next to the statement that reflects your situation.
1. During the 2019-2020 school year, I am working on a master’s or doctorate program (such as an MA, MBA,
MD, JD, PhD, EdD, graduate certificate, etc.).
2. Please place a checkmark next to the statement that reflects your situation regarding your Bachelor’s Degree.
☐ I DO have a bachelor’s degree from a United States college or university.
Name of College or University Date Received
☐ I DO have a bachelor’s degree from another country.
Name of College or University Name of Country Date Received
☐ I DO NOT have a bachelor’s degree from a college or university in the United States or any other country.
The highest degree beyond high school I have received is:
☐ Certificate (less than two years)
☐ Associate's Degree
By signing this form, you are certifying that all the
information reported on it is complete and correct.
WARNING: If you purposely give false or misleading
information on this worksheet, you may be fined, be
sentenced to jail, or both.
It is the policy of this College that no person, on the basis of race, color, religion, gender, national origin, age, disability,
sexual orientation, or veteran’s status, shall be discriminated against in employment, in educational programs and
activities, or in admission. Inquiries and complaints may be addressed to the Compliance Officer, Diversity Department.