19CVERI 1/11/2019
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
Your application was selected for review in a process called “Verification.” When a student file is
selected for verification, the Financial Aid Office must document and validate certain data elements
from the FAFSA. The law says we must ask you for additional information before awarding Federal
Aid and Maryland Grants or Scholarships. If there are differences between your application
information and your financial documents, the Financial Aid Office may need to make corrections
electronically and you may receive a corrected Student Aid Report (SAR).
Instructions: Complete all pages of this verification form and submit it to HCC Student Financial Aid
Office as soon as possible. Please fill out this form in your browser and then print and sign. We
require ink signatures on this form. Please contact us if you need any additional information to fill out
this form.
Step 1: Student Information
_________________________________________________________________ ___________________________
Last Name First Name MI HCC Student ID number
Dependency Status
I am an INDEPENDENT student.
My household will include:
Yourself.
Your spouse, if you are married.
Your children or your spouse’s children, if you and/or your spouse will provide more than half of the
children’s support from July 1, 2019, through June 30, 2020, even if the children do not live with you.
Other people if they now live with you and you and/or your spouse provides more than half of the
other people’s support and will continue to provide more than half of their support through June 30,
2020.
Step 2: Household Size & Number in College
List all the people whom you/your spouse support in the chart below.
Also, include in the chart 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, 2019, and June 30, 2020, 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.
Student Financial Aid Office
11400 Robinwood Drive
Hagerstown, MD 21742
finaid@hagerstowncc.edu
FAX: 301-791-9165
2019-2020
Independent
Verification Worksheet
Student Financial Aid Office
11400 Robinwood Drive
Hagerstown, MD 21742
Phone: 240-500-2473
finaid@hagerstowncc.edu
FAX: 301-791-9165
