2019-2020 Independent Verification Worksheet
Please return this completed form to Indian Hills Community College along with any other requested materials:
Fax: 641.683.5741│ Mail: IHCC Financial Aid Office, 525 Grandview Ave, Ottumwa, IA 52501
or bring to One Stop/Bennett Student Services Building
You can check your financial aid document status, print required forms, and view your financial aid award information (once available) on WebAdvisor.
Student’s Name
Student’s ID Number
Address
Phone
Number of Household Members: List below the people in the student’s household. Include:
The student.
Age
Relationship
College Attended at least half-time during
2019-2020 school year (if any)
Self
Indian Hills Community College
The student’s spouse, if the student is married.
Age
Relationship
College Attended at least half-time during
2019-2020 school year (if any)
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, 2019, through June 30, 2020, even if a child does not live with the student.
Other people 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, 2020.
List the college name for 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.
Age
Relationship
College Attended at least half-time during
2019-2020 school year (if any)
2. Did you attend a college other than IHCC during the 2019-20 school year?
Yes
No
3. Did you file or will you file a 2017 income tax return?
Yes
No*
*Submit a 19-20 Student NonTax Filers Form, provide copies of all 2017 IRS W-2 forms issued by employers, and submit
an IRS Verification of Nonfiling Letter. Print or download at https://www.irs.gov/individuals/get-transcript
4. Did your spouse file or will they file a 2017 income tax return?
Not Applicable
Yes
No*
*Submit a 19-20 Student NonTax Filers Form, provide copies of all 2017 IRS W-2 forms issued by employers, and submit
an IRS Verification of Nonfiling Letter. Print or download at https://www.irs.gov/individuals/get-transcript
5. Certifications and Signatures
Each person signing below certifies that all of the
information reported is complete and correct.
The student and one parent whose information was
reported on the FAFSA must sign and date.
A hand written signature, not typed, is required.
_____________________________________________________________________ ________________________
Student’s Signature (Required) Date
WARNING: If you purposely give false or
misleading information, you may be fined, sent to
prison, or both.
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