ICC-Financial Assistance Office
1 College Drive
East Peoria, IL 61635-0001
Phone: (309) 694-5311
Fax: (309) 694-5160
email: financialaid@icc.edu
Rev. March 14, 2019
2019-2020 Marital Status Review Form
Your 2019-2020 Free Application for Federal Student Aid (FAFSA) was selected for a process called “verification.” In this process,
we will compare the information from your application to the information on the form and other documentation that is submitted. The
law states that before awarding Federal Student Aid, we may ask you to confirm the information you submitted on your FAFSA. If
there are differences, we will make the required corrections. If we have any questions regarding the information you submitted to our
office and on the FAFSA, we may ask for additional information.
You must complete this form in INK and submit it along with
any other required documents to the ICC Financial Assistance Office.
Student Name:_____________________________________________ ICC Student ID #________________
Please Print
Student Marital Status - What is your current marital status? (Please check which one applies)
I am married or remarried.
Spouse’s name and date of birth
I am separated.
I am divorced.
I am widowed.
I am single/never married.
I certify that this information is correct and will verify the accuracy of this information if needed. WARNING: If you purposely
give false or misleading information on this worksheet you may be fined, sentenced to jail, or both.
Student Signature
Date
Parent Marital Status (If Applicable) - What is your current marital status? (Please check which one applies)
Parent Name: ______________________________________________
Please Print
My parents are married or remarried.
Date of marriage
Stepparent name and date of birth
My parents are separated.
Date of separation
My parent is divorced.
Date of divorce
My parent is widowed.
Date widowed
My parents are not married but live together.
My parent is single/never married.
I certify that this information is correct and will verify the accuracy of this information if needed. WARNING: If you purposely
give false or misleading information on this worksheet you may be fined, sentenced to jail, or both.
Parent of Dependent Student Signature
Date
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.
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