Fillable 2019-2020 V-4 Independent Verification Worksheet (Illinois Central College)

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2019-2020 V-4 Independent Verification Worksheet (Illinois Central College)

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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 V-4 Independent Verification Worksheet
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.
A Student Information:
___________________________________________
____________________
Student Name (please print)
ICC Student ID #
___________________________________________
____________________
Student Address
Date of Birth
___________________________________________
____________________
City State Zip
Phone Number (include area code)
B. Independent Student’s Household Information: List the people that you (and your spouse if
you are married) will support between July 1, 2019 and June 30, 2020.
YOURSELF AND, IF MARRIED, YOUR SPOUSE (Do not include spouse if you are divorced, separated, or widowed).
Name
Age
Will be Enrolled at Least Half Time
(Yes or No)
Illinois Central College
YOUR CHILDREN, if you will provide more than half of their support from July 1, 2019 through June 30, 2020. If more space is
needed, attach a separate page, make sure your name and ID is at the top.
Name
Age
Will be Enrolled at Least Half Time
(Yes or No)
OTHER PEOPLE ONLY if they now live with you and get more than half of their support from you AND will continue to get this
support from July 1, 2019 through June 30, 2020. If more space is needed, attach a separate page, make sure your name and ID is at
the top.
Name
Age
Will be Enrolled at Least Half Time
(Yes or No)
(over)
Rev. March 14, 2019
C. Certification and Signature
Each person signing below certifies that all of the
information reported is complete and correct.
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.
Print Student Name
Student ID Number
Student Signature (Required)
Date
Spouse's Signature (Optional)
Date
WARNING: If you purposely give false
or misleading information, you may be
fined, sent to prison, or both.
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2019-2020 V-4 Independent Verification Worksheet (Illinois Central College)

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Completed 25 July 2020

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