ICC Financial Assistance Of
1 College Drive
East Peoria, IL 61635-0001
Phone: (309) 694-5
Fax: (309) 694-
email: financialaid@icc.edu
Revised May 15, 2020
Student Name:
ICC Student ID:
According to your Student Aid Report or information provided to ICC, you have a bachelor's degree or are working towards a graduate
or professional degree. We need to confirm or correct this information. Please provide answers to both questions 1 and 2.
1. During the 2020-2021 school year, I will be working on a master’s or doctorate program (MA, MBA, MD, JD, PhD, EdD,
graduate certificate) *Please check one.
2. The following is true of your Bachelor’s Degree: *Please check one.
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 (please check one):
Certificate (less than two years)
Associate Degree
By signing this form, you are certifying that all the information reported on it is complete and correct.
FEDERAL WARNING: If you purposely give false or misleading information on this form; you may be fined, be sentenced to jail, or both.
Student Signature
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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