2020-2021 Dependent 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
1. Number of Household Members: List below the people in the parents’ household. Include:
The student.
Full Name
Age
Relationship
Self
The parent(s), including stepparent, if applicable, in the household. If your parents are separated or divorced, include only
the parent/stepparent whose information you were required to provide on the FAFSA application.
Full Name
Age
Relationship
The parents’ other children if the parents will provide more than half of the children’s support from July 1, 2020, through
June 30, 2021, or if the other children would be required to provide parental information if they were completing a FAFSA for
20202021. Include children who meet either of these standards, even if a child does not live with the parents.
Other people if they now live with the parents and the parents provide 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, 2021.
List the college name for any household member, excluding parents, 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, 2020,
and June 30, 2021.
Full Name
Age
Relationship
2. Did you attend a college other than IHCC during the 2020-2021 school year?
Yes
No
3. Did you file or will you file a 2018 income tax return?
Yes
No*
*Submit a 2020-2021 Student NonTax Filers Form, and provide copies of all 2018 IRS W-2 forms issued by employers.
4. Did your parents file or will they file a 2018 income tax return?
Yes
No*
*
Submit a 2020-2021 Parent NonTax Filers Form, provide copies of all 2018 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.
Electronic signatures will not be accepted.
Student’s Signature (Required)
Date
Parent’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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