2020-2021 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
1. Number of Household Members: List below the people in the student’s household. Include:
The student.
Full Name
Age
Relationship
Self
The student’s spouse, if the student is married.
Full Name
Age
Relationship
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, 2020, through June 30, 2021, 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, 2021.
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, 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, 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
4. Did your spouse file or will they file a 2018 income tax return?
Not Applicable
Yes
No*
*
Submit a 2020-2021 Student 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.
Electronic signatures will not be accepted.
_____________________________________________________________________ ________________________
Student’s Signature (Required) Date
WARNING: If you purposely give false or
misleading information, you may be fined, sent to
prison, or both.