ICC Financial Assistance Office
1 College Drive
East Peoria, IL 61635-0001
Phone: (309) 694-5
600
Fax: (309) 694-
5160
email: financialaid@icc.edu
Revised May 15, 2020
2020-2021 MARITAL STATUS REVIEW
Student Name:
ICC Student ID:
In reviewing your financial aid application (FAFSA), ICC needs to verify you and/or your parent(s)’ marital status. 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.
STUDENT Marital Status - What is your current marital status? Please check one:
I am single/never married.
I am separated -
Date of separation:
I am divorced -
Date of divorce:
I am widowed -
Date widowed:
I am married -
Date of marriage:
If married, complete
spouse’s name:
If married, complete
spouse’s date of birth:
I certify that this information is correct and will verify the accuracy of this information if needed
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
Date
PARENT Marital Status (if requested) - What is your current marital status? Please check one:
I am separated -
Date of separation:
I am divorced -
Date of divorce:
I am widowed -
Date widowed:
I am married -
Date of marriage:
If married, complete
spouse’s name:
If married, complete
spouse’s date of birth:
I certify that this information is correct and will verify the accuracy of this information if needed
FEDERAL WARNING: If you purposely give false or misleading information on this form; you may be fined, be 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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