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 April 16, 2020 Page 1 of 2
2020-2021 V1 & V5 INDEPENDENT VERIFICATION WORKSHEET
Your 2020-2021 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, 2020 and June 30, 2021.
YOURSELF AND, IF MARRIED, YOUR SPOUSE
(Do not include spouse if you are divorced, separated, or widowed).
WILL BE
ENROLLED
AT LEAST
HALF TIME?
NAME AGE RELATIONSHIP COLLEGE
YES NO
YES NO
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 and make sure your name and ID is at the top.
WILL BE
ENROLLED
AT LEAST
HALF TIME?
NAME AGE RELATIONSHIP COLLEGE
YES NO
YES NO
YES NO
YES
NO
YES
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.
WILL BE
ENROLLED
AT LEAST
HALF TIME?
NAME
AGE
COLLEGE
YES
NO
YES NO
self
Illinois Central College
Revised April 16, 2020 Page 2 of 2
C. Verification of 2018 Student and Spouse Income Information
Important Note: The questions below apply to you and your spouse, if you are married. Notify the Financial Assistance Office if you or your spouse
filed separate IRS income tax returns for 2018 or had a change in marital status after December 31, 2018.
1. Check the box that applies:
You (student) have used the IRS DRT in FAFSA on the Web to transfer 2018 IRS income tax return information into your FAFSA.
You (student) have not yet used the IRS DRT in FAFSA on the Web, but will use the tool to transfer 2018 IRS income tax return information
into the your FAFSA.
You (student) are unable to use the IRS DRT in FAFSA on the Web, and instead will provide the school with a 2018 IRS Tax Return
Transcript(s). Please refer to the “Verification of 2018 Income Information for Individuals with Unusual Circumstances” form online at
icc.edu/admissions/financial-aid/forms.
IRS Tax Return Transcript provided
IRS Tax Return Transcript will be provided at a later date
You (student) DID NOT FILE a 2018 IRS Tax Return and are not required to file a 2018 IRS Tax Return. Please provide a 2018 non-filing
status letter from the IRS dated on or after October 1, 2019 that indicates a 2018 IRS income tax return was not filed with the IRS.
Please refer to the “Verification of 2018 Income Information for Individuals with Unusual Circumstances” form online at
icc.edu/admissions/financial-aid/forms.
Verification of Non-Filing Letter provided
Verification of Non-Filing Letter will be provided at a later date.
Check the box that applies: Income Earned from Work
You(student) and/or spouse were not employed and had no income earned from work in 2018.
You(student) and/or spouse were employed in 2018 and has listed below the names of all employers and the amount earned from each
employer in 2018. PLEASE PROVIDE COPIES OF ALL 2018 IRS W-2 FORMS ISSUED TO YOU BY YOUR EMPLOYERS if you did not
use the IRS Data Retrieval Tool on the FAFSA. If you do not have the W-2(s) you can request an IRS Income and Wage Statement.
If more space is needed, provide a separate page with the student’s name and ID number at the top.
Employer’s Name Annual Amount Earned in 2018
$
$
$
$
$
$
Total Amount of Income Earned From Work
$
D. Certifications and Signatures
Each person signing below certifies that all of the information reported 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.
Print Student Name
ICC Student ID#
Student Signature (Required)
Date
Spouse’s Signature (Optional)
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.
click to sign
signature
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signature
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