ICC Financial Assistance Office
East Peoria, IL 61635-
Phone: (309) 694-5
Fax: (309) 694-
email:
Revised October 4, 2017 Page 1 of 2
2020-2021 V4 DEPENDENT 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)
Phone Number (include area code)
B. Dependent Student’s Household Information:
List person(s) that your parent’s will support July 1, 2020 - June 30, 2021.
YOURSELF even if you do not live with your parents
ENROLLED
AT LEAST
NAME AGE RELATIONSHIP COLLEGE
PARENT(S) even if you do not live with them. Include stepparent if your parent is married.
ENROLLED
AT LEAST
NAME AGE RELATIONSHIP COLLEGE
YOUR PARENTS’ OTHER CHILDREN if your 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 2020–2021. Include children who meet either of these standards, even if a child does not live with your parents. If
more space is needed, provide a separate page with the your name and ID number at the top.
WILL BE
ENROLLED
AT LEAST
(continued on next page)