Fillable 2020-2021 V4 INDEPENDENT VERIFICATION WORKSHEET (Illinois Central College)

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2020-2021 V4 INDEPENDENT VERIFICATION WORKSHEET (Illinois Central College)

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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 September 21, 2018 Page 1 of 2
2020-2021 V4 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, 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
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 RELATIONSHIP COLLEGE
YES NO
YES NO
(continued on next page)
self
Illinois Central College
Revised September 21, 2018 Page 2 of 2
C. 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
Student’s Spouse 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.
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2020-2021 V4 INDEPENDENT VERIFICATION WORKSHEET (Illinois Central College)

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Completed 25 July 2020

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