2020-2021 VERIFICATION OF DEPENDENTS OTHER THAN SPOUSE OR CHILDREN
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 _____________________
Independent -You indicated you have dependents other than your children or spouse, or are still supporting
children 24 years of age or older. Do you have dependents (other than your children or spouse) who live with
you and who receive more than half of their support from you, now and through June 30, 2021? Support
includes money, housing, food, clothes, medical and dental care, gifts, loans, payment of college costs, etc.
OR
Dependent - You indicated your parents have dependents other than their children or spouse, or are still
supporting their children 24 years of age or older. Do your parents have dependents who are not your parents’
children but who live with your parents and receive more than half of their support from your parents, and will
continue to receive more than half of their support from your parents, now and through June 30, 2021? Support
includes money, housing, food, clothes, medical and dental care, gifts, loans, payment of college costs, etc.
1. Check the box that applies:
No Select No if you/your parents do not have dependents (other than your children or spouse). Also,
select No if you/your parents have other dependents, but they are not be receiving more than half of their
support from you/your parents. Skip to 4. Certifications and Signatures.
YES Select Yes if you/your parents have dependents (other than your/their children or spouse). In the
chart below, list the people who meet the following criteria:
1) They live with you/your parents now
2) You/your parents provide more than half of their support, and
3) You/your parents will continue to provide more than half of their support from July 1, 2020 through
June 30, 2021.
2.
Full name of dependent
Age
Relationship to student
3. Check the box that applies IF you answered “YES”:
The dependent was not employed and had no income earned from work in 2018.
The dependent was employed in 2018. Provide copies of all 2018 IRS W-2 forms issued by their
employers. If your dependents listed above have filed or will file a 2018 federal tax return, have them
obtain their 2018 IRS tax return transcripts.
4. Certifications and Signatures
Each person signing below certifies that all of the
information reported is complete and correct.
The student and one parent whose information was
reported on the FAFSA must sign and date.
__________________________________________________________ ________________________
Student’s Signature (Required) Date
__________________________________________________________ ________________________
Other Dependent Signature (Required unless minor) Date
__________________________________________________________ ________________________
Parent’s Signature (Required if student is dependent) Date
WARNING: If you purposely give false or
misleading information, you may be fined,
sent to prison, or both.
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome