Dependent Verification Worksheet
2020-21 Financial Aid Year
Section 1. Student Information
Last Name First Name Middle Initial
LCCC Student ID #
Section 2. Household Information
List the people in your parents' household in the table below. Include:
(1) yourself,
(2) the parent(s), and
(3) your parents’ other children and other people, if your parents will provide more than half of their support between 7/1/20 - 6/30/21. Do
not include foster children.
Definition of a parent for financial aid purposes: A parent is defined as the biological or adoptive parent(s) of the student. If parents are married to each other, both
parents' information must be included. If parents are not married to each other but live together in the same household, both parents' information must be included.
If the student's parents are divorced or separated, use the information for the parent the student lived with more during the past 12 months. If that parent is
remarried, the stepparent's information must be included. A legal guardian, grandparent, or foster parent is not considered a parent unless they have legally adopted
the student.
Write your name and age on the first line below. THEN list the names, ages, and relationships to you for everyone else in your household (per the guidelines above).
If anyone but your parents will be enrolled at least half-time in a degree or financial aid-eligible certificate program between 7/1/20 and 6/30/21, include the name of
the school they will be attending. If more space is needed, continue this table on a separate page with the student's name and LCCC Student ID number at the top.
Full Name Age
Relationship to Student
in Section 1
College/Univ. in 2020-21 (Do
not include CCP)
Self (Student from Section 1) Lorain County Community College
Section 3. Additional Requirements
Do not submit this form until you have gathered all other required documents/forms to avoid processing delays.
All other required documents/forms are listed on your To Do list in MyCampus. To view your To Do list, log in to MyCampus and click on "Student Center." LCCC
form(s) listed can be found under the "Verification Forms" heading on our website, www.lorainccc.edu/finaidforms.
If your To Do list includes 2018 IRS Tax Transcript/1040(s), we can accept signed copies of 2018 1040 forms (including Schedules 1/2/3 as applicable), use and
successful transfer of tax data via the IRS Data Retrieval Tool while logged into your FAFSA, or a tax return transcript (TRT) from the IRS. To order the TRT free of
charge: start at www.irs.gov/Individuals/Get-Transcript and follow the prompts for "Get Transcript by MAIL." Be sure to request tax return transcripts. The tax return
transcript from the IRS is double-sided. Make a copy for your records and be sure to submit a copy of both sides of all pages to the Financial Aid office.
Section 4. Certification.
Each person signing this worksheet certifies that all of the information reported on it is complete and accurate. Warning: If you purposely give false or misleading
information on this worksheet, you may be fined, sentenced to jail, or both.
Student Signature: Date
Parent Signature Date
Electronic signatures will not be accepted. Please print this form to sign before submitting.
Section 5. Submission
Do not submit this form until you have gathered all other required documents/forms to avoid delays in processing. When all required documents have been
gathered, you may submit your information by: a) mail to the address below; b) fax to 440-366-4634 or; c) deliver to the Financial Services, First Floor, Bass Library.
Watch for two-sided documents. Be sure to include both sides when faxing. Do not email any documents with personally identifiable information.
Lorain County Community College Financial Services 1005 N. Abbe Rd, Elyria, OH 44035 Fax: 440-366-4634
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