Mail, fax, email, or deliver the completed worksheet to the financial aid office using the contact information listed below.
EMAILED FORMS MUST BE SENT FROM THE IWU STUDENT EMAIL ACCOUNT
Financial Aid Office, IWU National & Global 1900 West 50
th
Street Marion, IN 46953-9393 indwes.edu
800.621.8667 option 4 765.677.2516 765.677.2030 Fax IWUfinaid@indwes.edu
DEPENDENT STUDENT
( ) -
STUDENT INFORMATION
________________________________________ ____ _______________________________________________
First Name M.I. Last Name
___________________ OR __________________ ______________________________________
FC19DSNH
Student ID Last 4 Digits of SSN Phone Number
HOUSEHOLD INFORMATION (DEPENDENT STUDENT)
For questions regarding your parents’ household, use the following information to determine who is to be counted as a
member of the household:
•
You, the student
•
Your parent(s), including stepparent, even if you do not live with them.
•
Your parents’ other children, if your parent(s) will provide more than half of their support from July 1, 2019 through
June 30, 2020, or if the children would be required to provide parental information if they were completing a FAFSA
for 2019-2020. Include children who meet either of these standards even if they don’t live with your parent(s).
•
Other people if they now live with your parent(s) and your parent(s) provide more than half of their support and will
continue to provide more than half of their support from July 1, 2019 through June 30, 2020.
NUMBER IN HOUSEHOLD (DEPENDENT STUDENT)
Complete the following chart by entering the name, age, and relationship to you of each person in the household, as defined
above. Do not include foster children.
FULL NAME AGE RELATIONSHIP TO STUDENT
1
Self
2
3
4
5
6
7
8
If more space is needed, provide a separate page with the student name and ID number at the top.
CERTIFICATION AND SIGNATURES
By signing this worksheet, I certify that all the information reported on this worksheet is complete and correct.
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to
jail, or both.
_____________________________________________________________________________ _________________
Student Signature* Date
_____________________________________________________________________________ _________________
Parent Signature* Date
* Must be an actual “wet” signature. A digital signature or typed font signature is not acceptable. This form may be completed and “wet” signed via a tablet
or smartphone with PDF signing capability using a stylus pen. You may need to download an app to access this feature.
