2017-2018 Independent Verification Worksheet
Student’s Household Information:
1. List yourself below:
Indian Hills Community College
2. List your spouse below, if you are married. Do not include your fiancé. Do not include your spouse if you are
divorced, separated, or widowed. If your spouse will be, enrolled at least half time
in a degree, diploma, or certificate
program at an eligible postsecondary educational institution any time between July 1, 2017, and June 30, 2018, write in
the name of the college.
Name of College if enrolled @ least ½ time
Read Carefully:
3. List your or your spouse’s children below if you or spouse will provide more than half of the children’s support from
July 1, 2017, through June 30, 2018, even if a child does not live with the student. Do not include foster children.
4. Include other people only if they now live with you and you or spouse provides more than half of the other person’s
support, and will continue to provide more than half of that person’s support through June 30, 2018.
5. Write in the name of the college any household member who is, or will be, enrolled at least half time in a degree,
diploma, or certificate program at an eligible postsecondary educational institution any time between July 1, 2017, and
June 30, 2018. If you need more space, attach a separate page.
College (if enrolled @ least ½ time)
6. Did you attend a college other than IHCC during the 2017-18 school year?
7. Have you filed a 2015 income tax return?
8. Has your spouse filed a 2015 income tax return?
If you and your spouse filed taxes as “Married Filing Separately,” you must both submit a Tax Return Transcript.
Certification and Signature: Signing below certifies that all of the information reported is complete and correct.
WARNING: If you purposely give false or misleading information, you may be fined, sent to prison, or both.
Student Signature (Required)
Please return this completed form and all other required materials to:
Ottumwa Campus: Indian Hills Community College, Attn. Financial Aid, 525 Grandview Avenue, Ottumwa, Iowa 52501
Fax: 641-683-5741, Phone: 800-726-2585, ext. 5262 or 641-683-5262, Email: OneStop@indianhills.edu
Centerville Campus: Indian Hills Community College, 721 North First Street, Centerville, IA 52544
Fax: 641-856-3158, Phone: 800-670-3641, ext. 2200 or 641-856-2143, ext. 2200
To check the status of your documents, go to WebAdvisor and click the Financial Checklist, under the Financial Aid heading.
