Lorain County Community College Financial Services 1005 N. Abbe Rd, Elyria, OH 44035 Phone: 440-366-4034
Independent 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 household in the table below. Include:
(2) your spouse, if you are married; and
(3) your children and other people, if you will provide more than half of their support between 7/1/20 - 6/30/21. Do not include foster
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 in your household 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 your 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 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.
I certify that all of the information reported 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
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 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.