450 North Avenue • Battle Creek, MI 49017-3397
269-965-4123 • FAX 269-966-4089
2019-2020 Independent Student
You were selected for VERIFICATION
by the Department of Education.
Before the Financial Aid Oce
(FAO) can award Federal Student
Aid, please conrm the information
you and your parents reported on
your 2019-2020 FAFSA. A Kellogg
Community College Financial Aid
Administrator will compare the
information reported on your
FAFSA with the information on this
worksheet. If there are dierences,
your FAFSA information will need
to be corrected. Complete and
sign this worksheet, attach any
required documents, and submit
the form to the FAO. The FAO may
ask for additional information. If you
have questions about verication,
contact the FAO as soon as possible
so that your nancial aid will not be
Part I. STUDENT INFORMATION
Last Name First Name M.I. Student ID#
Street Address (include apt. no.) Social Security #
City State Zip Date of Birth
Home Phone Cell Phone Alternative Phone
Part II. HOUSEHOLD INFORMATION
In the box below list ALL members of your household. If you have questions
regarding household members, contact the FAO. Your household should include:
• The student
• The student’s spouse, if the student is married.
• The student’s or spouse’s children if the student or spouse will provide more
than half of their support from July 1, 2019, through June 30, 2020, even if the
children do not live with the student.
• Other people if they now live with the student and the student or spouse
provides more than half of their support and will continue to provide more
than half of their support through June 30, 2020.
Full Name Age
Male or Female
M or F Relationship College
*Will be Enrolled at
Least Half Time
(Yes or No)?
Self Kellogg Community College Yes
*For any household member who will be enrolled at least half time (6 credits) in a degree, diploma, or certicate program at an eligible
postsecondary educational institution any time between July 1, 2019, and June 30, 2020, include the name of the college. If more space
is needed, provide a separate page with the student’s name and ID number at the top.
NOTE: We may require additional documentation if we have reason to believe that the information regarding the household members
enrolled in eligible postsecondary educational institutions is inaccurate.