Financial Aid Office
(708) 709-3735
Fax: (708) 709-3716
m:\stuserv\favaoffice\2015-16 forms\2015-16unusualenrollmenthistoryform.docx
2015-16 Unusual Enrollment History Form
Your 2015-2016 Free Application for Federal Student Aid (FAFSA) has been selected for ‘unusual enrollment
history’ review by the U.S. Department of Education because you received federal aid (grants/loans) at multiple
postsecondary institutions. This review will analyze your completed enrollment, earned academic credit, and
federal student aid paid for the enrollment periods 2011-2012, 2012-2013, 2013-2014, and 2014-2015. The
outcome of this review will determine your 2015-2016 eligibility for federal student aid at Prairie State College.
Please complete this form and submit it to the Prairie State College Office of Financial Aid.
___________________________________________________ ________________________________
Student’s Last Name First Name Middle/Maiden Name
____________________________ ________________________ _________________________
ID Number Social Security Number Date of Birth
___________________________________________________ ________________________________
Address (include apartment number) Phone number (include area code)
___________________________________________________ ________________________________
City State Zip Email Address
Please list all institutions attended during the enrollment periods 2011-2012, 2012-2013, 2013-2014, and 2014-2015.
Attach an official transcript from each of the institutions attended AND attach a statement of explanation for any
course for which you failed or withdrew from. Attach any additional documentation that supports circumstances
that affected course completion or course withdrawal (i.e., medical bills/hospital records, military assignment, or
court documentation of legal events). Additional information may be requested.
Name of College/University
Dates of Attendance
Federal Student Aid Received
I certify that I have read and understand all items on this form and all information provided for my
financial aid is true and correct.
_________________________________________ _______________________________________
Student Date