Financial Aid Office
Fax: (708) 709-3716
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
COLLEGE AND UNIVERSITIES ATTENDED
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
Federal Student Aid Received
STUDENT CERTIFICATION AND SIGNATURE
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.