2019-20 Appeal for Unusual Enrollment History
Your financial aid application has been selected for a review based upon your enrollment history. The Financial Aid Office is required
to review your academic history for the past four years before your financial aid eligibility can be determined. If you fail to provide
the required documentation, you will be denied federal financial aid.
Student Name: UH ID#:
Phone Number: Date of Birth:
A. INSTITUTION(S) ATTENDED: Please complete the information below for all institutions attended for the years:
Academic
Year
Name of Institution(s) Attended
Did you receive a Federal
Pell Grant or Direct Loan?
(Answer 'Yes' or 'No')
Academic Credit(s) Earned
(Answer 'Yes' or 'No'
then go to Step B)
2015-16
2016-17
2017-18
2018-19
B. ACADEMIC HISTORY
i.
If you answered ‘Yes’ to earning academic credits (above), submit a transcript documenting the credits earned. If you attended
any University of Hawaiʻi campus during the above years, you do not need to submit a transcript from that UH campus.
ii.
If you answered ‘No‘ to earning academic credits (above), attach a written statement that explains why you failed to earn
academic credit at each of the institutions where no credit was earned.
I certify that the information is true and correct to the best of my knowledge. I understand that any false statement or
misrepresentation may be cause for denial, reduction, or repayment of financial aid.
Student’s Signature: Date:
Electronic signature or digital signature will NOT be accepted.
RETURN THIS FORM ALONG WITH ANY OTHER REQUIRED DOCUMENTATION TO THE COMMUNITY COLLEGE CAMPUS THAT YOU WILL BE ATTENDING:
Hawaiʻi Community College
1175 Manono Street * Hilo, HI 96720
Honolulu Community College
874 Dillingham Boulevard * Honolulu, HI 96817
Kapiʻolani Community College
4303 Diamond Head Road * Honolulu, HI 96816
3-1901 Kaumualiʻi Highway * Lihuʻe, HI 96766
Leeward Community College
96-045 Ala Ike Street * Pearl City, HI 96782
University of Hawaiʻi Maui College
310 West Kaʻahumanu Ave * Kahului, HI 96732
Windward Community College
45-720 Keaʻahala Road * Kāneʻohe, HI 96744
The University is committed to a policy of nondiscrimination on the basis of race, sex, gender identity and expression, age, religion, color, national origin, ancestry, citizenship, disability,
genetic information, marital status, breastfeeding, income assignment for child support, arrest and court record (except as permissible under State law), sexual orientation, national guard
absence, or status as a covered veteran. UH Title IX Coordinators' names and contact information are available at: https://www.hawaii.edu/titleix/help/coordinator/ and UH 504
Coordinators’ names and contact information are available at: https://www.hawaii.edu/offices/eeo/ada-504-coordinators/
UH HILO, UH WEST OAHU AND UH MANOA STUDENTS NEED TO CONTACT THEIR FINANCIAL AID OFFICE FOR CAMPUS SPECIFIC FORMS.
Rev. 04/2020
