Fillable 2019-20 Unusual Enrollment History Form (Eastern Florida State College)

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2019-20 Unusual Enrollment History Form (Eastern Florida State College)

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* This form must be submitted by the priority deadline to ensure a determination of eligibility before the Fee Due Date. Students may still apply
for aid after the priority deadlines, but EFSC cannot guarantee that late submissions will be notified of aid eligibility prior to the Fee Due Date.
01/30/19
20UEH
FA Unusual
Enrollment History
2019-20 Unusual Enrollment History Form
Your 2019-2020 Free Application for Federal Student Aid (FAFSA) was selected for review by the U.S. Department of
Education due to an unusual enrollment history. Unusual enrollment is defined as having received Federal Pell Grant or
Direct Loan funds at multiple educational institutions during the period of 2015-16 through 2018-19. Some students
with an unusual enrollment history have legitimate reasons for their enrollment at multiple institutions while others do
not. EFSC must obtain additional information to determine your eligibility for federal student aid.
Priority Deadlines*: Fall 2019 – 07/18/19 | Spring 2020 – 11/25/19 | Summer 2020 – 04/23/20
A. Student Information
B#
Last Name First Name M.I. Student ID
B. Schools Attended
List all colleges attended during the 2015-16, 2016-17, 2017-18 and 2018-19 academic years.
• Indicate whether or not you earned academic credit at each institution. Academic credit is considered to
have been earned if the academic records show that you completed any credit hours or clock hours.
• If you have not already done so, submit your transcripts (official or unofficial) from all colleges listed below
to the Office of Admission or Office of Financial Aid.
• Failure to report all colleges attended and/or failure to submit transcripts (official or unofficial) will result in
denial of financial aid eligibility at Eastern Florida State College.
• If more space is needed, attach a separate page with your name and B Number at the top.
Institution Dates of Attendance
Credit Hours
Earned?
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
☐ Yes ☐ No
EFSC Office of Financial Aid
www.easternflorida.edu/go/aid | (321) 433-7339 | finaid@easternflorida.edu
2
C. Extenuating Circumstances
If you answered “NO” to the Credit Hours Earned question in Section B for ANY of the schools you attended in
2015-16, 2016-17, 2017-18, or 2018-19 you must provide a typewritten, signed, detailed explanation of your failure
to earn academic credit and provide third party documentation to support your explanation. Valid reasons for
failure to complete academic credit include, but are not limited to:
• Documented medical condition or serious illness
• Documented family emergency
• Documented change of city and/or state residence
• Documented death of an immediate family member
• Documented military obligations
• Documented change in conditions of employment
• Other extraordinary/emergency circumstances, such as natural disasters or crimes
Attach date-specific support documentation from a third party. Letters from family and friends are not acceptable.
Documentation includes, but is not limited to:
• Letter from a physician or counselor
• Copy of a death certificate, obituary, or third party documentation of death
• Accident reports, police reports, court records, etc.
• Rental agreements, utility bills, etc. to show relocation
• Copy of military orders
D. Certification and Signature
By signing below I certify that all of the information reported is
complete and correct.
Student’s Original Signature (cannot be signed electronically) Date
E. Document Submission
You may submit this document by the following methods:
1. EFSC DOCUMENT DROPBOX (RECOMMENDED)
Print and complete this document (including the original signature), scan the document, and upload the
document via the Document Dropbox in myEFSC. Printers and scanners are available in EFSC’s open
computer labs and libraries.
WARNING: If you purposely give false
or misleading information, you may be
fined, sent to prison, or both.
EFSC Office of Financial Aid
www.easternflorida.edu/go/aid | (321) 433-7339 | finaid@easternflorida.edu
3
2. IN PERSON
Submit your document in person at the Office of Financial Aid on any campus:
Cocoa
Building 11, Room 209
Monday through Thursday, 8 a.m. to 7 p.m.
Palm Bay
Building 1, Room 117
Monday through Thursday, 8 a.m. to 7 p.m.
Melbourne
Building 1, Room 137
Monday through Thursday, 8 a.m. to 7 p.m.
Titusville
Building 3, Room 125
Monday through Wednesday, 8 a.m. to 5:30 p.m.
Thursday, 8 a.m. to 7 p.m.
3. BY MAIL
Mail your document to the Office of Financial Aid on any campus:
Eastern Florida State College
Office of Financial Aid, C11-209
1519 Clearlake Road
Palm Bay
Eastern Florida State College
Office of Financial Aid, PB1-117
250 Community College Parkway
Palm Bay, FL 32909
Eastern Florida State College
Office of Financial Aid, M1-137
3865 N. Wickham Road
Titusville
Eastern Florida State College
Office of Financial Aid, T3-125
1311 N. US 1
Titusville, FL 32976
QUESTIONS?
Financial Aid Specialists are available at the campus locations listed above, by phone at 321-433-7339, and via e-mail at
finaid@easternflorida.edu.
Eastern Florida State College is committed to equal access/equal opportunity in its programs, activities, and employment.
For additional information, visit Eastern Florida State College: easternflorida.edu/go/equity.
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2019-20 Unusual Enrollment History Form (Eastern Florida State College)

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Completed 21 July 2020

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