Office of Financial Aid • 1420 N. Charles St. • Baltimore, MD 21201 • p: 410.837.4763 • f: 410.837.5493
2019-2020 Unusual Enrollment History
The US Department of Education has determined that you have an unusual enrollment history and have received the
Federal Pell Grant or Direct Stafford Loans at three or more institutions during a review period of 2015-2016,
2016-2017, 2017-2018, and 2018-2019. The flag requires the Office of Financial Aid at the University of Baltimore
review your enrollment history.
Please complete and return this form and any requested documentation to the Office of Financial Aid. Documents may
be faxed to 410.837.5493 or scanned and emailed to Please allow up 3-5 business days for your
To Do List to be updated once submitted.
Last Name First Name M.I. Student ID Number (begins with 1 or 3)
Email Address Telephone Number Date of Birth
Please complete the chart below listing all colleges and universities where you received the Federal Pell Grant and
Stafford Loans. If you are unsure what those schools are, you may visit the National Student Loan Data System
(NSLDS) at to assist you in determining the schools you attended. You also need to provide official
or unofficial academic transcripts from all of the schools you listed below.
School Attended
Dates of
Enrollment Status
Total Credits
Pell Grant
Date Transcript
Submitted (See
If you have already submitted your transcripts to the Admissions Office please indicate the submission date. If you
failed to earn any academic credits at any of the schools listed above, please provide a written explanation on a
separate page and third party supporting documentation.
By signing this worksheet, I certify that all the information reported on this worksheet to qualify for federal student aid is
complete and correct. If you are dependent for financial aid purposes, at least one parent must sign. Warning: If you
purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
________________________________ __________
Student’s signature Date
click to sign
click to edit