Office of Financial Aid • 1420 N. Charles St. • Baltimore, MD 21201 • p: 410.837.4763 • f: 410.837.5493 • email@example.com
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 firstname.lastname@example.org. Please allow up 3-5 business days for your
To Do List to be updated once submitted.
A. STUDENT INFORMATION
Last Name First Name M.I. Student ID Number (begins with 1 or 3)
Email Address Telephone Number Date of Birth
B. ENROLLMENT HISTORY
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 www.nslds.ed.gov 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.
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.
C. SIGN THIS WORKSHEET
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
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