2020-2021
UNUSUAL ENROLLMENT HISTORY
APPEAL STATEMENT
S
TUDENT
I
NFORMATION
Last Name
First Name M.I.
Student ID#
The U.S. Department of Education has determined that you have an unusual
enrollment history which indicates that you received the Federal Pell Grant funds and/
or Federal Direct Loans at three or more institutions during the past four years.
We h
ave reviewed your submitted academic transcripts and your Statement of
Enrollment History. It was determined that you did not earn academic credit at one, or
more, of the previously attended institutions. Additionally, you have not provided
compelling reasons and documentation as to why you failed to receive academic credit
for the period you received financial aid.
If you wish to appeal this decision, please attach a typed statement to explain the
extenuating circumstances for your failure to earn academic credit. Explain all terms in
which you failed to earn credit. Include any documentation to support your statement
that has not already been submitted.
By signing this form, I certify that all the information
reported to qualify for federal student aid is complete
and correct.
Student Signature:
Date:
RETURN TO FINANCIAL AID OFFICE:
WARNING: If you purposely give
false or misleading information you
may be fined, sentenced
to jail, or
both.
CERTIFICATION AND SIGNATURE
FSGA63
