2020-2021 Unusual Enrollment History Name________________________
____________________ ______________________ ____ __________________________
Student first name Student last name M.I. Social Security #
The Department of Education has selected your file for review due to a pattern of unusual enrollment history at the colleges you
have previously attended. Federal regulations dictate that we must ask you for additional information before determining your
eligibility for federal student aid. You must submit this form and required documentation to our office to determine your financial
aid eligibility at Louisiana College.
Schools Attended:
Access the National Student Loan Database (NSLDS) at www.nslds.ed.gov to assist you in filling out the information below.
Please list all colleges attended during the time frame listed below. Using NSLDS you will be able to view your Pell Grant records
associated with the school you attended. If you attended multiple schools during the indicated time frame attach an additional page.
You must attach an academic transcript or grade report from each education institution attended. You must submit an official
academic transcript from each previously attended college to the Louisiana College Office of Admissions if you have not already
done so. Failure to report all colleges with attached transcript/grade reports will result in denial of your request for financial aid at
Louisiana College.
Name of School
Date of Attendance
Credits Earned?
2015-2016
Yes No*
2016-2017
Yes No*
2017-2018
Yes No*
2019-2020
Yes No*
Extenuating Circumstances
*If you answered “No” to the Credit/Clock Hours Earned question for any of the schools you listed above you must provide a typed
detailed explanation of the special circumstance(s) that caused your failure to earn academic credit/hours at each school and
provide third-party documentation to support your explanation. This office will review your academic transcripts and/or
explanation and documentation to determine your financial aid eligibility and will send you a decision letter.
A. Certification and Signatures
Each person signing below certifies that all of the information reported on it is complete and correct.
The student must sign and date.
___________________ _________________________________________________
Student’s Signature (Required) Last 4 of Social Security # Date
Submit this worksheet to:
Louisiana College, Office of Financial Aid, 1140 College Drive, P.O. Box 582, Pineville Louisiana 71359
Or scan and email it to financial_aid@lacollege.edu
Warning: If you purposely give false or misleading
information, you may be fined, be sentenced to jail,
or both.
click to sign
signature
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome