2020-2021Unusual Enrollment History Form
Financial Aid Office, P.O. Box 917, Henderson, NC 27536
Telephone: (252) 738-3280, Fax: (252) 738-3388, Email: fao@vgcc.edu
The U.S. Department of Education identifies students with Unusual Enrollment Histories in an effort to prevent
fraud and abuse in Federal Student Aid Program. If it has been determined a student has an Unusual
Enrollment History, and VGCC has reason to believe the student remained enrolled only long enough to
receive a Title IV credit balance, and/or no academic credit has been earned, a student may complete the
Unusual Enrollment History Form documenting legitimate reasons for his/her enrollment at multiple
institutions without earning academic credit.
Federal regulations authorize the Financial Aid administrator to determine whether the student’s
circumstances of the failure to receive academic credit, as evidenced by the student’s academic records and
other documentation, justify the continuation of Title IV eligibility. The Financial Aid administrator’s decision
is final.
If approval of continued eligibility is granted, the student may be required to establish an academic plan with
the VGCC Financial Aid Office. Failure to meet the requirements of the academic plan will result in
termination of Title IV eligibility. If continued eligibility is denied, the student must successfully earn academic
credit to regain Title IV eligibility.
Please complete all sections and return to the Financial Aid Office with required documentation. All
documentation submitted is confidential. Each file submitted will be reviewed and notification of the decision
will be provided to the student within 15 college working days. The Financial Aid Office will send official
notification to the student’s VGCC e-mail address.
Student Information:
________________________________________________ _____________________________________
Last Name First Name M.I. VGCC Student ID Number
________________________________________________ _____________________________________
Address Phone Number (with area code)
_______________________________________________ _____________________________________
City State Zip Code Other Phone (cell, work, etc.)
Email address
2020-2021 Unusual Enrollment History Form Revised Date: 06/08/2020/FAO
____________________________________________ ___________________________________________
Identify the reason(s) academic credit has not been earned. (Please check all that apply.)
Loss or illness of student/family member due to: sickness, death, disability, etc.
Family emergency of student/family member
Change in student/family member’s residence due to: job relocation, separation/divorce, etc.
Student/Parent/Spouse called to active duty in the armed forces
Submit the following documentation with this form:
Student Parent Spouse
Letter explaining special circumstance
Employment termination notice
Physician’s statement of disability
Employer disability payments
Worker’s compensation statements
Unemployment benefit statements
Benefit provider’s loss of benefit
Statements from doctor/health care provider
Separation agreement or divorce decree
Death certificate
Military documents
Letter from third party
Certification Statement: I/We certify that the information provided is true, complete, and correct to the best
of my/our knowledge. I/We understand that false statements or misrepresentations are cause for denial,
reductions, withdrawals, and/or repayment of financial aid. I/We also understand that this information will be
used in accordance with Federal guidelines and may or may not result in adjustments to the student’s financial
aid eligibility.
Student Signature Date Parent or Spouse Signature Date
2020-2021 Unusual Enrollment History Form Revised Date: 06/08/2020/FAO
Letter of Explanation
Please use this section to provide a detailed explanation of the circumstances that have led to your unusual
enrollment history. Attach additional pages and documentation if necessary. (Please print clearly)
Financial Aid Office Use Only
Date Received: ____________________ FAO Decision: Approved Denied
If approved, Date of Academic Plan: ____________________________
Financial Aid Staff Initials: _________________Date:___________________
2020-2021 Unusual Enrollment History Form Revised Date: 06/08/2020/FAO