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# # # # # # # # # # # #
2020-21 %Appeal% for% Unusual% Enrollment% History%
Your financial aid application has been selected for a% review based upon your enrollment history. The Financial Aid Office is required
to review your% academic history for% the past% four% years before your% fin an cial aid eligibility can be determined . If% you fail to provide
the required documenta tion, you will be denied federal financial aid.
Student Name: UH
ID#:%
Phone Number: Da
te of Birth:
A. INSTITUT IO N ( S) +A T T E N D E D : +P le a se +comple te +th e +informa tion below for all institutions attended for the years:
Name of Institution(s) Attended
Did you receive a Federal
Pell Grant or Direct Loan?
(Answer 'Yes'+ or 'No')
Academic Credit(s)
Earned (Answer 'Yes' or
'No'+then +go +to +Step +B)
B. ACADEMIC HISTORY
i.
If %you %answ e re d ‘Yes’%to %earning %a c ademic %cred it s %(a b o v e ),%s u b mit a %trans c rip t %d o c u menting %th e %c re d it s %e a rn e d . If
you attended any University of Hawaiʻi campus during the above years, you do not need to submit a transcript from
that% UH campus.
ii.
If you answered ‘No‘ to earning academic credits (above), attach a written statement that explains why you failed to
earn academic credit at each of the% institutions where no credit was earned.
I"certify "that "t
he "inform a tio n is "true "and "co rre c t "to "th e "b es t "of "my "knowle d g e. "I"u n d ers ta n d "that "any "fals e "st a tement "or
misrepresentation may be cause for denial, reduction, or repayment of financial aid.
Student’s Signature: Date:
RETURN +THIS+ FORM +ALONG +WITH +ANY+ OTHER+RE QUIRED+ DOCUMENTATION +TO+ THE+ COMMUNITY+ COLLEGE+ CAMPUS+ THAT+ YOU+ WILL+ BE+ ATTENDING:+
Hawaiʻi Community College
1175% Manono Street *% Hilo, HI 96720
Honolulu Community College
874% Dillingham Boulevard *% Hono lulu, HI 96817
Kapiʻolani Community College
4303% Diamond Head Road *% Honolulu, HI 96816
3-1901% Kaum ualiʻi Highway *% Lihuʻe, HI 96766
Leeward Community College
96-045% Ala% Ike% Street *% Pearl City, HI 96782
University of Hawaiʻi Maui College
310% West Kaʻahumanu Ave *% Kahului, HI 96732
Windward Community College
45-720% Keaʻahala% Road *% Kāneʻohe, HI 96744
The University is committed% to% a policy of nondiscrimination% on% the basis of race, sex, gender identity and% expression, age, religion, color, national origin, ancestry, citizenship, disability,
genetic% information, marital status, breastfeeding, income% assignment for child support, arrest and court record (except as% permissible% under State% law), sexual orientation, national guard
absence, or status% as% a% covered veteran.
UH Title% IX% Coordinators' names% and contact information are% available% at: https://www.hawaii.edu/titleix/help/coordinator/ and UH 504%
Coordinators’ names and% c
ontact information% are available at: https://www.hawaii.edu/offices/eeo/ada-504-coordinators/
UH# HILO, UH# WEST OAHU# AND# UH# MANOA STUDENTS NEED# TO# CONTACT THEIR FINANCIAL AID# OFFICE FOR CAMPUS SPECIFIC FORMS.
Rev.%10/2019%
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