Office of Financial Aid
323 Erie Street, P.O. Box 5015, Port Huron, Michigan 48061-5015
810-989-5530 fax 810-989-5774 sc4.edu
2020-21 Unusual Enrollment History Form
Per federal regulations, you are required to complete the National Student Loan Data System (NSLDS)
Unusual Enrollment History Form so we may further analyze your Federal Pell Grant or Federal Direct Loan
activity over the past three academic years.
Name ____________________________________________ Student ID # _________________________
Phone ______________________________ Email ______________________________
Section 1- Schools Attended
• You must provide the following information for each school you attended during the period listed.
If you attended multiple schools during the indicated period, attach a separate piece of paper listing all schools you
• You MUST attach an official transcript from each school attended; each transcript must clearly show the name of
• If you fail to report a school that you attended during the indicated period or fail to attach an official
transcript, you will be denied financial aid at SC4.
Section 2 - Extenuating Circumstances
You may present personal reasons to explain your failure to earn academic credit. You MUST include third party
documentation to substantiate your claim or you will be denied financial aid at SC4.
Death of an immediate family member (must include the relationship of family member to the student, copy of death
Documented hospitalization or illness of self, child or parent (must include dates and a health care provider's
decision, written on official letterhead, as to the student's readiness to return to school)
Military Obligations (must include documentation from commanding officer)
Victim of a crime or unexpected disaster (must include copy of police report, third party letters, etc.)
Other (must include appropriate documentation) ___________________________________________
I certify that the information reported on this form is true and correct. If requested, I agree to provide additional documentation
to the Financial Aid Office. 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 _________________
If you are able, please print and physically sign this form. If you do not have access to print, please type your name above, but you will
need to come into the Financial Aid office once we re-open to sign.
Submit this worksheet to the Financial Aid Office at SC4.
St. Clair County Community College