Virginia Community College System
12745 College Drive, Glenns, VA 23149-2616 / 804-758-6700 (TDD 758-6760)
52 Campus Drive, Warsaw, VA 22572-4272 / 804-333-6700 (TDD 333-6760)
2020-21 Unusual Enrollment History Form
Name
Last First MI
EMPLID Date of Birth VCCS email address
@email.vccs.edu
Your
2020-2021 Free Application for Federal Student Aid (FAFSA) has been flagged forUnusual Enrollment
History Review” by the U.S. Department of Education because you received Federal Pell Grant and/or Direct
Loan funds at multiple education institutions during the review periods of 2016-17, 2017-18, 2018-19 and
2019-20. The flag requires Rappahannock Community College to review your enrollment history and
determine whether or not you are enrolling only long enough to receive cash refunds of feder
al student aid. In
the process of reviewing your enrollment history, Rappahannock will check the National Student Loan Data
System (NSLDS) to obtain a complete history including the names of institutions you have attended and the
dates of attendance.
Plea
se complete the steps below. This is an appeal process and there are no guarantees of an approval.
Your application for financial aid will not be considered until you submit this form with the required
documentation.
A. Please list ALL institutions (including Rappahannock) that you attended during the academic periods of 2016-17, 2017-
18, 2018-19 and 2019-20. Please attach an academic transcript for EACH of the schools listed (excluding Rappahannock or
any other Virginia Community College System institution).If you are unaware of where you received aid, you may log into
NSLDS to assist you at
www.nsl
ds.ed.gov.
Name of College or University
Dates of Attendance
Type of aid received (Pell Grant,
Federal Student Loan, etc.)
Number of credits earned at the
college/university?
B.
If you did not earn any academic credit at one or more of the schools listed above, attach to this form, a
typed statement explaining the reason(s) for your failure to earn any academic credit. Provide an
explanation for EACH of the schools where you did not earn any academic credit. Attach any supporting
documentation (i.e., military obligations, police reports, medical documentation, etc.). The Office of
Financial Aid will review your statement and supporting documentation to determi
ne if you are eligible
to continue receiving financial aid assistance.
Virginia Community College System
Certification and Signature: I certify that the submitted information is true and correct to the best of my
knowledge and belief. If asked by an authorized official, I agree to provide additional proof of the information
provided on this form. I understand that purposely providing false or misleading information on this form may
result in reduction or repayment of aid, fines and/or imprisonment in this and/or future years.
Sign
ature Date