M
Office of Student Financial Aid
Phone: 240-567-5100
FinancialAid@montgomerycollege.edu
Office Use Only Code: EDHISE/ FA ENROLL HISTORY
EVEN
2019 - 2020 Enrollment History
Verification
SECTION A: STUDENT INFORMATION
The US Department of Education has determined that you have an unusual enrollment history and have received a Federal Pell Grant
and/or Federal Direct Loan at three or more institutions during the past four award years. The following information must be
submitted to our office to assist in the determination of your federal financial aid eligibility.
PLEASE COMPLETE ALL SECTIONS OF THIS FORM BEFORE SUBMITTING IT WITH ALL OTHER REQUESTED DOCUMENTS TOGETHER.
SECTION B: ENROLLMENT INFORMATION
Please list all Colleges, Universities, and trade schools in which you received a Federal Pell Grant and/or Federal Direct Loan from
in 2015-2016, 2016-2017, 2017-2018, and 2018-2019 award years. You can go to the National Student Loan Data System (NSLDS)
at www.nslds.ed.gov to assist you in determining the schools that you attended.
You must provide an official academic transcript from each school listed in the NSLDS system in which you attended in the last 4
years. All transcripts should be submitted in sealed envelopes with this form.
Attended
Attended
Earned
Federal Direct
Loan received
been submitted to MC
Admissions office (see
to
to
to
SECTION C: ACADEMIC HISTORY INFORMATION
Read and Initial the Following Statements:
1. After reviewing your
academic transcripts, if we find that you failed to earn any academic credits or make satisfactory
academic progress at any of the schools listed above for which you received funds, you may not be eligible to receive
financial aid at Montgomery College. __________
2. You may be required to provide a written explanation with documentatio
n to support why you did not earn any credits and/or
did not make satisfactory academic progress at your previous institutions. __________
3. If requested, you may be required to provide an academic plan. __________
By signing this worksheet I certify that all the information reported on this form is complete and correct.
_________________________________________________________________
______________________________ Student Signature (must be signed in ink)
Date
WARNING:
If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both. All documents
requested must be complete and submitted together by mail, or in person. Do not fax this document. Incomplete forms will delay the
processing of your financial aid.
