FORM UEHFLG - IDAHO STATE UNIVERSITY 19-20
UNUSUAL ENROLLMENT HISTORY REQUEST
Please complete the information below, provide the requested documentation, and
return the completed form to one of the following addresses:
Offi
ce of Financial Aid, Idaho State University, Museum Building, Room 337
921 S 8
th
Ave, Stop 8077, Pocatello, ID 83209-8077
Phone: (208)282-2756 Fax: (208)282-4755 Email: finaidem@isu.edu
Web: www.isu.edu/financialaid/forms/
University Place, Bennion Student Union Building, Student Services Office
1784 Science Center Dr, Idaho Falls, ID 83402 Phone: (208)282-7704
*Student Name:
(Use blue or black ink) Last First M.I.
*ISU ID: *Last 4 Digits of Social Security #:
(Find under Academic Tools tab on BengalWeb) *Required
The ISU Financial Aid Office has received information from the National Student Loan Database
System (NSLDS) regarding an “unusual enrollment history” during your post-secondary education.
The following information must be submitted to our office to assist in the determination of your federal
aid eligibility. Our office will then review the information you provide and may request additional
documentation, if necessary.
I. ENROLLMENT INFORMATION
Please list all institutions (including ISU) attended during the academic periods that include
2015-2016, 2016-2017, 2017-2018 and 2018-2019. You will need to confirm that all official
transcripts from previous schools have been received and processed by the ISU Admissions Office
(208-282-2475). For each school listed, attach a separate explanation if you failed to earn any
academic credit for a term at that specific school. Attach any additional supporting documentation
(i.e., medical bills, physician letters, accident reports, etc.) that supports your reason for not earning
any credits for a term. Please include your Student/ISU ID number at the top of each page of the
attachments. Your application for financial aid will not be considered until you submit the
completed form and all required documentation.
Dates of
Hours
Pell Grant
Direct Loan
at ISU
II. CERTIFICATION: The person signing below certifies that all of the information reported is
complete and correct. Purposefully giving false or misleading information on this form may lead
to fines, prison or both.
Student’s Signature: Date:
WARNING: If you purposely give false or misleading information, you may be fined, sent to prison, or both.
(v. 12/14/2018) (S:\16_Forms\formUEHFLG.docx)
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