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SCC Financial Aid Use Only
Approved____ Date/Initials __________
Denied___ Date/Initials _____________
SOUTHEASTERN COMMUNITY COLLEGE
FINANCIAL AID OFFICE
2020-2021 REQUEST FOR REVIEW OF UNUSUAL ENROLLMENT HISTORY
______________________________ __________________ _____________________________________
Student’s Last Name, First Name Student’s ID or SSN Student’s Date of Birth
________________________________________________________________________________
Student’s Street Address, City, State and Zip Code
____________________________________
Student’s Email Address
___________________________ ____________________________
Student’s Home Phone Number Student’s Cell Phone Number
Semester you are planning to attend __________________
Your financial aid application has been flagged by the Department of Education because your enrollment pattern over the
last couple of years indicates that you have been enrolled at several different colleges and received federal financial aid.
In this case, a student must provide documentation to the SCC Financial Aid Office as follows:
1) Official college transcripts from any previous college attended.
2) Complete this Enrollment History form and provide written statement of any special circumstances as noted
below. Documentation from a third party is required to support your circumstance.
These circumstances must be one of the following:
Death in the family
Medical Illness (Personal/Immediate family)
Divorce or Separation
Change in where the student is living
Military obligations
Other Academic circumstances:
Academic program not meeting student’s needs
Unexpected academic challenges.
Instructions:
Complete the reverse side of this form, providing a detailed statement of the extenuating circumstances for each
period of enrollment that you did not earn any academic credit at the prior college. Please include:
What specifically happened that caused you not to complete your classes?
When did the above occurrence happen (month and year)?
How did the above occurrence affect your academic performance?
Briefly explain what has now changed, or the steps you have taken, that should now result in you completing your
classes in the future.
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Provide documentation for the above occurrences.
Signed statement from a medical professional stating the circumstances and specific date of occurrence.
Signed statement from a parent/relative describing a family emergency that required your attention and specific
date of occurrence. Along with this statement, include a copy of death certificate or physician’s statement.
Copy of divorce or separation papers.
Copy of proof showing prior address where you were living.
Copy of military orders.
You may provide any additional documentation that will help us make a decision.
Please explain your circumstances. Attach copies of the documentation described above.
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Please explain the steps you have taken or what you will do differently in the future. Attach a copy of your
Individual Graduation Plan (IGP) and explain when you will graduate. Note: An academic plan is required for approval.
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
The SCC Office of Financial Aid will review your Enrollment History with supporting documentation, and you will
receive a letter that will inform you of the results of your continued eligibility for federal financial aid. If your request is
denied, you have the right to question the decision with the Director of Financial Aid or Dean of Students.
________________________________________________________________________
Student Signature and Date
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