Fillable UEH UNUSUAL ENROLLMENT HISTORY SECONDARY REVIEW FORM (Strayer College)

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UEH UNUSUAL ENROLLMENT HISTORY SECONDARY REVIEW FORM (Strayer College)

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UNUSUAL ENROLLMENT HISTORY
SECONDARY REVIEW FORM
August 3, 2015
Student Name:
Diamond ID:
Campus:
Submission Number:
The U.S. Department of Education has selected your file for review due to your unusual enrollment history. Upon review of your
academic records, it has been determined that you did not earn academic credit at one or more of the institutions that you previously
attended and where you received Pell Grant and/or DL funds. We are unable to award federal Title IV funding until we have received a
satisfactory explanation as to why academic credit was not earned at these institutions.
Please complete all sections of this form, supplying any additional required documentation indicated within the form. This form
and the additional documentation will then be uploaded to the Unusual Enrollment History Secondary Review document
requirement in Diamond.
Step 1: Read the complete Reason for Unusual Enrollment History chart below. Check the type of special circumstance
you are claiming in this review, as well as the type of supporting documents you will be supplying to document the
special circumstances. Then, in the spaces provided, give a brief explanation of the specific special circumstance and
how it has affected your ability to earn academic credit at each institution.
Step 2: All documents must be uploaded into the Diamond Financial Aid Management System for review and processing.
Reason for Unusual Enrollment History
Supporting Documentation Required:
You must submit one or more of the following documents pertaining to the time
period in which academic credit was not earned:
Medical Bill(s)
Medical Record(s)
Doctor’s Note(s)
Other third-party proof of debilitating injury or illness
You must submit one of the following:
Death certificate (preferred)
Obituary (preferred)
Other third party proof of relative’s passing
You must submit one or more of the following documents pertaining to the time
period in which academic credit was not earned:
Medical Bill(s)
Medical Record(s)
Doctor’s Note(s)
Other third-party proof of debilitating injury or illness
Signed statement of the person being cared for
You must submit one of the following:
Birth certificate
Adoption papers
Court ordered documentation
UNUSUAL ENROLLMENT HISTORY
SECONDARY REVIEW FORM
August 3, 2015
Your written statement must include:
Explanation as to why this relocation has affected your ability to earn academic credit
You must submit one of the following:
Bill(s) from the moving company or moving equipment rental company
Forwarded mail from old to new address
Utility bill from the old and new addresses
Other third-party proof of relocation
You must submit one of the following:
Proof of termination
Signed statement by employer on company letterhead outlining the time and
resource constraints of the work-related complication
Letter from State Unemployment Office confirming unemployment status
Your written statement must include:
Explanation of how your program didn’t meet your needs and how it resulted in your
inability to earn academic credit
You must submit:
Correspondence from faculty/staff
Documentation proving that Academic Success was attempted
Your written statement must include:
An explanation as to what special circumstance has contributed to your inability to
earn academic credit
An explanation of what you have changed or will change going forward to prevent
inability to earn academic credit.
You must submit:
Documentation supporting your statement
Please note that this is not a complete list of possible reasons for why a student failed to earn academic credit. If you have questions
regarding a specific situation, please contact your Campus Business Office for further guidance. Student Financial Services may
need to request additional documentation or information pertaining to a submitted Secondary Review.
Please also note that the submission of an accurate and complete Secondary Review is not a guarantee that you will receive Title IV
funding.
In the space provided, give a brief, type-written explanation of the specific special circumstance pertaining to the term in which
academic credit was not earned, how it has affected your ability to earn academic credit, and how it has been/will be remedied to
enable you to earn academic credit moving forward.
UNUSUAL ENROLLMENT HISTORY
SECONDARY REVIEW FORM
August 3, 2015
Please attach additional pages if more space is needed. Be sure to include all supporting documentation.
College/University _______________________________________________ Term(s)/Date ____________________________________________
College/University _______________________________________________ Term(s)/Date ____________________________________________
College/University _______________________________________________ Term(s)/Date ____________________________________________
I attest that the written statements and attached documents are true and accurate to the best of my knowledge and belief.
Student Signature: ___________________________________________ Date: __________________
UNUSUAL ENROLLMENT HISTORY
SECONDARY REVIEW FORM
August 3, 2015
Please list all colleges/universities and corresponding terms covered in this Secondary Review:
College/University
Term in which academic credit was not received
I certify that I have reviewed all of the documents attached to this form.
Business Office Name: ____________________________________ Signature: ________________________ Date: __________________
DAte daddadd D
FOR OFFICE USE ONLY
SFS Reviewer Signature: __________________________________ Date: ___________________
Approved/Denied: ________________________________________
Reason for Denial: ______________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
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UEH UNUSUAL ENROLLMENT HISTORY SECONDARY REVIEW FORM (Strayer College)

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Completed 4 August 2020

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