Fillable Unusual Enrollment History Appeal Form U.S. Department of (Northwest State Community College)

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Unusual Enrollment History Appeal Form U.S. Department of (Northwest State Community College)

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Unusual Enrollment
History Appeal Form
Northwest State Community College • 22600 State Route 34 • Archbold • OH • 43502
Phone: 419-267-1333 • Fax 419-267-5587 • finaid@northweststate.edu
v
Name: ___________________________________ NSCC ID number: N________________________
Phone: _________________________ Email: _____________________@students.northweststate.edu
Which term will you be attending next? (check one): __ Summer 2019 __ Fall 2019 __ Spring 2020
Current major: ______________________________________________________________________
U.S. Department of Education Unusual Enrollment History Regulation (GEN-13-09)
Academic Credit Not Earned – if the student did not earn academic credit at a previously attended institution and, if
applicable, at the institution performing the review, the intuition must obtain documentation from the student
explaining why the student failed to earn academic credit. The institution must determine whether the documentation
supports (1) the reasons given by the student for the student’s failure to earn academic credit; and (2) that the student
did not enroll only to receive credit balance funds.
Reasons could include illness, family emergency, change in students living arrangement, and military obligations. The
institution should, to the extent possible, obtain third party documentation to support the student’s claim. The
financial aid administrator may choose to require the student to establish an academic plan, similar to the type of plan
used to resolve satisfactory academic progress appeals.
If the student did not earn academic credit at one or more of the relevant institutions and does not provide acceptable
explanation and documentation for each of those failures, the institution must deny the student any additional title IV
program assistance.
If the institution denies a student continued title IV program assistance, it must provide the student with information
as to how the student may subsequently regain title IV program eligibility. Since the basis for the denial is the
student’s academic performance, it is expected that successful completion of academic credit would form the basis for
the student’s subsequent request for renewal of title IV eligibility. This could include meeting the requirements of an
academic plan that the institution established with the student.
Name of School Attended
Dates of Attendance
(To – From)
(MM-DD-YYYY)
Credit
Hours
Earned
Transcript
Received by NSCC
Yes __ No* __
Yes __ No* __
Yes __ No* __
Yes __ No* __
*We will not be able to process your file until we receive official transcripts from each of the listed institutions.
The information provided on this form, in my typed statement and all accompanying documentation, is accurate
and complete to the best of my knowledge. I agree to provide additional documentation if requested by the
Financial Aid Office.
Student Signature: _______________________________________ Date: ________________________
Northwest State Community College does not discriminate on the basis of race, color, national origin, sex, gender identity, disability, religion
or age in its programs or activities.
Unusual Enrollment
History Appeal Form
Northwest State Community College • 22600 State Route 34 • Archbold • OH • 43502
Phone: 419-267-1333 • Fax 419-267-5587 • finaid@northweststate.edu
Required Documentation
1. Financial Aid Appeal Form.
2. Typed letter from student explaining the circumstance for not earning credit at each of the institutions he/she
attended during the 2015-2016, 2016-2017, 2017-2018, and 2018-2019 academic aid years. Clearly explain how
your situation has changed and what your plans are to be successful in the upcoming semesters. Please make sure
to include your, name, student ID number, date, and signature.
3. Independent third party documentation to support the reasons stated in the appeal letter. Examples of
documentation may include: medical documentation, note from physician, copy of new work schedule, copy of
death certificate, military obligations, etc.
4. Official Transcripts from each previously attended institution (if not previously submitted with Unusual
Enrollment History Verification Form) and print off your academic transcripts from your myNSCC account if you
have previously attended NSCC.
5. Plan of study entered in DegreeWorks by the advisor. An appointment is required to meet with an advisor in
order to complete the plan of study (see below for contact information). The plan of study must list all courses the
advisor recommends the student to enroll in during the next 2 semesters.
6. Complete the Appeal Workshop. The workshop is available online. Students can access the workshop by logging
into their Sakai account online at sakai.northweststate.edu. After completing the workshop, all students must
complete the Appeal Workshop Quiz and attach a copy of their score with their appeal information. This must be
completed prior to submitting the appeal form to the Financial Aid Office. Student must pass the workshop quiz
with a score of at least 70%.
It may take up to 15 working days before a decision is made. If a decision has not been made on your appeal by the
time payment is due, you will need to make payment arrangements with the Business Office.
Plan of Study
Please contact the division secretary from your department of study to make an appointment with an advisor in order to
complete your plan of study.
Allied Health, Business, & Public Services: 419-267-1345 Industrial: 419-267-1483
Arts & Science: 419-267-1247 Nursing: 419-267-1246
Engineering: 419-267-1394 Undecided: 419-267-1247
Plan of study entered in DegreeWorks by the advisor. The plan of study must list all of the courses the advisor
recommends the student to enroll in during the next 2 semesters.
*Attention Advisor* Please enter the student’s plan of study in DegreeWorks. The spaces below are intended for
the student to make a draft of their plan of study prior to meeting with you.
Semester _______________ 20_____
Semester _______________ 20_____
CRS (e.g.
ENG100)
Description
Credits
CRS (e.g.
ENG100)
Credits
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Unusual Enrollment History Appeal Form U.S. Department of (Northwest State Community College)

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Completed 3 October 2020

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