Fillable Unusual Enrollment History (UEH) 11400 Robinwood Drive Hagerstown, (Hagerstown Community College)

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Unusual Enrollment History (UEH) 11400 Robinwood Drive Hagerstown, (Hagerstown Community College)

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19CUNEA 1/11/2019
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
First Name: __________________________ Last Name: ___________________________
HCC Student ID #: ____________________________________________
You have been selected by the Federal Government, U.S. Department of Education, Office of
Student Financial Aid for prior enrollment verification while receiving Pell Grant and/or Federal
Student Loans. This is a serious matter that we will try to help you resolve internally.
1. List all colleges attended during the time frame specified below. (This information will be
verified by the Financial Aid Office based on the information provided at www.nslds.ed.gov.)
• Official transcripts from all listed colleges must be submitted to: Hagerstown
Community College, Admissions and Registration Office, 11400 Robinwood Drive,
Hagerstown, MD 21742. HCC will not automatically evaluate your transcript to determine if
credits will transfer to HCC. To have your transfer credits evaluated you must meet with an
Academic Advisor.
Name of College
Dates
Attended
Credits Earned
1.)
2015-2016
Yes No
2.)
Yes No
3.)
Yes No
1.)
2016-2017
Yes No
2.)
Yes No
3.)
Yes No
1.)
2017-2018
Yes No
2.)
Yes No
3.)
Yes No
1.)
2018-2019
Yes No
2.)
Yes No
3.)
Yes No
CONTINUED ON NEXT PAGE
Student Financial Aid Office
11400 Robinwood Drive
Hagerstown, MD 21742
2019-2020
Unusual Enrollment
History (UEH)
Appeal Form
11400 Robinwood Drive
Hagerstown, MD 21742
Phone: 240-500-2473
finaid@hagerstowncc.edu
19CUNEA 1/11/2019
2. Submit a typed explanation of any extenuating circumstances that have contributed to your
inability to successfully complete coursework at any/all of the institutions listed on your chart.
Also state what has changed that will allow you to be successful in the future. You must also
provide supporting third-party documentation that supports your explanation. Extenuating
circumstances include:
• Health reasons – Include medical documentation – physician’s note and release to
return to school/work etc.
• Death of an Immediate Family Member – Include a copy of the death certificate,
obituary, or other official documentation.
• Undue Hardship – Include document from a third party professional (instructor,
counselor, clergy, court records, etc.) who can verify your claim.
IMPORTANT: Consideration for extreme circumstances does not include employer related issues or
work schedule concerns.
I certify that all information submitted with this form is true and complete to the best of my
knowledge.
Signature _____________________________________________ Date _______________________
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Unusual Enrollment History (UEH) 11400 Robinwood Drive Hagerstown, (Hagerstown Community College)

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Completed 20 August 2020

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