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Unusualenrollmenthistoryform

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Financial Aid Office
(708) 709-3735
Fax: (708) 709-3716
m:\stuserv\favaoffice\2016-17 forms\unusualenrollmenthistoryform.docx
2016-17 Unusual Enrollment History Appeal Form
Your 2016-2017 Free Application for Federal Student Aid (FAFSA) has been selected for ‘unusual enrollment
history’ review by the U.S. Department of Education because you received federal aid (grants/loans) at multiple
postsecondary institutions. This review will analyze your completed enrollment, earned academic credit, and
federal student aid paid for the enrollment periods, 2012-2013, 2013-2014, 2014-2015, 2015-2016. The outcome
of this review will determine your 2016-2017 eligibility for federal student aid at Prairie State College. Please
complete this form and submit it to the Prairie State College Office of Financial Aid.
STUDENT INFORMATION
_____________________________________________ ____________________________
Student’s Name ID Number
A. SCHOOLS OF ATTENDANCE
• You must provide the following information for each school you attended during the time frame listed. If
you attended multiple schools during the indicated time frame, you must list each school and provide dates
of attendance.
• You must submit official academic transcripts from each college attended.
• If you fail to report a school during the indicated time frame or fail to submit a transcript, you will be denied
federal financial aid at PSC.
2012-2013 Academic Year
School Name
School Location
Date of Attendance
Number of Credits Earned
2013-2014 Academic Year
School Name
School Location
Date of Attendance
Number of Credits Earned
2014-2015 Academic Year
School Name
School Location
Date of Attendance
Number of Credits Earned
2015-2016 Academic Year
School Name
School Location
Date of Attendance
Number of Credits Earned
Financial Aid Office
(708) 709-3735
Fax: (708) 709-3716
m:\stuserv\favaoffice\2016-17 forms\unusualenrollmenthistoryform.docx
B. EXTENUATING CIRCUMSTANCES
If you failed to earn academic credit for any period of attendance in provided in Section A, you must provide a
written explanation that outlines the reason(s) for not earning credit during each enrollment period. You may
present personal reasons to explain your failure to earn academic credit. You must provide an explanation for each
academic period that you failed to earn credit and therefore, may have multiple circumstances that may include, but
not limited to the following:
Death of an immediate family member (must include the relationship of family member to the student
and a copy of the death certificate)
Documentation of hospitalization or illness of self, spouse, child, or parent (must include dates of health
care provider’s decision, written on official letterhead, as to the student’s readiness to return to school)
Military obligations (must include documentation from commanding officer)
Victim of a crime or unexpected disaster (must include copy of police report, their party letters, etc.)
Other (must include appropriate documentation
C. STUDENT CERTIFICATION AND SIGNATURE
If you purposely give false or misleading information on this form, you may be: denied financial aid at
PSC, subjected to disciplinary action, fined, imprisonment, and/or all of the aforementioned.
I certify that the information reported on this form is true and correct. If requested, I agree to provide
additional documentation or clarification to the financial aid office.
_________________________________________ _______________________________________
Student Signature Date
D. TO BE COMPLETED BY THE FINANCIAL AID SAP COMMITTEE
Approved
Denied
Reason:
Date:_______________________________
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Completed 20 February 2020

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