Unusual Enrollment History Appeal Form

Your Free Application for Federal Student Aid (FAFSA) has been flagged for “Unusual Enrollment History (UEH) Review” by the U.S. Department of Education because you received Federal Pell Grant funds at multiple institutions during the four preceding academic years reviewed. This flag requires SCIT to review your enrollment history and determine whether or not you are enrolling only long enough to receive cash refunds of federal student financial aid. In the process of reviewing your enrollment history, SCIT will check the National Student Loan Data System (NSLDS) to obtain a complete history including the name of the institutions you have attended and the dates of attendance.

Student Name*

First NameLast Name

Student Number*

Instructions

Please select ALL the academic years you attended at least one other institution during the last four academic years. Then, enter the details for each institution attended during the selected academic year in the table that shows following your selection.

For the column named Credit/Clock Hours Earned, select Yes if you completed at least 1 course in the respective institution (i.e. received a passing grade in at least 1 enrolled course at the respective institution). Otherwise, select No and answer the subsequent question.

Academic Years Attended Other Institutions*

2019-2020 (attended anytime between July 1, 2019 - June 30, 2020)2020-2021 (attended anytime between July 1, 2020 - June 30, 2021)2021-2022 (attended anytime between July 1, 2021 - June 30, 2022)2022-2023 (attended anytime between July 1, 2022 - June 30, 2023)

Colleges or Universities Attended in 2019-2020*

	Name of College or University	Types of Aid Received (e.g. Pell Grant, Loans, etc.)	Credit/Clock Hours Earned?
College/University 1
College/University 2
College/University 3

Colleges or Universities Attended in 2020-2021*

	Name of College or University	Types of Aid Received (e.g. Pell Grant, Loans, etc.)	Credit/Clock Hours Earned?
College/University 1
College/University 2
College/University 3

Colleges or Universities Attended in 2021-2022*

	Name of College or University	Types of Aid Received (e.g. Pell Grant, Loans, etc.)	Credit/Clock Hours Earned?
College/University 1
College/University 2
College/University 3

Colleges or Universities Attended in 2022-2023*

	Name of College or University	Types of Aid Received (e.g. Pell Grant, Loans, etc.)	Credit/Clock Hours Earned?
College/University 1
College/University 2
College/University 3

You have specified that you have not earned any academic credit at one or more previous institutions. For each institution you failed to earn academic credit, please write the name of the institution followed by the reasons you failed to earn academic credit. For example:

Cal State Fullerton: I withdrew due to being ill.

Please attach any additional documentation that supports your reason for withdrawal/failure. Examples include medical bills, hospital records, accident reports, etc.

Reason(s) for failing to earn academic credit (specify the name of each institution followed by the reason).*

Additional Documentation Supporting Reasons

Your request for financial assistance will not be considered until you have submitted this completed Unusual Enrollment History Appeal Form along with all required documentation to the Financial Aid Department. You must be approved in order to receive federal financial aid for the applicable academic year. Submitting an explanation with supporting documentation does not guarantee that financial aid eligibility will be reinstated. If approved, you may be placed on an Academic Plan that, if followed, will ensure college success.

Signing below certifies that all the information reported is complete and and correct.

Signature*

Date*

Date

Unusual Enrollment History Appeal Form

Colleges or Universities Attended

Instructions

Certification