PDF UNUSUAL ENROLLMENT HISTORY APPEAL

UNUSUAL ENROLLMENT HISTORY APPEAL

Appeal Term: ____________________________ Part A: Student Information (Please Print)

Date: ________________________________

Student Name: __________________________________________ Student ID #: _________________________

Address: ______________________________________________ Date of Birth: _________________________

CPCC Email: __________________________________________ Cell Phone: __________________________

Part B: Enrollment History

Based on Central Piedmont Community College's records, academic records from other institution(s), and the National Student Loan Database (NSLDS) enrollment and financial aid records, it has been determined that credit may not have been earned at each institution attended within the past four award years while receiving a Pell Grant and/or Direct Loan.

Was CPCC the institution you attended in your most recent semester?

[ ] Yes

[ ] No

If yes, did you complete any courses with passing grades?

[ ] N/A [ ] Yes

[ ] No

If you answered yes to both questions above, attach your program evaluation from MyCollege and a printout of your NSLDS Financial Aid Review from nslds.. You may submit this appeal without additional college transcripts, however, CPCC reserves the right to request additional documentation, if warranted, upon review of your appeal.

Below, please list all the institutions attended within the last four award years. In order to obtain your Federal Direct Loan, Pell Grant, and enrollment history, visit nslds. and sign in using your Federal Student Aid (FSA) ID. Print and attach a copy to this form.

Institution Attended

Example:

USA University

Academic Year

2014-2015 2014-2015 2015-2016

2016-2017

2017-2018

Credit Earned?

Yes (or) No

Transcript Attached?

Yes (or) No

Part C: Required Appeal Documentation

Be sure to submit this form, your statement and all requested documentation (NSLDS History, Transcripts, and Mitigating/Non-Mitigating Circumstances) at the same time. Incomplete submissions will be denied.

Check each item off that you are now submitting with your appeal:

1. Attach a printout of your NSLDS History Financial Aid Review (nslds.). 2. For each school attended within the last four award years, attach an academic transcript or grade

report. If you do not attach an academic transcript or grade report for a previous institution, it is assumed credit was not earned. Official and unofficial transcripts are both acceptable. Attach copies of all transcripts to this appeal. Full review cannot be completed without your transcripts.

 3. Submit a written statement indicating the reason credit was not earned at each of the institutions

listed and attach appropriate third-party documentation that supports your statement. ? For "mitigating" circumstances (e.g., illness, injury, bereavement, military, change in location, etc.)

appropriate documentation may include a statement of support from a physician, counselor or clergy; court documents, obituaries, military orders, etc. ? For "non-mitigating" circumstances (e.g., change of major, unexpected academic challenges etc.) appropriate documentation may include a statement of support from an academic advisor, faculty member or tutor, etc.

SUBMISSION OF AN APPEAL DOES NOT GUARANTEE THE REINSTATEMENT OF FINANCIAL AID ELIGIBILITY.

Part D: Student Certification

? I certify that I, (please print name) _______________________________________, am the individual

signing this form and that the Federal student financial assistance I may receive will only be used for educational purposes and to pay the cost of attending Central Piedmont Community College.

? I understand that there is a lifetime Pell Grant limit of 600% (equivalent to 12 full-time semesters). I can

access my remaining Pell Grant eligibility using my FSA ID online at nslds..

? It is my responsibility to check my CPCC student email and MyCollege accounts for updates to my

financial aid status including the result of this appeal.

? If I fail to submit any additional information requested by the Student Financial Aid Office

regarding this appeal, my appeal will be denied.

? I am responsible for paying any charges on my student account, including tuition, fees and bookstore

charges whether I have financial aid or not. (Failure to pay outstanding charges on my account may result in all classes being dropped for non-payment and/or a block placed on registration.)

? If my appeal is denied, I understand that in order to regain eligibility for Title IV funding, I should complete

two consecutive semesters of six or more credit hours with a 2.0 GPA and a 100% completion rate without the use of financial aid.

My signature below confirms all of the information I am providing on this application and supporting documentation is true, accurate and complete.

Student Signature: __________________________________________________________ Date: _______________

FINANCIAL AID OFFICE USE ONLY

Approved ___________

Denied ____________

Comments: ______________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

Date: ________________________________ Financial Aid Administrator: ___________________________________

Warning: According to the U.S. Department of Education, if you purposely give false or misleading information on form, you may be subject to a fine of up to $20,000 or imprisonment for up to 5 years, or both.

Financial Aid/Veteran's Affairs ? Central Piedmont Community College ? PO Box 35009 ? Charlotte, NC 28235-5009 Telephone: (704) 330-6942 Fax: (704) 330-5053

You may submit, fax or mail your documents to any of our six locations.

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