UNEN17
Unusual Enrollment History Verification
Academic Year 2016-2017
Your 2016–2017 Free Application for Federal Student Aid (FAFSA) has been flagged for “Unusual Enrollment History Review” by the U.S.
Department of Education because you have received Federal Pell Grant funds at multiple education institutions during the past four academic
years (2012-2013, 2013-14, 2014-15 and 2015-16). This flag requires Cameron University to review your enrollment history and determine whether
or not you are enrolling in an institution long enough to have received aid without earning any academic credit towards degree completion. In the
process of reviewing your enrollment history, we will check the National Student Loan Data System (NSLDS) to obtain a complete academic record
including the name of institutions you have attended and the dates of attendance. You must complete and sign this worksheet, attach any required
documents, and submit the form to our office. Do not leave any questions blank. If you are unable to provide the required transcripts, you must
submit a signed and dated statement explaining in detail why you are unable to provide the transcripts.
A. Student Information
Student Last Name
Student First Name
Student M.I.
Student ID Number
Student Street Address
Student Date of Birth
City
State
Zip Code
Student Primary Phone Number
Student Email Address
Student Alternate Phone Number
B. Colleges, Vocational Schools, and other Postsecondary Institutions
Academic
Year
Names of Schools, Institutions, Colleges, etc.
Dates of Attendance
Transcript
Submitted to
Cameron? (Yes/No)
EXAMPLE
Cameron University
Aug 2012 – May 2013
Yes
2012-2013
2013-2014
2014-2015
2015-2016
C. Certification and Signatures
Each person signing this form certifies that all the information reported on it is complete and correct. The student and one parent (if
student is dependent) must sign and date. WARNING: IF YOU PURPOSELY GIVE FALSE OR MISLEADING INFORMATION ON THIS
WORKSHEET, YOU MAY BE FINED, SENTENCED TO JAIL, OR BOTH.
Student Signature
Date
Parent’s Signature
Date
Submit this worksheet and required documents to:
Office of Financial Assistance
Cameron University – North Shepler #301
2800 West Gore Boulevard
Lawton, OK 73505-6320
FAX: 580-581-2556 | EMAIL: financialaid@cameron.edu