2016-2017 UNUSUAL ENROLLMENT
HISTORY VERIFICATION (3)
A: Student Information
Last
First
MI
SSN
SID
B: Enrollment Information
The Office of Financial Aid has received information from the National Student Loan Data System (NSLDS) regarding an ‘unusual
enrollment history’ during your post-secondary education. The information below must be submitted to our office to assist in the
determination of your Federal Financial Aid eligibility. Our office will then review the information you have provided and may
request additional documentation if necessary. We recommend that you submit all requested documents within 14 calendar days
of receipt of this notice.
Please visit the National Student Loan Data System (NSLDS) at www.nslds.ed.gov to assist you in filling out the following. You
will need your FSA ID in order to access this information. Review information for the 2012/2013, 2013/2014, 2014/2015 and
2015/2016 Aid Years and initial the correct situation below.
Name of School
Attended
City/State
Dates
Attended
(From-To)
FT/HT/Less
than Half
time
Each person signing below certifies that all of the
information reported is complete and correct.
Credits
earned
Pell
Rec’d
(Y/N)
If No to Rec’d Pell – Explain why.
WARNING: If you purposely give false or
misleading information you may be fined,
be sentenced to jail, or both.
________________________________________
Print Student’s Name
________________________
Student’s ID Number
________________________________________
Student’s Signature (Required)
________________________
Date
As set forth in its student catalog, Athens Technical College does not discriminate on the basis of race, color, creed, national or ethnic origin, gender, religion,
disability, age, political affiliation or belief, genetic information, veteran status, or citizenship status (except in those special circumstances permitted or
mandated by law).