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
Date:_______________________________
click to sign
signature
click to edit