Western Connecticut State University
181 White Street, Old Main 105, Danbury, CT 06810 | wcsu.edu/finaid
2024–2025 UNUSUAL ENROLLMENT HISTORY WORKSHEET
Your Free Application for Federal Student Aid (FAFSA) has been flagged for an “Unusual Enrollment History Review” by the
U.S. Department of Education because you received Federal Pell Grant and/or Federal Direct Loan funds at multiple educational
institutions. Federal law requires a review of your enrollment history as it corresponds to federal aid received. In the process of
reviewing your enrollment history, the university will check the National Student Loan Database System to obtain a complete
history including the names of institutions you have attended and the dates of attendance.
Failure to submit this form and any supporting documents could result in cancellation of your financial aid award or
prevent further processing of your financial aid application.
A. Student Information
Student Name: ____________________________________ Student ID: __________________________
Date of Birth: _____________________________________ Phone: ______________________________
B. Colleges or Universities Attended
1. Please list all institutions (including WCSU) attended since 2020.
2. Attach an official academic transcript for each of the prior schools listed (excluding WCSU).
3. For each college listed, attach a separate explanation if you failed to earn any academic credit at that college.
4. Attach additional documentation (e.g., medical bills, hospitalization records, accident reports) that supports your reason
for withdrawal. Please make sure to include your Student ID at the top of each page or document you submit.
Your application for financial aid will not be considered until you submit this completed form and all required
documentation to our office.
Name of College or University
Dates of Attendance
Type of Financial Aid Received
(e.g., Pell Grant, Student Loan)
C. Certification and Signature
By signing this worksheet, I (we) certify that all of the information reported on this worksheet is complete and
accurate.
Warning: If you purposely give false or misleading information on this form, you may be fined, sentenced to jail, or both.
Student Signature: _____________________________________________ Date: ________________________________
Parent Signature: ______________________________________________ Date: ________________________________
(if dependent student)
