The U.S. Department of Education has selected your file for review due to your unusual enrollment history. An unusual enrollment history is defined by having attended and received federal Pell Grant and/or Direct Stafford Loan funds from multiple colleges/universities during the review period of: 2020-2024. Before processing your federal aid file, Chattahoochee Technical College is required to review your enrollment history and determine whether or not you are enrolling only long enough to receive cash refunds of federal student aid. In the process of reviewing your enrollment history, the Financial Aid Office will review the colleges listed on your Admissions application and check the National Student Loan Data System (NSLDS) for a complete history of the federal Pell Grants and/or Direct Stafford Loans you may have received.

 

 

Section A: Student Information
Last Name:	First Name:
CTC Student ID:	Social Security Number:	Date of Birth:
Street Address:

City:	State: Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	ZIP:
CTC Email Address:	Phone:

If you did not earn any academic credits at a college where you received a Pell Grant and/or Direct Stafford Loan, please attach a detailed explanation for your failure to earn credits along with any additional documentation (i.e. medical bills, hospitalization records, accident reports, military transfer etc.) that supports your explanation. Your eligibility for financial aid will not be determined until you submit this completed form and all required documentation to our office. After submission of this form and supporting documents, students who are determine ineligible for aid, will receive a notification via CTC email. The email will include appeal information and options to regain eligibility on your own.

Section B: Colleges or Universities Attended

Please list all institutions (including Chattahoochee Technical College) attended during the academic periods that includes 2020-2024. Unless already on file with CTC Admissions, please attach your academic transcript for each of the prior schools listed. Please visit the Federal Student Aid website (https://studentaid.gov/) to assist you in filling out the following chart. You will need your FSA ID in order to access your previous enrollment history.

Name of College or University	Dates Attended	Loan or Grant?	Credits Earned?
		Yes No	Yes No
		Yes No	Yes No
		Yes No	Yes No
		Yes No	Yes No

Attach supporting documentation here.

Section C: Certification and Signature

Each person signing below certifies that the information reported and submitted on it is complete and correct. The student whose information was reported on the FAFSA must sign and date. If you were required to provide parent information, at least one parent must also sign this form. Warning: If you purposely give false or misleading information, you may be fined, be sentenced to jail, or both.

Student Signature By checking this box, you are certifying the information submitted is complete and correct.

Parent Signature (Only if Dependent)

By checking this box, you are certifying the student is your dependent.