FOOTHILL COLLEGE

DE ANZA COLLEGE

FINANCIAL AID OFFICE

12345 El Monte Rd.
Los Altos Hills, CA 94022-4599

FINANCIAL AID OFFICE

21250 Stevens Creek Blvd.
Cupertino, CA 95014-5793

2016-2017
Unusual Enrollment History Verification

20231770

adams
donovan
Students Name: ______________________________________________
SID:____________________
Last
First
(Student ID#)
Preferred Name (if different than above) _______________________________________________
Last
First
The U.S. Department of Education (DOE) is concerned that you have an Unusual Enrollment History (UEH). UEH
means the student might be attending an institution just long enough to receive (Title IV) federal student aid funds, leaves
without completing the enrollment period, enrolls at another institution, and repeats the pattern of attending just long
enough to collect Title IV funds without having earned any academic credits. This form will determine your eligibility for
additional Title IV funds.
Please list below all institutions/universities attended during award years 2012-2013, 2013-2014, 2014-2015 and 20152016. Please attach all academic transcripts (unofficial or official) for all institutions listed. If your only enrollment was
at Foothill or De Anza Colleges, check with the Financial Aid Office to determine whether or not you need to complete
this step.
College or University
Name

Enrollment Period
(Semester, Quarter)

Example: ABC College

Fall 2014

Rio salado college

gate way community college
estrella mountain comm college
foothills college
foothills college

Number of
Units/Credits
Attempted/Enrolled
12

fall2014
spring 2015

fall 2015

3.5

winter 2016
Spring 2016

Number of
Units/Credits
Completed/Earned
0

0
0
0.5

9
0

Certification and Signature

I certify that all of the information reported is complete and correct. I know that if I purposely give false or misleading
information on this worksheet, I may be prosecuted with the outcome being fines and/or jail time.

08-23-2016

_____________________________________________________

___________________

Students Signature

Date

3/28/16