UEHFORM myUH ID __________
4434 University Drive, Houston, Texas 77204-2010 · Phone (713)743-1010 · Fax (713)743-9098
Welcome Center hours: Monday-Thursday, 8 a.m.-5 p.m.; Friday, 9 a.m.-5 p.m. · www.uh.edu/verification
2024-2025 Unusual Enrollment History Form
A. Student Information
_______________________________________________________________________________
Last Name First Name MI myUH ID
B. Schools Attended
Processing for Unusual Enrollment History cannot begin until a completed form and all academic transcripts are provided.
• Please list all colleges attended during the time frame listed below, including the University of Houston. If you attended additional or
multiple schools during the indicated time frame, attach an additional page listing the schools you attended and include your name
and myUH ID at the top of each page.
• You must provide an academic transcript (official or unofficial) from each college attended and received federal aid for.
Please note: if any unofficial transcripts are unclear you will be required to provide official academic transcripts.
• You must also submit an official transcript to the Admissions Office. If you have not submitted official transcripts to the University of
Houston, please attach an academic transcript for any institution attended.
Name of College
Dates Attended
Did You Earn Credits?
2020-2021
☐
Yes
☐
No
2021-2022
☐Yes ☐ No
2022-2023
☐
Yes
☐
No
2023-2024
☐
Yes
☐
No
C. Personal Statement for Extenuating Circumstances
If there are personal reasons for failing to earn academic credit at an institution, attach a statement along with any relevant documentation
(i.e., medical bills, hospitalization records, accident reports, etc..) or you will be denied financial aid at UH. Examples of extenuating
circumstances include:
• Death of an immediate family member (must include the relationship of family member to student, copy of death certificate)
• Documented hospitalization or illness of self, child or parent (if self, must include dates and medical records as to the student’s
readiness to return to school)
• Military withdrawal (include documentation from commanding officer)
• Victim of a crime or unexpected disaster (include copy of policy report, third party letters, etc.)
• Other circumstances not addressed in the above categories, submit a written statement that explains your situation including
supporting documentation.
D. Certification and Signatures (blue/black ink, no electronic signatures accepted)
Each person signing this form certifies that all the information reported on it is complete and correct. 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 on this worksheet, you may be fined, be sentenced to jail, or both.
___________________________________________________ ______________________
Student Signature Date
State law requires that you be informed of the following: (1) with few exceptions, you are entitled on request to be informed about the information the University collects about you by use of this form; (2) under sections 552.021 and
552.023 of the Government Code, you are entitled to receive and review the information; and (3) under section 559.004 of the Government Code, you are entitled to have the University correct information about you that is incorrect
Your 2024-2025 Free Application for Federal Student Aid (FAFSA) was selected for review due to your unusual enrollment history in college.
Federal regulations dictate that we must ask you for additional information before determining your eligibility for federal student aid. The
purpose of this form is to analyze your receipt of Federal Pell Grant funds and/or Federal Direct Loans over the past four years.
