School Data Collection

OMB Package for Pell Grant Experiments Enrollment Information Form

Data Collection Form: PGE Student Enrollment and Program Characteristics

Instructions: Please provide the following data elements for all students at your institution who are currently participating in the Pell Grant Experiments Study. The data matrix below can be completed electronically and uploaded to the secure website upon completion (insert web submission instructions here).

List of Data Elements for Student Enrollment and Program Characteristics

Data Element	Entry Field Instructions
Student’s First Name
Student’s Middle Name
Student’s Last Name
Social Security Number	(xxx-xx-xxxx)
Date of Birth	(yyyy, mm, dd)
Name of PGE Program	(Insert course title)
Start Date of PGE Program Enrollment	(yyyy, mm, dd)
End Date of PGE Program Enrollment	(yyyy, mm, dd) (leave blank if still enrolled)
Academic Department of PGE Program	(Insert Department name offering PGE course)
Number of Credits Earned from PGE Program	(Enter number of credits)
Scholarships Awarded	(Enter “yes” or “no”)
Type of Scholarship Awarded	(If applicable, enter name and/or type of scholarship)
Scholarship Amount Offered	(If applicable, enter dollar amount)
Other Grants Awarded	(Enter “yes” or “no”)
Type of Other Grant Awarded	(If applicable, enter name and /or type of grant)
Grant Amount Offered	(If applicable, enter dollar amount)
Pell Grant Awarded	(Enter “ yes” or “no”)
Pell Grant Amount Offered	(If applicable, enter dollar amount)
Fed Direct Student Subsidized Loan	(Enter “yes” or “no”)
Fed Direct Student Subsidized Loan Amount	(If applicable, enter dollar amount)
Fed Direct Student Unsubsidized Loan	(Enter “yes” or “no”)
Fed Direct Student Unsubsidized Loan Amount	(If applicable, enter dollar amount)
Parent Loan	(Enter “yes” or “no”)
Parent Loan Amount	(If applicable, enter dollar amount of award)
Placement or Support Services Provided	(Enter “yes” or “no”)
Type of Placement or Support Services Provided	(Enter description of services)