Request for Student Loans

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Name Name First Last
Student ID
School

School Bienen School of Music The Graduate School McCormick School of Engineering & Applied Sciences School of Communication School of Education & Policy
Will you be receiving aid from outside sources (e.g. outside scholarship, employer assistance, etc.)?

Will you be receiving aid from outside sources (e.g. outside scholarship, employer assistance, etc.)? Yes No
Please list the source(s) and amount(s) of funding.
Do you plan to use the University's Health Insurance plan?

Do you plan to use the University's Health Insurance plan? Yes No
Summer Enrollment (units)
Must be a number less than or equal to 5.
Fall Enrollment (units)
Must be a number less than or equal to 5.
Winter Enrollment (units)
Must be a number less than or equal to 5.
Spring Enrollment (units)
Must be a number less than or equal to 5.
Summer Enrollment (units)
Must be a number less than or equal to 5.
I certify that the information I have provided is true and correct to the best of my knowledge. I understand that information from this form may be released to scholarship programs and/or designated donors of funds for which I am selected. I agree to notify the Office of Financial Aid of any changes to the above information. Furthermore, I understand that if I have knowingly provided false and/or misleading information, I may be reported to the governing agency, which may result in possible penalties and/or revocation of funds for misrepresentation.

I certify that the information I have provided is true and correct to the best of my knowledge. I understand that information from this form may be released to scholarship programs and/or designated donors of funds for which I am selected. I agree to notify the Office of Financial Aid of any changes to the above information. Furthermore, I understand that if I have knowingly provided false and/or misleading information, I may be reported to the governing agency, which may result in possible penalties and/or revocation of funds for misrepresentation. Yes
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date / MM / DD YYYY