Federal Direct Plus Loan Request Form
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12015-2016 FEDERAL DIRECT PLUS LOAN
REQUEST
Office of Financial Aid
Borrower Information To Be Completed By Parent
(You must PRINT this information legibly)
1.
Parent Name
: ____________________________________________________________________________
Last
First
Middle Initial
CUNYfirst EMPLID: _____________________ (If assigned)
2.
SSN
3.
: ________-_______-__________
4.
Date of Birth: ____MM)____(DD)____(YY)
5.
Driver’s License #:_________________ State_____
6.
Permanent Address
: _____________________________________________________________________
Number and
Street
Apt #
City
State
Zip
7.
Are you a U.S. Citizen?
Yes
No
If you answered NO, are you a U.S. permanent resident?
Yes
No
If you answered YES, provide your alien registration number: A-_________________
8.
Requested Loan Amount
$
:
Loan Period: Loan requests are processed for the Fall 2015/ Spring 2016 semesters
9.
except where enrollment is for one semester. Loan disbursements will be made in
two equal payments for the loan period certified
.
Are you currently in default of a Federal Education Loan, or do you owe a refund on
10.
a Federal Student Grant?
Yes
No
Employer’s Name: ______________________________________________________________________
11.
Employer’s Address: ____________________________________________________________________
How many years with this employer? __________Employer’s Phone: (______)________________
PARENT CERTIFICATION:
My signature below certifies that I understand that this request form is not a
Master Promissory Note (MPN) and that I must fill out, sign, and return the actual MPN(s) at a later date for
this loan to be processed. Further, I understand the Office of Financial Aid will determine eligibility for
Federal Direct PLUS Loans based on federal regulations. My Federal Direct PLUS Loan request cannot be
processed until the Office of Financial Aid has received the results of my child’s 2015-2016 FAFSA in printed
or electronic form, collected the required documentation, and determined the application information is
correct. My child must maintain half-time enrollment (6 credits) for the Fall and/or Spring semesters for
Direct Plus Loan funds to be disbursed.
Date: __________________________
Parent Signature:_____________________________________
Information To Be Completed By Student
(You must PRINT this information legibly)
Student’s Name
12.
: _________________________________ ___________________________ __________
Last
First
MI
13. Student’s SSN:________-_________–___________ Student’s EMPLID:_______________________
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