2. Social Security Number
4. Area Code/Telephone Number
( )
6. E-mail Address
Borrower Section
Print using a dark ink ballpoint pen or type. Read the instructions carefully.
1. Last Name
First Name MI
3. Permanent Address (See instructions.)
City
State
Zip Code
5. Date of Birth (mm-dd-yyyy)
7. Driver’s License State and Number
State #
Borrower Request, Certifications, and Authorizations
Read carefully before signing below.
20. I promise to pay to the order of the lender all loan amounts disbursed (hereafter “loan” or “loans”) under the terms of this MPN, plus interest and other charges and fees that may become due as provided in this MPN.
I understand that, if I qualify, more than one loan may be made to me under this MPN for myself or for the student identified in the Student Information Section. I understand that by accepting any disbursement issued
at any time under this MPN, I agree to repay the loan(s). I understand that, within certain time frames, I may cancel or reduce the amount of any loan by refusing to accept or by returning all or a portion of any disbursement
that is issued. Unless I make interest payments, interest that accrues on my loan(s) during deferment, forbearance, and other periods may be added as provided under the Act to the principal balance of such loan(s). If I
do not make any payment on any loan made under this MPN when it is due, I will also pay reasonable collection costs including, but not limited to, attorney fees, court costs, and other fees. I will not sign this MPN before
reading the entire MPN, even if I am told not to read it, or told that I am not required to read it. I am entitled to a copy of this MPN and the Borrower’s Rights and Responsibilities Statement. My signature certifies I have
read, understand, and agree to the terms and conditions