_EntryPointName=PCAPDisplayPDF&SessionID=36c122e51868468485884cfd6cc67930&TimeStamp=03192008

_EntryPointName=PCAPDisplayPDF&SessionID=36c122e51868468485884cfd6cc67930&TimeStamp=03192008

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Return Application To: Sallie Mae • P.O. Box 147023 • Gainesville, FL 32614-7023 (Copyright © Sallie Mae 2000-2007) Have you ever defaulted on a student loan? (check one) Yes No If yes, see instructions for required action 2. 3. 4. Full-time Half-time I declare that the information provided above is true and complete to the best of my knowledge and belief. I have read the Promissory Note accompanying this application and each applicable Notice to Cosigner and agree to the terms therein. Promise to pay: Jointly and severally with the other signers below, I promise to pay the lender or any other holder of this loan all sums disbursed under the terms of the Promissory Note, plus interest and all other fees, charges, and costs that may become due. The terms and conditions set forth in the Promissory Note constitute the entire agreement between us. Notice to Customer (a) Do not sign this before you read the Promissory Note even if otherwise advised. (b) Do not sign this if it contains any blank spaces. (c) You are entitled to an exact copy of any agreement you sign. (d) You have the right at any time to pay in advance the unpaid balance due under this agreement and you may be entitled to a partial refund of the finance charge. Social Security Number Last Name and Suffix First Name MI Address (No P.O. Boxes) Permanent Phone Number City ZIP Code State Cellular Phone Number City Gross Monthly Income (see instructions) Note: You do not have to reveal alimony, child support or separate maintenance income unless you wish it to be considered as a basis for loan repayment Salary $ Other $ Source Monthly Mortgage/Rent Amount (check one) $ Own Rent References—You must provide two (2) adult references other than the borrower. One of them should be a relative. Date of Birth (mm/dd/yy) Present Employer Name Employer Address (City, State, ZIP Code) CAUTION – IT IS IMPORTANT THAT YOU THOROUGHLY READ THE CONTRACT BEFORE YOU SIGN IT. I, THE COSIGNER, HAVE READ THE APPLICABLE COSIGNER NOTICE(S). Cosigner Signature (if applicable) (seal) Date Borrower Signature (seal) Date School Name For the Enrollment Period (not to exceed 12 months) From Date (mm/dd/yy) To Date (mm/dd/yy) Grade Level (check one) Please refer to instructions. Undergraduate 1 2 3 4 5 Graduate A B C D School Code/Branch Disbursement Date (mm/dd/yy) Disbursement Amount 1. 1. $ 2. $ 3. $ 4. $ Total Certified Amount: $ Section C: Borrower and Cosigner Signature Section D: School Certification Must be completed by an authorized school official. As an authorized representative of the school identified above, I hereby certify the following: (i) the borrower is eligible for a Signature Student Loan; (ii) the information completed in this school certification is accurate; (iii) the Total Certified Amount does not exceed the student’s cost of attendance minus other financial aid; (iv) that school will notify Sallie Mae if the borrower withdraws from the school; (v) if applicable, then prior to certification the school has complied with the disclosure requirements in Section 626(1) and all other provisions of the NY SLATE ACT, Law of
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