12955579[1] - Federal Direct Stafford/Ford Loan Federal...

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Sheet1 Page 1 Federal Direct Stafford/Ford Loan Federal Direct Unsubsidized Stafford/Ford Loan Master Promissory Note William D. Ford Federal Direct Loan Program Warning: Any person who knowingly makes a false statement or misrepresentation on this form will be subject to penalties which may include fines, imprisonment, or both, under the U.S. Criminal Code and 20 U.S.C. 1097. 1. Driver} s License State and No. 2. Social Security No. OH sm406298 294862587 3. E-mail Address (optional) [email protected] 4. Name and Address OMB No. 1845-0007 Form Approved Exp. Date 05/31/2011 SECTION A: BORROWER INFORMATION READ THE INSTRUCTIONS IN SECTION F BEFORE COMPLETING THIS SEC T 5. Date of Birth 10/02/1985 THOMAS , ANNA M 6. Area Code/Telephone No 2254 NAPOLEON RD FREMONT , OH UNITED STATES 43420 7. References: List two persons with different U.S. addresses who have known you for at least three years. The first reference Name 1. steven s thomas 2. wilhelm h roehrich Permanent Street Address 2254 napoleon rd 509 pennsylvania ave City, State, Zip Code fremont , OH UNITED STATES 43420 fremont , OH UNITED STATES 43420 Area Code/Telephone No. 4196813968 Relationship to Borrower spouse FATHER SECTION B: SCHOOL INFORMATION TO BE COMPLETED BY THE SCHOOL 8. School Name and Address UNIVERSITY OF PHOENIX 9. School Code/Branch 10. Identification No. 4615 EAST ELWOOD STREET G20988 294862587M11G20988999 PHOENIX , AZ 850401958 SECTION C: BORROWER REQUEST, CERTIFICATIONS, AUTHORIZATIONS, AND UNDERSTANDINGS READ CAREFUL L This is a Master Promissory Note (MPN) for one or more Federal Direct Stafford/ Ford (Direct Subsidized) Loans and/or Federal Direct Unsubsidized Stafford/Ford (Direct
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Sheet1 Page 2 Unsubsidized) Loans. I request a total amount of Direct Subsidized Loans and/or Direct Unsubsidized Loans under this MPN not to exceed the allowable maximums under the Act (& the Act0 is defined in Section E under Governing Law). My school will notify me of the loan type and loan amount that I am eligible to receive. I may cancel a loan or request a lower amount by contacting my school. Additional information about my right to cancel a loan or request a lower amount is included in the Borower¶ s Rights and Responsibilities Statement and in the disclosure statements that will be provided to me. Under penalty of perjury, I certify that: A. The information I have provided on this MPN and as updated by me from time to time is true, complete, and correct to the best of my knowledge and belief and is made in good faith. B. I will use the proceeds of loans made under this MPN for authorized educational expenses that I incur and I will immediately repay any loan proceeds that cannot be attributed to educational expenses for attendance on at least a half-time basis at the school that certified my loan eligbility. C.
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12955579[1] - Federal Direct Stafford/Ford Loan Federal...

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