apppnote - Federal Direct Consolidation Loan Application...

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Submit pages 1, 2, and 3 Page 1 of 9 Federal Direct Consolidation Loan Application and Promissory Note 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. Before You Begin Read the instructions for completing this Federal Direct Consolidation Loan Application and Promissory Note. Print using blue or black ink or type. You must sign and date this form. If you cross out anything and write in new information, put your initials beside the change. NOTE: PAGES 1, 2, and 3 OF THIS FORM MUST BE SUBMITTED IN ORDER TO PROCESS YOUR LOAN REQUEST. Section A: Borrower Information 1. Last Name First Name Middle Initial 2. Social Security Number 3. Permanent Street Address (if P.O. box or general delivery, see instructions) ______________________________________________________________________________ ______________________________________________________________________________ _______________________________________ _____________ _______________________ 4. Area Code/Telephone Number ( ) City State Zip Code 5. E-Mail Address (Optional) 6. Former Name(s) 7. Date of Birth (mm-dd-yyyy) 8. Driver’s License State and Number State Number 9. Employer’s Name 10. Employer’s Address 11. Work Area Code/Telephone Number City State Zip Code ( ) Section B: Reference Information 12. References: List two persons with different addresses who have known you for at least three years. Do not list individuals who live with you (for example, your spouse) or who live outside the United States. Name 1. 2. Permanent Address City, State, Zip Code E-Mail Address (optional) Area Code/Telephone Number ( ) ( ) Relationship to Borrower Section C1: Education Loan Indebtedness – Loans You Want to Consolidate (continued on page 2) Read the instructions before completing this section. List each federal education loan that you want to consolidate, including any William D. Ford Federal Direct Loan (Direct Loan) Program loans that you want to include in your Direct Consolidation Loan. If you need more space to list additional loans, use the Additional Loan Listing Sheet included with this package. List each loan separately. Please print. ONLY LIST LOANS THAT YOU WANT TO CONSOLIDATE IN THIS SECTION. 13. Loan Type (See Instructions) 14. Loan Holder’s/Servicer’s Name, Address, and Area Code/Telephone Number (See Instructions) 15. Loan Account Number 16. Estimated Payoff Amount OMB No. 1845-0053 Form Approved Exp. Date 11/30/2010
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Submit pages 1, 2, and 3 Page 2 of 9 Borrower’s Name (please print) Social Security Number Section C1: Education Loan Indebtedness – Loans You Want to Consolidate (continued from page 1) 13. Loan Type (See Instructions) 14. Loan Holder’s/Servicer’s Name, Address, and Area Code/Telephone Number (See Instructions) 15. Loan Account Number 16. Estimated Payoff Amount 17. Grace Period End Date. If any of the loans you want to consolidate are in a grace period, you can delay the processing of your Direct Consolidation Loan until the end of your grace period by entering your expected grace period end date in the space provided. If you leave this
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apppnote - Federal Direct Consolidation Loan Application...

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