Application for Federal Direct Parent Loan for Undergraduate Students (FPLUS) 2017-2018 Under the Federal Direct Loan Program, your lender is the United States Government. You MUST complete a Master Promissory Note (MPN) before your loan can be disbursed. You may complete an electronic Master Promissory Note, using your FSA user id and password, at www.studentloans.gov. If you wish to complete a paper MPN, you may print one out at www.studentloans.gov and mail it in. Please be advised that that paper process will delay receipt of the loan funds requested. If you qualify for a Direct Loan, the excess funds will be disbursed to you in a check mailed to the address you provide on the application, or to your child if you so designate below. The Interest rate on the FPLUS loan is currently fixed at 7.00% (subject to change). Repayment of this loan begins within 60 days of disbursement. Please refer to https://studentaid.ed.gov/sa/types/loans/plus for more information on FPLUS loans. Student Information: Name __________________ _ SS# Empl ID__ ____Date of Birth__ __/_ _/_____ Address_______________________ _ City State __Zip Code______________ ___ ___ Student’s Signature _____________ ___ _______ _ Date__________________________ ___ ____ ______________________________________ _____ ____________________________________________ __ Parent Borrower Information: Name _______________________________ SS# Empl ID_ __ ____ _ __ _ Address______________________ ________ City State __Zip Code_____________________ Please be advised that the student for whom you are borrowing must meet all federal loan eligibility requirements in order to apply/receive loan funds. Requested Loan Amounts: Summer $_______ .00 Fall/Spring $_______ _ .00 *Loans will be processed for the full academic year (half in Fall/half in Spring) unless otherwise indicated Intake Counselor’s Signature: _______________________ Citizenship Status: U.S. Citizen: (_) Native (_) Naturalized Permanent Resident: Alien Reg. # A__________________ *Country of Birth__________________________________ Biographical Information: D.O.B. ____ /____ /_____ Gender ( ) Male ( ) Female Marital Status ( ) Single ( ) Married Contact Information: Email Address __________________ _________ Home Phone: ( ) ___ ___-___ _____ Cell Phone ( ) ___ -_ _ ____ Certifications: I am the legal parent or step-parent of the student for whom I am borrowing. I request any excess funds from this loan to be disbursed to me ____ OR to my child____. I certify that NEITHER I nor my child for whom I am requesting this loan are in default of any Federal Student Loan, nor do we owe a repayment of any Federal Title IV grant. I understand that this is a request form. In order to receive funds from this loan I must complete and sign a promissory note, either electronically or on paper. My signature below authorizes Lehman College to deduct from these loan funds any outstanding balance owed to the college on my child’s behalf. ____________________________________________ ______________________ Signature of Parent Borrower Date Office of Financial Aid Phone: 718-960-8545 Consent to Obtain Credit Report 2007 Lehman Logos I consent to the U.S. Department of Education and its agents obtaining a report of my credit Shuster Hall, Room 136 Fax: 718-960-8328 250 Bedford Park Blvd. West www.lehman.edu/financialaid record and using the information from that report in determining whether to make a Direct PLUS Loan to me. I understand that I will be notified in writing of the results of the credit check with respect to my loan application. Bronx, NY 10467 Privacy Act Disclosure Notice The Privacy Act of 1974 (5 U.S.C.552a) requires that the following notice be provided to you. The authority for Social Security Number ______-______-______ collecting the information requested on this form is §451 et seq. of the Higher Education Act of 1965, as amended. Date of Birth (MM/DD/YYYY) _____/_____/________ Last Name __________________________________ First Name ____________________________ M.I. ___ Your disclosure of this information is voluntary. However, if you do not provide this information, you cannot be Street ____________________________________________________________________________________ considered for a Direct PLUS Loan. The information on this form will be used to determine your eligibility for a City _________________________________________________ State ________ Zip __________________ Direct PLUS Loan. The information in your file may be disclosed to third parties as authorized under routine uses Phone Number (____) _____-________ Signature of Borrower ____________________________________________ Today’s Date _______________ in the Privacy Act notices called "Title IV Program Files" (originally published on April 12, 1994, Federal Register, Vol. 59 p. 17351) and "National Student Loan Data System" (originally published on December 20, 1994, Federal Register, Vol. 59 p. 65532). Thus, this information may be disclosed to federal and state agencies, private parties such as relatives, present and former employers and creditors, and contractors of the Department of Education for purposes of administration of the student financial assistance program, for enforcement purposes, for litigation where such disclosure is compatible with the purposes for which the records were collected, for use by federal, state, local, or foreign agencies in connection with employment matters or the issuance of a license, grant, or other benefit, for use in any employee grievance or discipline proceeding in which the Federal Government is a party, for use in connection with audits or other investigations, for research purposes, for purposes of determining whether particular records are required to be disclosed under the Freedom of Information Act, and to a Member of Congress in response to an inquiry from the congressional office made at your written request. Because we request your social security number (SSN), we must inform you that we collect your SSN on a voluntary basis, but section 484(a)(4) of the HEA (20 U.S.C. 1091(a)(4)) provides that, in order to receive any grant, loan, or work assistance under Title IV of the HEA, a student must provide his or her SSN. Your SSN is used to verify your identity, and as an account number (identifier) throughout the life of your loan(s) so that data may be recorded accurately.