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Below is a cache of http://www.jwu.edu/sfs/PLUS.pdf. It's a snapshot of the page taken as our search engine crawled the Web.
The web site itself may have changed. You can check the current page or check for previous versions at the Internet Archive. Yahoo! is not affiliated with the authors of this page or responsible for its content. PLUS MPN LOAN AMOUNT REQUEST FORM PLUS MPN LOAN AMOUNT REQUEST FORM If you choose to borrow a PLUS Loan for your childs education, please complete this form and write in
the amount you wish to borrow in the space provided. It is strongly recommended that you only borrow
what you need to cover educational expenses for your child. If you are unsure on how much you need to
borrow, please call Student Financial Services at your campus, for assistance.
Johnson & Wales University School Code 003404-00
Loan Period (month/year) From:______________ To:_______________
Requested PLUS loan amount: $______________________________________
Students name: _______________________________________
Students Social Security #: _______________________________________
Students Johnson & Wales ID #: _______________________________________
Parent borrowers name: _______________________________________
Parents date of birth: _______________________________________
Parents U.S. citizenship status: a. citizen/national b. permanent resident/other eligible non-citizen If b, Alien Registration number: __________________
Parents street address: _______________________________________
City: ________________________ State: ______________ ZIP: __________
Parents Social Security #: _______________________________________
Signature of Parent borrower: _______________________________________
Lender: _______________________________ Lender code:__________________
This document must be completed and signed in order for JWU to process your request.
Please mail both this form and your completed PLUS Master Promissory Note to:
Johnson & Wales University Student Financial Services P.O. Box 5956 Providence, RI 02903 For questions contact Student Financial Services at your campus:
Providence: (800) 343-2565 North Miami: (866)598-3567 Denver: (877) 598-3368 Charlotte: (866) 598-2427 2. Social Security Number 4. Home Area Code/Telephone Number ( ) 6. E-mail Address Borrower (Parent) Section Please print neatly in ink or type. Read the instructions carefully. 1. Last Name First Name MI 3. Permanent Street Address (If P.O. Box, see instructions.) City State Zip Code WARNING: Any person who knowingly makes a false statement or misrepresentation on this form is subject to
penalties which may include fines, imprisonment, or both, under the United States Criminal Code and 20 U.S.C. 1097. 5. Date of Birth (Month/Day/Birth Year) 7. Drivers 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 Application and Master Promissory Note (hereafter MPN), plus interest and other charges and fees that may become due as provided in this MPN. I understand that multiple loans may be made to me under this MPN for the dependent identified in the Student Information Section.
I understand that by accepting any disbursements 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 or forbearance
periods or other periods will be added as provided under the Act to the principal balance of such loan(s). If I fail to make any payment on any loan made under this MPN when due, I will also pay
reasonable collection costs, including but not limited to attorneys 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 an exact copy of this MPN and the Borrowers Rights and Responsibilities Statement. My signature certifies I have read, understand, and agree to the terms and
conditions of this MPN, including the Borrower Request, Certifications, and Authorizations printed above, the Notice About Subsequent Loans Made Under This MPN, and the Borrowers Rights and
Responsibilities Statement. I UNDERSTAND THAT I MAY RECEIVE ONE OR MORE LOANS UNDER THIS MPN AND THAT I MUST REPAY ALL LOANS THAT I RECEIVE UNDER THIS MPN. 21. Parent Borrowers Signature 22. Todays Date (Month/Day/Year) Guarantor, Program, or Lender Identification 9. Lender Name City State Zip Code Promise to Pay In this MPN, lender refers to, and this MPN benefits, the original lender and its successors and assigns, including any subsequent holder of this MPN. 17. Requested Loan Amount: This is an Application and Master Promissory Note (hereafter, MPN) for one or more Federal PLUS Loans. I request a Federal PLUS Loan under this MPN in
an amount not to exceed the annual cost of attendance for the student identified in the Student
Information Section of this MPN, minus other financial aid that the student receives each
academic year. For each loan, the school will notify me of the loan amount that I am eligible to
receive. I may cancel my loan or request a lower amount by contacting my lender or the
school. Additional information about my right to cancel a loan or request a lower amount is
included in the Borrowers Rights and Responsibilities Statement and disclosure statements
that have been or will be provided to me. If I have an adverse credit history and obtain an
endorser to receive a PLUS Loan, only one loan may be made to me under this MPN. 18. Under penalty of perjury, I certify for any loan I receive under this MPN 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 am: (i) the biological or adoptive parent; or (ii) the spouse of a parent and my income and assets were reported on the Free Application for Federal Student Aid (FAFSA) or would be
reported if a FAFSA were filed. C. Loan proceeds will be used for authorized educational costs incurred by the dependent student named in the Student Information Section and that I will immediately repay any loan
proceeds that cannot be attributed to educational costs for attendance on at least a half-time
basis at the school that certified my loan eligibility. D. (i) I do not now owe an overpayment on a Federal Pell Grant, Federal Supplemental Educational Opportunity Grant, or Leveraging Educational Assistance Partnership Grant
(formerly State Student Incentive Grant); or, if I owe an overpayment, I have made
repayment arrangements with the holder to repay the amount owed, (ii) I am not now in
default on any loan received under the Federal Perkins Loan Program (including NDSL
loans), the Federal Direct Loan Program, or the Federal Family Education Loan Program
(FFELP as defined in the Borrowers Rights and Responsibilities Statement); or I am in
default on a loan and I have made satisfactory payment arrangements with the holder of the
defaulted loan. 19. For all Federal PLUS Loans (as described in the additional MPN provisions and the Borrowers Rights and Responsibilities Statement) I receive under this MPN, and for certain other loans as
described below, I make the following authorizations: A. I authorize the school to certify my eligibility for Federal PLUS Loans under this MPN.
B. I authorize the lender, the guarantor, or their agents, to investigate my credit record and report information concerning my loan status to persons and organizations permitted by
law to receive such information. C. I authorize the school to pay to the lender any refund that may be due up to the full amount of the loan(s). D. I authorize the school to transfer loan proceeds received by electronic funds transfer (EFT) or master check to my dependent students account at the school. E. I may tell my lender that I want to pay the interest that accrues. However, in all cases, unless I pay the interest, my lender will add the unpaid interest that accrues during forbearance and
deferment and other periods on each PLUS Loan made under this MPN to the principal
balance of that loan (capitalization) as provided under the Act. Capitalization will increase the
principal balance on my loan(s) and the total amount of interest costs I must pay. F. I authorize the release of information pertinent to my loan(s): (i) by the school, the lender, and the guarantor, or their agents, to the references on the applicable loan(s) and to
members of my immediate family unless I submit written directions otherwise; and (ii) by
and among the schools, lenders, guarantors, the U.S. Department of Education (the
Department), and their agents. G. So that the loan(s) requested can be approved, I authorize the Department to send any information about me that is under its control, including information from the FAFSA, to the
school, to the lender, and to state agencies and nonprofit organizations that administer
financial aid programs under the FFELP. I understand that information reported on this MPN
may be shared with the Department, and that the Department has the authority to verify that
information with other federal agencies. H. I authorize my lender to defer repayment of principal on my loan(s) based on my in- school status. OMB No.1845-0069
Form approved
Exp. date 03/31/2008 11. Employer (Name, Address, City, State, Zip) 10. Lender Code, if known 8. U.S. Citizenship Status (Check a or b, and if b is checked, list Registration No.) a. Citizen/National b. Permanent Resident/Other Eligible Non-Citizen If b, Alien Registration No. Additional MPN provisions follow 15. Social Security Number 14. Last Name First Name MI Student Information Section 16. Date of Birth (Month/Day/Birth Year) 12. Employer Telephone Number ( ) Federal Family Education Loan Program (FFELP) Federal PLUS Loan
Application and Master Promissory Note 13. Borrower References: You must provide two separate references with different U.S. addresses who have known you for at least three years. Both references must be completed in full. Do not list the
the student as a reference. Name A. B. Permanent Address City, State, Zip Code E-mail Address Area Code/Telephone Number ( ) ( ) Relationship to Borrower Federal PLUS Loan Master Promissory Note (continued) Disclosure of Loan Terms Loans disbursed under this MPN are subject to the loan limits specified in the Higher Education Act of 1965,
as amended (20 U.S.C. 1070, et seq.), and applicable U.S.
Department of Education regulations (collectively referred
to as the Act). Under this MPN, the principal amount
that I owe and am required to repay, will be the sum of
all disbursements issued (unless I reduce or cancel any
disbursements as provided below). My lender will determine whether to make any loan to me under this MPN after my loan eligibility is determined by
my dependents school. At or before the time of the first
disbursement for each loan, a disclosure statement will be
issued to me identifying the amount of the loan and
additional terms of the loan. Important additional
information is also disclosed in the Borrowers Rights
and Responsibilities Statement accompanying this MPN.
The Borrowers Rights and Responsibilities Statement and
any disclosure statement I receive in connection with any
loan under this MPN are hereby incorporated into this MPN. I may request additional loan funds to pay for my dependents educational costs. The school will determine
my eligibility and notify the lender. I will be notified of any
increase or other change in the amount of my loan(s). I agree that the lender may sell or assign this MPN and/or my loan(s) and acknowledge that any loan may be
assigned independently of any other loan to which this
MPN applies. I agree that each loan is separately
enforceable based on a true and exact copy of this MPN. Loan Cancellation I may pay back all or a portion of a disbursement within time frames set by the Act and explained in the Borrowers
Rights and Responsibilities Statement or other disclosure
statement I receive at or before disbursement. In such
case, the origination fee and guarantee fee will be reduced
or eliminated in proportion to the amount of the
disbursement returned. I will not incur interest charges if
I return the full loan amount as provided in the Act. Interest Unless my lender notifies me in writing of a lower rate(s), the rate(s) of interest for my loan(s) is that
specified in the Act. Interest rate Information is presented
in the Borrowers Rights and Responsibilities Statement
accompanying this MPN. The interest rate is presented in a
disclosure that is issued to me. Interest accrues on the unpaid principal balance of each loan from the date of disbursement by the lender until the
entire principal balance is paid in full. This includes interest
accruing during any period of deferment or forbearance. I
agree to pay all interest charges on my loan(s). I will begin paying interest upon disbursement of my loan. If I do not make required payments of interest
before the beginning of principal repayment, or during
a period of authorized deferment or forbearance, I agree
that the lender may capitalize such interest to the extent
permitted by the Act. Origination Fee and Guarantee Fee For each loan, the federal government charges an origination fee equal to the amount required by the Act.
The guaranty agency(ies) that guarantee(s) my loan(s)
(in each case, the guarantor) may charge a per loan
guarantee fee not to exceed a maximum amount specified
in the Act. I will pay these fees, as identified in the
disclosure statement, which will be deducted
proportionately from each disbursement of my loan(s).
I understand the origination and guarantee fees may
be refundable only to the extent permitted by the Act. Late Charges and Collection Costs The lender may collect from me: (i) a late charge for each late installment payment if I fail to make any part of a required installment payment within 15 days after the
date it becomes due, and (ii) any other charges and fees
that are permitted by the Act for the collection of my loan(s).
If I default on any loan(s), I will pay reasonable collection
fees and costs, plus court costs and attorney fees. Repayment I must repay the full amount of the loan(s) made under this MPN and the accrued interest. I will repay the principal
of each loan in periodic installments during a repayment
period that begins on the day of the final disbursement for
that loan. My lender must provide me with a choice of repayment plans consistent with the provisions of the Act. My
principal repayment period for each loan, exclusive of any
period(s) of deferment or forbearance, generally lasts five
years but may not exceed 10 years unless I am eligible
for an extended repayment plan. The lender will provide me with a repayment schedule that identifies my payment amounts and due dates. Except
as otherwise provided in the Act, the minimum annual
payment required on all my FFELP loans is $600 or the
amount of interest due and payable, whichever is larger.
Payments submitted by me or on my behalf (exclusive
of refunds) may be applied first to charges and collection
costs that are due, then to accrued interest that has not
been capitalized, and finally to the principal amount. If I am unable to make my scheduled loan payments, the lender may allow me to reduce my payment amount,
to extend the time for making payments, or to temporarily
stop making payments as long as I intend to repay my
loan(s). Allowing me to temporarily delay or reduce loan payments is called forbearance. I agree that the lender may
align payment dates on my loans or grant me a
forbearance to eliminate a delinquency that persists
even though I am making scheduled payments. I may prepay all or any part of the unpaid balance on my loan(s) at any time without penalty. If I do not specify
which loan(s) I am prepaying, the lender will determine
how to apply the prepayment in accordance with the Act.
Upon repayment in full of each loan under this MPN, I
agree to accept written notification of such loan payoff in
place of receiving the original MPN. Acceleration and Default At the option of the lender, the entire unpaid balance of a loan made under this MPN will become immediately
due and payable if any one of the following events occurs:
(i) the dependent for whom I am borrowing fails to enroll
as at least a half-time student at the school that certified
my loan eligibility, (ii) I fail to use the proceeds of the
loan(s) solely for educational costs of the dependent
student for whom I am borrowing, (iii) I make a false
representation(s) that results in my receiving any loan(s)
for which I am not eligible, or (iv) I default on the loan(s). The following events will constitute a default on my loan(s): (i) I fail to pay the entire unpaid balance of the
applicable loan(s) after the lender has exercised its option
under items (i), (ii), or (iii) in the preceding paragraph;
(ii) I fail to make installment payments when due, provided
my failure has persisted for at least 270 days for payments
due monthly or 330 days for payments due less frequently
than monthly; or (iii) I fail to comply with other terms
of the loan(s), and the lender or guarantor reasonably
concludes I no longer intend to honor my repayment
obligation. If I default, the guarantor may purchase
my loan(s) and capitalize all outstanding interest into
a new principal balance. The new principal balance and
collection fees will become immediately due and payable. If I default, this will be reported to all national credit bureaus and will significantly and adversely affect my
credit history. I understand that a default will have
additional adverse consequences to me as disclosed in the
Borrowers Rights and Responsibilities Statement. Following default, the loan(s) may be subject to income-
contingent repayment (including potential collection of
amounts in excess of the principal and interest) in
accordance with the Act. Governing Law and Notices The terms of this MPN will be interpreted in accordance with the Higher Education Act of 1965, as amended
(20 U.S.C. 1070, et seq.), other applicable federal statutes
and regulations, and the guarantors policies. Applicable
state law, except as preempted by federal law, may provide
for certain borrower rights, remedies, and defenses
in addition to those stated in this MPN. If a particular loan under this MPN is made by the school, or if the proceeds of a particular loan made under
this MPN are used to pay tuition and charges at a for-profit
school that refers loan applicants to the lender, or that is
affiliated with the lender by common control, contract, or
business arrangement, any lender holding such loan is
subject to all claims and defenses that I could assert
against the school with respect to such loan. My recovery
under this provision shall not exceed the amount
I paid on such loan. If I reside in the state in which the principal office of the guarantor is located, the guarantor may sue to
enforce the applicable loan(s) in the county in which the
guarantors office is located. However, if I object to being
sued there and I mail a written objection to the guarantor
that is postmarked no later than 30 days after I am served
with the suit, the guarantor will either have the court
transfer the suit to the county in which I live or will
dismiss the lawsuit. Any notice required to be given to me will be effective if sent by first class mail to the latest address the lender
has for me or by electronic means to an address that I have
provided. I will immediately notify the lender of any change
of address or status as specified in the Borrowers Rights
and Responsibilities Statement. Failure by the lender to
enforce or insist on compliance with any term on this MPN
will not be a waiver of any right of the lender. No provision
of this MPN may be modified or waived except in writing.
If any provision of this MPN is determined to be
unenforceable, the remaining provisions shall remain
in force. Notice About Subsequent Loans
Made Under This MPN This Master Promissory Note authorizes the lender to disburse multiple loans to pay the educational costs
of the dependent student identified in the Student
Information Section during the multi-year term of this
MPN upon my request and upon the schools
certification of my loan eligibility. Subsequent loans for
this dependent may be made for the same or
subsequent periods of enrollment at schools designated
by the Secretary of the U.S. Department of Education. I understand that no subsequent loan (s) will be made under this MPN after the earliest of the following
dates: (i) the date my lender receives my written notice
that no further loans may be disbursed under the MPN;
(ii) one year after the date of my signature on this
MPN if no disbursement is made during such twelve-
month period; or (iii) ten years after the date of my
signature on this MPN; or the date the lender receives
this MPN. Any amendment to the Act governs the terms of any loan (s) disbursed on or after the effective date of such amendment, and such amended terms are
hereby incorporated into this Master Promissory Note. Guarantor, Program, or Lender Identification Federal Family Education Loan Program (FFELP) Federal PLUS Loan Application and Master
Promissory Note Instructions and Notices 50 states, the District of Columbia, Puerto Rico, the
U.S. Virgin Islands, Guam, and the Northern Mariana
Islands. A U.S. national includes all U.S. citizens and
citizens of American Samoa and Swain's Island. Item (b): Check this box if you are a permanent
resident/other eligible non-citizen. Write in your
eight- or nine-digit Alien Registration Number.
"Permanent Resident" means someone who can
provide documentation of this status from the U.S.
Immigration and Naturalization Service. "Other
Eligible Non-Citizen" includes individuals who can
provide documentation from the U.S. Immigration
and Naturalization Service that they are in the United
States for a purpose that is not temporary, with the
intention of becoming a citizen or permanent
resident. This category includes refugees, persons
granted asylum, Cuban-Haitian entrants, temporary
residents under the Immigration Reform and
Control Act of 1986, and others.
NOTE: If your citizenship status is not one of the
categories described above, you are not eligible to
receive a Federal PLUS Loan. Item 9: Enter the name and address of the lender
from which you wish to borrow. If you do not have
a lender, contact the schools financial aid office, a
bank or other financial institution, or the guarantor
or program listed in the upper right-hand corner of
this form for information on lenders willing to make
Federal PLUS Loans. Item 10: If you know the lender code, enter it here.
Otherwise, leave this item blank. Item 11: It is important that the lender be able to reach you during the process of making your loan(s) and
during repayment. Enter your employers name and address, including city, state, and zip code. If you are
self-employed, enter the name and address of your
business. If you are not employed, enter N/A. Item 12: Enter the area code and telephone number of
your employer. If you are self-employed, enter the area
code and telephone number of your business. If you
do not have a business telephone number, enter N/A. Item 13: Enter the requested reference information
for two adults with different U.S. addresses who have
known you for at least three years. Do not list the
student as a reference. References with addresses
outside the U.S. are not acceptable. If a reference does not have a telephone number or e-mail address,
or does not wish to provide an e-mail address, enter
N/A. If you provide an e-mail address for a reference,
the lender or holder of your loan(s) may use it to
communicate with the reference. All requested items
must be completed or the processing of your loan
will be delayed. Item 14: Enter the last name of the dependent
student for whom you are borrowing, then first name
and middle initial. Item 15: Enter the student's nine-digit Social
Security Number. Item 16: Enter the month, day, and four-digit year of
the student's birth. Use only numbers. Be careful not
to enter the current year. Item 17: The school will notify you of the amount of
Federal PLUS Loan you are eligible to receive each
time you request Federal PLUS funds. You may
decline a loan or request a lower amount by
contacting your lender or the school. You should
apply only for what you will need to pay your
dependent's educational costs each year. Additional
information is included under "Loan Cancellation" in
the Borrower's Rights and Responsibilities
Statement. Items 18 and 19: Read these items carefully. Item 20: Read the entire MPN carefully. Then
complete Items 21 and 22. Item 21: Sign your legal name, including your first
name, middle initial, and last name. Item 22: Enter the date you are signing this MPN in
month/day/year format. This is a Master Promissory Note under which you may receive multiple Federal PLUS Loans for the same dependent student over a maximum ten-year period. A
Federal PLUS Loan is a loan available to certain parent(s) of dependent undergraduate students ("dependent" is defined in the Higher Education Act and may be
different from the definition used by the Internal Revenue Service) attending participating postsecondary schools. You are responsible for paying the principal
amount of your loan(s) and all interest that accrues from the date of disbursement until the loan(s) is paid in full. Your lender will perform a standard credit check with a national credit bureau before approving each loan. As required under federal law, if your lender deter-
mines you have adverse credit, you may not receive a Federal PLUS Loan unless: 1) you provide information to your lender's satisfaction that there are extenuat-
ing circumstances, or 2) you obtain an endorser who does not have an adverse credit history. An endorser is someone who agrees to repay the loan if you fail to
do so. The endorser may not be the student for whom the loan is being made. This form is to be completed by the parent borrower.
Use a dark ink, ballpoint pen or typewriter. Do not
complete this form in pencil. If an item has been
completed for you and it is incorrect, cross out the
incorrect information and print the correct
information. Incorrect, incomplete, or illegible
information may cause the processing of your loan to
be delayed. Item 1: Enter your last name, then your first name
and middle initial. Item 2: Enter your nine-digit Social Security Number.
If this item has been completed for you, review it for
correctness. If it is incorrect, cross out the entire
number and print the entire correct Social Security
Number in this box. Your loan(s) cannot be processed
without a Social Security Number. Read the Privacy
Act and Financial Privacy Act Notices in these
instructions before completing this item. Item 3: Enter your permanent home street address,
apartment number, city, state and zip code. If you
have a Post Office Box and a street address, list both. Item 4: Enter the area code and telephone number
for the address listed in Item 3. If you do not have
a telephone, enter N/A. Item 5: Using only numbers, enter the month, day, and
four-digit year of your birth. (For example, for June 24,
1982, you would enter 06/24/1982.) Be careful not to
enter the current year. Item 6: Enter your preferred e-mail address for
receiving correspondence. If you do not have an
e-mail address, or do not wish to provide it, enter
N/A. If you provide your e-mail address, the lender or
holder of your loan(s) may use it to communicate
with you. Item 7: Enter the two-letter abbreviation for the state
that issued your drivers license followed by the
drivers license number. If you do not have a drivers
license, enter N/A. Item 8: Indicate your U.S. citizenship status. Contact
the schools financial aid office if you are unsure of
your eligibility. Item (a): Check this box if you are a U.S. citizen or
U.S. national. A U.S. citizen includes citizens of the Borrower (Parent) Section Borrower Request, Certifications, and Authorizations Student Information Section Promise to Pay Important Notices Privacy Act Notice The Privacy Act of 1974 (5 U.S.C. 552a) requires that
the following notice be provided to you: The authority for collecting the requested information
from and about you is
The web site itself may have changed. You can check the current page or check for previous versions at the Internet Archive. Yahoo! is not affiliated with the authors of this page or responsible for its content. PLUS MPN LOAN AMOUNT REQUEST FORM PLUS MPN LOAN AMOUNT REQUEST FORM If you choose to borrow a PLUS Loan for your childs education, please complete this form and write in
the amount you wish to borrow in the space provided. It is strongly recommended that you only borrow
what you need to cover educational expenses for your child. If you are unsure on how much you need to
borrow, please call Student Financial Services at your campus, for assistance.
Johnson & Wales University School Code 003404-00
Loan Period (month/year) From:______________ To:_______________
Requested PLUS loan amount: $______________________________________
Students name: _______________________________________
Students Social Security #: _______________________________________
Students Johnson & Wales ID #: _______________________________________
Parent borrowers name: _______________________________________
Parents date of birth: _______________________________________
Parents U.S. citizenship status: a. citizen/national b. permanent resident/other eligible non-citizen If b, Alien Registration number: __________________
Parents street address: _______________________________________
City: ________________________ State: ______________ ZIP: __________
Parents Social Security #: _______________________________________
Signature of Parent borrower: _______________________________________
Lender: _______________________________ Lender code:__________________
This document must be completed and signed in order for JWU to process your request.
Please mail both this form and your completed PLUS Master Promissory Note to:
Johnson & Wales University Student Financial Services P.O. Box 5956 Providence, RI 02903 For questions contact Student Financial Services at your campus:
Providence: (800) 343-2565 North Miami: (866)598-3567 Denver: (877) 598-3368 Charlotte: (866) 598-2427 2. Social Security Number 4. Home Area Code/Telephone Number ( ) 6. E-mail Address Borrower (Parent) Section Please print neatly in ink or type. Read the instructions carefully. 1. Last Name First Name MI 3. Permanent Street Address (If P.O. Box, see instructions.) City State Zip Code WARNING: Any person who knowingly makes a false statement or misrepresentation on this form is subject to
penalties which may include fines, imprisonment, or both, under the United States Criminal Code and 20 U.S.C. 1097. 5. Date of Birth (Month/Day/Birth Year) 7. Drivers 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 Application and Master Promissory Note (hereafter MPN), plus interest and other charges and fees that may become due as provided in this MPN. I understand that multiple loans may be made to me under this MPN for the dependent identified in the Student Information Section.
I understand that by accepting any disbursements 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 or forbearance
periods or other periods will be added as provided under the Act to the principal balance of such loan(s). If I fail to make any payment on any loan made under this MPN when due, I will also pay
reasonable collection costs, including but not limited to attorneys 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 an exact copy of this MPN and the Borrowers Rights and Responsibilities Statement. My signature certifies I have read, understand, and agree to the terms and
conditions of this MPN, including the Borrower Request, Certifications, and Authorizations printed above, the Notice About Subsequent Loans Made Under This MPN, and the Borrowers Rights and
Responsibilities Statement. I UNDERSTAND THAT I MAY RECEIVE ONE OR MORE LOANS UNDER THIS MPN AND THAT I MUST REPAY ALL LOANS THAT I RECEIVE UNDER THIS MPN. 21. Parent Borrowers Signature 22. Todays Date (Month/Day/Year) Guarantor, Program, or Lender Identification 9. Lender Name City State Zip Code Promise to Pay In this MPN, lender refers to, and this MPN benefits, the original lender and its successors and assigns, including any subsequent holder of this MPN. 17. Requested Loan Amount: This is an Application and Master Promissory Note (hereafter, MPN) for one or more Federal PLUS Loans. I request a Federal PLUS Loan under this MPN in
an amount not to exceed the annual cost of attendance for the student identified in the Student
Information Section of this MPN, minus other financial aid that the student receives each
academic year. For each loan, the school will notify me of the loan amount that I am eligible to
receive. I may cancel my loan or request a lower amount by contacting my lender or the
school. Additional information about my right to cancel a loan or request a lower amount is
included in the Borrowers Rights and Responsibilities Statement and disclosure statements
that have been or will be provided to me. If I have an adverse credit history and obtain an
endorser to receive a PLUS Loan, only one loan may be made to me under this MPN. 18. Under penalty of perjury, I certify for any loan I receive under this MPN 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 am: (i) the biological or adoptive parent; or (ii) the spouse of a parent and my income and assets were reported on the Free Application for Federal Student Aid (FAFSA) or would be
reported if a FAFSA were filed. C. Loan proceeds will be used for authorized educational costs incurred by the dependent student named in the Student Information Section and that I will immediately repay any loan
proceeds that cannot be attributed to educational costs for attendance on at least a half-time
basis at the school that certified my loan eligibility. D. (i) I do not now owe an overpayment on a Federal Pell Grant, Federal Supplemental Educational Opportunity Grant, or Leveraging Educational Assistance Partnership Grant
(formerly State Student Incentive Grant); or, if I owe an overpayment, I have made
repayment arrangements with the holder to repay the amount owed, (ii) I am not now in
default on any loan received under the Federal Perkins Loan Program (including NDSL
loans), the Federal Direct Loan Program, or the Federal Family Education Loan Program
(FFELP as defined in the Borrowers Rights and Responsibilities Statement); or I am in
default on a loan and I have made satisfactory payment arrangements with the holder of the
defaulted loan. 19. For all Federal PLUS Loans (as described in the additional MPN provisions and the Borrowers Rights and Responsibilities Statement) I receive under this MPN, and for certain other loans as
described below, I make the following authorizations: A. I authorize the school to certify my eligibility for Federal PLUS Loans under this MPN.
B. I authorize the lender, the guarantor, or their agents, to investigate my credit record and report information concerning my loan status to persons and organizations permitted by
law to receive such information. C. I authorize the school to pay to the lender any refund that may be due up to the full amount of the loan(s). D. I authorize the school to transfer loan proceeds received by electronic funds transfer (EFT) or master check to my dependent students account at the school. E. I may tell my lender that I want to pay the interest that accrues. However, in all cases, unless I pay the interest, my lender will add the unpaid interest that accrues during forbearance and
deferment and other periods on each PLUS Loan made under this MPN to the principal
balance of that loan (capitalization) as provided under the Act. Capitalization will increase the
principal balance on my loan(s) and the total amount of interest costs I must pay. F. I authorize the release of information pertinent to my loan(s): (i) by the school, the lender, and the guarantor, or their agents, to the references on the applicable loan(s) and to
members of my immediate family unless I submit written directions otherwise; and (ii) by
and among the schools, lenders, guarantors, the U.S. Department of Education (the
Department), and their agents. G. So that the loan(s) requested can be approved, I authorize the Department to send any information about me that is under its control, including information from the FAFSA, to the
school, to the lender, and to state agencies and nonprofit organizations that administer
financial aid programs under the FFELP. I understand that information reported on this MPN
may be shared with the Department, and that the Department has the authority to verify that
information with other federal agencies. H. I authorize my lender to defer repayment of principal on my loan(s) based on my in- school status. OMB No.1845-0069
Form approved
Exp. date 03/31/2008 11. Employer (Name, Address, City, State, Zip) 10. Lender Code, if known 8. U.S. Citizenship Status (Check a or b, and if b is checked, list Registration No.) a. Citizen/National b. Permanent Resident/Other Eligible Non-Citizen If b, Alien Registration No. Additional MPN provisions follow 15. Social Security Number 14. Last Name First Name MI Student Information Section 16. Date of Birth (Month/Day/Birth Year) 12. Employer Telephone Number ( ) Federal Family Education Loan Program (FFELP) Federal PLUS Loan
Application and Master Promissory Note 13. Borrower References: You must provide two separate references with different U.S. addresses who have known you for at least three years. Both references must be completed in full. Do not list the
the student as a reference. Name A. B. Permanent Address City, State, Zip Code E-mail Address Area Code/Telephone Number ( ) ( ) Relationship to Borrower Federal PLUS Loan Master Promissory Note (continued) Disclosure of Loan Terms Loans disbursed under this MPN are subject to the loan limits specified in the Higher Education Act of 1965,
as amended (20 U.S.C. 1070, et seq.), and applicable U.S.
Department of Education regulations (collectively referred
to as the Act). Under this MPN, the principal amount
that I owe and am required to repay, will be the sum of
all disbursements issued (unless I reduce or cancel any
disbursements as provided below). My lender will determine whether to make any loan to me under this MPN after my loan eligibility is determined by
my dependents school. At or before the time of the first
disbursement for each loan, a disclosure statement will be
issued to me identifying the amount of the loan and
additional terms of the loan. Important additional
information is also disclosed in the Borrowers Rights
and Responsibilities Statement accompanying this MPN.
The Borrowers Rights and Responsibilities Statement and
any disclosure statement I receive in connection with any
loan under this MPN are hereby incorporated into this MPN. I may request additional loan funds to pay for my dependents educational costs. The school will determine
my eligibility and notify the lender. I will be notified of any
increase or other change in the amount of my loan(s). I agree that the lender may sell or assign this MPN and/or my loan(s) and acknowledge that any loan may be
assigned independently of any other loan to which this
MPN applies. I agree that each loan is separately
enforceable based on a true and exact copy of this MPN. Loan Cancellation I may pay back all or a portion of a disbursement within time frames set by the Act and explained in the Borrowers
Rights and Responsibilities Statement or other disclosure
statement I receive at or before disbursement. In such
case, the origination fee and guarantee fee will be reduced
or eliminated in proportion to the amount of the
disbursement returned. I will not incur interest charges if
I return the full loan amount as provided in the Act. Interest Unless my lender notifies me in writing of a lower rate(s), the rate(s) of interest for my loan(s) is that
specified in the Act. Interest rate Information is presented
in the Borrowers Rights and Responsibilities Statement
accompanying this MPN. The interest rate is presented in a
disclosure that is issued to me. Interest accrues on the unpaid principal balance of each loan from the date of disbursement by the lender until the
entire principal balance is paid in full. This includes interest
accruing during any period of deferment or forbearance. I
agree to pay all interest charges on my loan(s). I will begin paying interest upon disbursement of my loan. If I do not make required payments of interest
before the beginning of principal repayment, or during
a period of authorized deferment or forbearance, I agree
that the lender may capitalize such interest to the extent
permitted by the Act. Origination Fee and Guarantee Fee For each loan, the federal government charges an origination fee equal to the amount required by the Act.
The guaranty agency(ies) that guarantee(s) my loan(s)
(in each case, the guarantor) may charge a per loan
guarantee fee not to exceed a maximum amount specified
in the Act. I will pay these fees, as identified in the
disclosure statement, which will be deducted
proportionately from each disbursement of my loan(s).
I understand the origination and guarantee fees may
be refundable only to the extent permitted by the Act. Late Charges and Collection Costs The lender may collect from me: (i) a late charge for each late installment payment if I fail to make any part of a required installment payment within 15 days after the
date it becomes due, and (ii) any other charges and fees
that are permitted by the Act for the collection of my loan(s).
If I default on any loan(s), I will pay reasonable collection
fees and costs, plus court costs and attorney fees. Repayment I must repay the full amount of the loan(s) made under this MPN and the accrued interest. I will repay the principal
of each loan in periodic installments during a repayment
period that begins on the day of the final disbursement for
that loan. My lender must provide me with a choice of repayment plans consistent with the provisions of the Act. My
principal repayment period for each loan, exclusive of any
period(s) of deferment or forbearance, generally lasts five
years but may not exceed 10 years unless I am eligible
for an extended repayment plan. The lender will provide me with a repayment schedule that identifies my payment amounts and due dates. Except
as otherwise provided in the Act, the minimum annual
payment required on all my FFELP loans is $600 or the
amount of interest due and payable, whichever is larger.
Payments submitted by me or on my behalf (exclusive
of refunds) may be applied first to charges and collection
costs that are due, then to accrued interest that has not
been capitalized, and finally to the principal amount. If I am unable to make my scheduled loan payments, the lender may allow me to reduce my payment amount,
to extend the time for making payments, or to temporarily
stop making payments as long as I intend to repay my
loan(s). Allowing me to temporarily delay or reduce loan payments is called forbearance. I agree that the lender may
align payment dates on my loans or grant me a
forbearance to eliminate a delinquency that persists
even though I am making scheduled payments. I may prepay all or any part of the unpaid balance on my loan(s) at any time without penalty. If I do not specify
which loan(s) I am prepaying, the lender will determine
how to apply the prepayment in accordance with the Act.
Upon repayment in full of each loan under this MPN, I
agree to accept written notification of such loan payoff in
place of receiving the original MPN. Acceleration and Default At the option of the lender, the entire unpaid balance of a loan made under this MPN will become immediately
due and payable if any one of the following events occurs:
(i) the dependent for whom I am borrowing fails to enroll
as at least a half-time student at the school that certified
my loan eligibility, (ii) I fail to use the proceeds of the
loan(s) solely for educational costs of the dependent
student for whom I am borrowing, (iii) I make a false
representation(s) that results in my receiving any loan(s)
for which I am not eligible, or (iv) I default on the loan(s). The following events will constitute a default on my loan(s): (i) I fail to pay the entire unpaid balance of the
applicable loan(s) after the lender has exercised its option
under items (i), (ii), or (iii) in the preceding paragraph;
(ii) I fail to make installment payments when due, provided
my failure has persisted for at least 270 days for payments
due monthly or 330 days for payments due less frequently
than monthly; or (iii) I fail to comply with other terms
of the loan(s), and the lender or guarantor reasonably
concludes I no longer intend to honor my repayment
obligation. If I default, the guarantor may purchase
my loan(s) and capitalize all outstanding interest into
a new principal balance. The new principal balance and
collection fees will become immediately due and payable. If I default, this will be reported to all national credit bureaus and will significantly and adversely affect my
credit history. I understand that a default will have
additional adverse consequences to me as disclosed in the
Borrowers Rights and Responsibilities Statement. Following default, the loan(s) may be subject to income-
contingent repayment (including potential collection of
amounts in excess of the principal and interest) in
accordance with the Act. Governing Law and Notices The terms of this MPN will be interpreted in accordance with the Higher Education Act of 1965, as amended
(20 U.S.C. 1070, et seq.), other applicable federal statutes
and regulations, and the guarantors policies. Applicable
state law, except as preempted by federal law, may provide
for certain borrower rights, remedies, and defenses
in addition to those stated in this MPN. If a particular loan under this MPN is made by the school, or if the proceeds of a particular loan made under
this MPN are used to pay tuition and charges at a for-profit
school that refers loan applicants to the lender, or that is
affiliated with the lender by common control, contract, or
business arrangement, any lender holding such loan is
subject to all claims and defenses that I could assert
against the school with respect to such loan. My recovery
under this provision shall not exceed the amount
I paid on such loan. If I reside in the state in which the principal office of the guarantor is located, the guarantor may sue to
enforce the applicable loan(s) in the county in which the
guarantors office is located. However, if I object to being
sued there and I mail a written objection to the guarantor
that is postmarked no later than 30 days after I am served
with the suit, the guarantor will either have the court
transfer the suit to the county in which I live or will
dismiss the lawsuit. Any notice required to be given to me will be effective if sent by first class mail to the latest address the lender
has for me or by electronic means to an address that I have
provided. I will immediately notify the lender of any change
of address or status as specified in the Borrowers Rights
and Responsibilities Statement. Failure by the lender to
enforce or insist on compliance with any term on this MPN
will not be a waiver of any right of the lender. No provision
of this MPN may be modified or waived except in writing.
If any provision of this MPN is determined to be
unenforceable, the remaining provisions shall remain
in force. Notice About Subsequent Loans
Made Under This MPN This Master Promissory Note authorizes the lender to disburse multiple loans to pay the educational costs
of the dependent student identified in the Student
Information Section during the multi-year term of this
MPN upon my request and upon the schools
certification of my loan eligibility. Subsequent loans for
this dependent may be made for the same or
subsequent periods of enrollment at schools designated
by the Secretary of the U.S. Department of Education. I understand that no subsequent loan (s) will be made under this MPN after the earliest of the following
dates: (i) the date my lender receives my written notice
that no further loans may be disbursed under the MPN;
(ii) one year after the date of my signature on this
MPN if no disbursement is made during such twelve-
month period; or (iii) ten years after the date of my
signature on this MPN; or the date the lender receives
this MPN. Any amendment to the Act governs the terms of any loan (s) disbursed on or after the effective date of such amendment, and such amended terms are
hereby incorporated into this Master Promissory Note. Guarantor, Program, or Lender Identification Federal Family Education Loan Program (FFELP) Federal PLUS Loan Application and Master
Promissory Note Instructions and Notices 50 states, the District of Columbia, Puerto Rico, the
U.S. Virgin Islands, Guam, and the Northern Mariana
Islands. A U.S. national includes all U.S. citizens and
citizens of American Samoa and Swain's Island. Item (b): Check this box if you are a permanent
resident/other eligible non-citizen. Write in your
eight- or nine-digit Alien Registration Number.
"Permanent Resident" means someone who can
provide documentation of this status from the U.S.
Immigration and Naturalization Service. "Other
Eligible Non-Citizen" includes individuals who can
provide documentation from the U.S. Immigration
and Naturalization Service that they are in the United
States for a purpose that is not temporary, with the
intention of becoming a citizen or permanent
resident. This category includes refugees, persons
granted asylum, Cuban-Haitian entrants, temporary
residents under the Immigration Reform and
Control Act of 1986, and others.
NOTE: If your citizenship status is not one of the
categories described above, you are not eligible to
receive a Federal PLUS Loan. Item 9: Enter the name and address of the lender
from which you wish to borrow. If you do not have
a lender, contact the schools financial aid office, a
bank or other financial institution, or the guarantor
or program listed in the upper right-hand corner of
this form for information on lenders willing to make
Federal PLUS Loans. Item 10: If you know the lender code, enter it here.
Otherwise, leave this item blank. Item 11: It is important that the lender be able to reach you during the process of making your loan(s) and
during repayment. Enter your employers name and address, including city, state, and zip code. If you are
self-employed, enter the name and address of your
business. If you are not employed, enter N/A. Item 12: Enter the area code and telephone number of
your employer. If you are self-employed, enter the area
code and telephone number of your business. If you
do not have a business telephone number, enter N/A. Item 13: Enter the requested reference information
for two adults with different U.S. addresses who have
known you for at least three years. Do not list the
student as a reference. References with addresses
outside the U.S. are not acceptable. If a reference does not have a telephone number or e-mail address,
or does not wish to provide an e-mail address, enter
N/A. If you provide an e-mail address for a reference,
the lender or holder of your loan(s) may use it to
communicate with the reference. All requested items
must be completed or the processing of your loan
will be delayed. Item 14: Enter the last name of the dependent
student for whom you are borrowing, then first name
and middle initial. Item 15: Enter the student's nine-digit Social
Security Number. Item 16: Enter the month, day, and four-digit year of
the student's birth. Use only numbers. Be careful not
to enter the current year. Item 17: The school will notify you of the amount of
Federal PLUS Loan you are eligible to receive each
time you request Federal PLUS funds. You may
decline a loan or request a lower amount by
contacting your lender or the school. You should
apply only for what you will need to pay your
dependent's educational costs each year. Additional
information is included under "Loan Cancellation" in
the Borrower's Rights and Responsibilities
Statement. Items 18 and 19: Read these items carefully. Item 20: Read the entire MPN carefully. Then
complete Items 21 and 22. Item 21: Sign your legal name, including your first
name, middle initial, and last name. Item 22: Enter the date you are signing this MPN in
month/day/year format. This is a Master Promissory Note under which you may receive multiple Federal PLUS Loans for the same dependent student over a maximum ten-year period. A
Federal PLUS Loan is a loan available to certain parent(s) of dependent undergraduate students ("dependent" is defined in the Higher Education Act and may be
different from the definition used by the Internal Revenue Service) attending participating postsecondary schools. You are responsible for paying the principal
amount of your loan(s) and all interest that accrues from the date of disbursement until the loan(s) is paid in full. Your lender will perform a standard credit check with a national credit bureau before approving each loan. As required under federal law, if your lender deter-
mines you have adverse credit, you may not receive a Federal PLUS Loan unless: 1) you provide information to your lender's satisfaction that there are extenuat-
ing circumstances, or 2) you obtain an endorser who does not have an adverse credit history. An endorser is someone who agrees to repay the loan if you fail to
do so. The endorser may not be the student for whom the loan is being made. This form is to be completed by the parent borrower.
Use a dark ink, ballpoint pen or typewriter. Do not
complete this form in pencil. If an item has been
completed for you and it is incorrect, cross out the
incorrect information and print the correct
information. Incorrect, incomplete, or illegible
information may cause the processing of your loan to
be delayed. Item 1: Enter your last name, then your first name
and middle initial. Item 2: Enter your nine-digit Social Security Number.
If this item has been completed for you, review it for
correctness. If it is incorrect, cross out the entire
number and print the entire correct Social Security
Number in this box. Your loan(s) cannot be processed
without a Social Security Number. Read the Privacy
Act and Financial Privacy Act Notices in these
instructions before completing this item. Item 3: Enter your permanent home street address,
apartment number, city, state and zip code. If you
have a Post Office Box and a street address, list both. Item 4: Enter the area code and telephone number
for the address listed in Item 3. If you do not have
a telephone, enter N/A. Item 5: Using only numbers, enter the month, day, and
four-digit year of your birth. (For example, for June 24,
1982, you would enter 06/24/1982.) Be careful not to
enter the current year. Item 6: Enter your preferred e-mail address for
receiving correspondence. If you do not have an
e-mail address, or do not wish to provide it, enter
N/A. If you provide your e-mail address, the lender or
holder of your loan(s) may use it to communicate
with you. Item 7: Enter the two-letter abbreviation for the state
that issued your drivers license followed by the
drivers license number. If you do not have a drivers
license, enter N/A. Item 8: Indicate your U.S. citizenship status. Contact
the schools financial aid office if you are unsure of
your eligibility. Item (a): Check this box if you are a U.S. citizen or
U.S. national. A U.S. citizen includes citizens of the Borrower (Parent) Section Borrower Request, Certifications, and Authorizations Student Information Section Promise to Pay Important Notices Privacy Act Notice The Privacy Act of 1974 (5 U.S.C. 552a) requires that
the following notice be provided to you: The authority for collecting the requested information
from and about you is
