New Student Form

Applicant Information

* - Indicates required fields

First Name *

Middle Initial *

Last Name *

Address *

City *

State *

ZIP *

Phone *

Date of Birth *

Email *

Cosigner Information

Please provide information for two cosigners below.

Cosigner 1*

Cosigner's Occupation *

Address *

City *

State *

ZIP *

Phone *

Email *

Cosigner 2*

Cosigner's Occupation *

Address *

City *

State *

ZIP *

Phone *

Email *

Add Cosigner

Siblings

Sibling Name 1*

Age *

Occupation *

Add Sibling Remove Sibling

Educational Information

High School *

Expected Graduation Date *

Cumulative GPA (Based on 4.0 scale) *

College/University/Trade School/Post-Secondary Program you have been accepted to and plan to attend: *

What will be your major area of study? *

What are your athletic, music, other extracurricular, and social activities? *

Summer and/or school year employment plans *

Financial Information

Maximum loan amount is $4,000 per year disbursed up to $2,000 per semester. Loan amounts will be determined by the trustees and may be less than $2,000 per semester.

Amount To Borrow *

Academic Year *

Creditor Information

List all loans and other debts owed by the student to all persons and financial institutions. Please include car loans, home loans, credit card debt, and all school or college loans.

Name 1*

Address *

Total Amount Due *

Date Made *

Date Due *

Add Creditor Remove Creditor

Describe and provide estimated values of all real estate (homes, buildings, land) and personal property (cars, boats, business equipment) owned by you

Estimate student expenses for the time period during which the loan is to be used. Estimate the income and other resources you expect to have to meet these expenses. The “amount needed” should represent what you need to borrow. The budget should cover a one-year period for the upcoming academic year.

ANTICIPATED EXPENSES

AMOUNT

Tuition

Board (dining)

Room (dorm contract, rent)

Book/Supplies

Fees (health, sports, tech., org.)

Travel/Transportation (auto expenses)

Clothing/personal items

Insurance premiums

Debts to be paid

Miscellaneous/Other

ANTICIPATED INCOME

AMOUNT

Savings

Earnings during year

Gifts (parents/relatives/ friends)

Scholarships/Grants -Local

Scholarships/Grants -College

FAFSA Grants

Federal Student Loans (FAFSA)

Other Loans

Other

Total Expenses

Total Income

Amount Needed (Expenses - Income)

References

Give three references who have known you for several years and who are apt to be in reasonably close touch with you throughout your life. Please do not give the names of college officials, students, or casual acquaintances. Please provide complete name and addresses.

Name 1 *

Address, Telephone & Email *

Occupation *

Add Reference

Additional information of value in the consideration of this loan

Signature

To the best of my knowledge the answers to the foregoing questions are correct. I understand that this application is for a loan--not a scholarship--and that two cosigners will be required should it be approved. If this loan is approved, the money will be used for necessary expenses incident to securing my education and the maximum final loan amount available will be determined by the trustees. By listing email and cell phone numbers, I agree that the trustees may contact me or anyone on this application through those means of communication. Should this application be approved, I agree that an electronic note document may be generated and signed by myself and my cosigners through electronic means and that our electronic signatures can be used as a replacement to a signature on paper.

First Name *

Date *

Additional Information

High School and/or College Transcript Please attach a copy of your high school and/or college transcript.

Course Registration Please attach a copy of your course registration for the upcoming semester which includes credit hours.

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