MPN Certification

Federal Family Education Loan Program (FFELP) Federal PLUS Loan Information and School Certification WARNING: Any person who knowingly makes a false statement or misrepresentation on this form is subject to penalties that may include fines, imprisonment, or both, under the U.S. Criminal Code and 20 U.S.C. 1097.

G OMB No. 1845-0069 Form approved Exp. date 08/31/2010 CLEAN DRAFT 02-10-2009 uarantor, Program, or Lender Identification

(Reserved for school, lender, or guarantor mailing address as appropriate)

1. School Code 2. School Information (Name, Address, and Phone Number)

Borrower and Student Information

3. Borrower Last Name

First Name

MI

4. Borrower Social Security Number

5. Permanent Address (See instructions.)

6. Area Code/Telephone Number

7. Borrower Date of Birth (mm-dd-yyyy)

City

State

Zip Code

8. Borrower E-mail Address

9. Lender Name/Lender Code, if known

City

State

10. Borrower Requested Loan Amount $ .00

11. Loan Period (mm-dd-yyyy) From: To:

12. Student Last Name

First Name

MI

13. Student Social Security Number

14. Student Date of Birth (mm-dd-yyyy)

School Certification Information

(To be completed only by the school.)

15. Enrollment Status (Check one)  Full Time  At Least Half Time

16. Anticipated Graduation (Completion) Date (mm-dd-yyyy)

17. Loan Period (mm-dd-yyyy) From: To:

18. Grade Level

19. Certified Loan Amount $ .00

20. Recommended Disbursement Date(s) (mm-dd-yyyy)

1st

2nd

3rd

4th

5th

6th

This space reserved for additional disbursement dates, if needed.

School Certification

(To be completed only by the school.)

I certify: That the graduate or professional student borrower or the dependent undergraduate student named on this Certification is accepted for enrollment in an eligible program on at least a half-time basis, is a U.S. citizen, permanent resident, or other eligible non-citizen, and is making satisfactory academic progress; That the borrower is an eligible borrower in accordance with the Higher Education Act of 1965, as amended, and applicable U.S. Department of Education regulations (collectively referred to as the Act) and has been determined eligible for a loan in the amount certified; That the borrower, if a graduate or professional student, has completed a Free Application for Federal Student Aid (FAFSA) and that the borrower’s eligibility for the maximum annual amount of a Stafford Loan (subsidized and unsubsidized) has been determined; That the disbursement schedule complies with the requirements of the Act; Based on available records and appropriate inquiry, that: (i) the graduate or professional student borrower or the dependent undergraduate has met the requirements of the Selective Service Act, and is not incarcerated; (ii) neither the borrower nor, if applicable, the dependent undergraduate student is liable for an overpayment of any federal grant or loan made under the Act; (iii) neither the borrower nor, if applicable, the dependent undergraduate student is in default on any Title IV education loan(s); or if the borrower or student is in default, satisfactory repayment arrangements have been made with the holder(s) of any defaulted loan(s); (iv) neither the borrower nor, if applicable, the dependent undergraduate student has been convicted of or pled nolo contendere (no contest) or guilty to a crime involving fraud in obtaining funds under Title IV of the Higher Education Act of 1965 (HEA), as amended; or if the borrower or student has pled nolo contendere or guilty to such a crime, the borrower or student has repaid the funds to the Secretary of Education or to the loan holder in the case of a Title IV federal student loan; (v) neither the borrower nor, if applicable, the dependent undergraduate student has property subject to a judgment lien for a debt owed to the U.S.; and (vi) the information provided in this Certification is true, complete, and accurate to the best of my knowledge and belief. I agree to provide the borrower with (i) confirmation of any transfer of funds through electronic funds transfer (EFT) or master check to the graduate or professional student borrower’s or dependent student’s account, and (ii) an opportunity to cancel or reduce any disbursement of a loan.

21.

Signature of Authorized School Official

22.

Today’s Date (mm-dd-yyyy)

Name/Title (Printed or Typed)

Please refer to the instructions for completing this form.

Instructions for Completing Federal PLUS Loan Information

and School Certification

Items 1 and 2 may be prefilled or completed by the school.

Item 1: Enter the code for your school. This code is provided by the U.S. Department of Education for the Federal Family Education Loan Program.

Item 2: Enter your school name and address, and the telephone number, including area code, of a school official who can answer questions about this certification.

Items 3-14 may be completed by the borrower, school, or lender. If the borrower is completing this section and any information has been prefilled by the school or lender, the borrower should review it for correctness. If any part of the prefilled information is incorrect, cross out the incorrect information and print the correct information. Incorrect, incomplete, or illegible information may delay the loan.

If the borrower is the parent of a dependent undergraduate student borrowing for the student’s education, all references to “student” mean the dependent undergraduate student named in Item 12.

Enter dates as month-day-year (mm-dd-yyyy). Use only numbers. Example: June 24, 1982 = 06-24-1982.

Item 3: Enter or correct the borrower’s last name, first name, and middle initial.

Item 4: Enter or correct the borrower’s Social Security Number. This loan cannot be processed without the borrower’s Social Security Number.

Item 5: Enter the borrower’s permanent address (number, street, apartment number) or rural route number and box number, then city, state, and zip code. If the borrower’s mailing address is a post office box or general delivery, list both the mailing address and the street address or rural route number and box number.

Item 6: Enter the borrower’s area code and telephone number. If the borrower does not have a telephone, enter N/A.

Item 7: Enter the date of the borrower’s birth. Be careful not to enter the current year.

Item 8: Enter the borrower’s e-mail address.

Item 9: Enter the borrower’s lender selection (name, identification number, city, and state), if known.

Note to Borrower: If you do not have a lender for this loan, contact the school’s financial aid office, a bank or other financial institution, or the guarantor or program listed on this form for information on lenders willing to make Federal PLUS Loans.

Item 10: Enter the maximum Federal PLUS Loan amount the borrower wishes to borrow for himself/herself or for the dependent undergraduate student listed in Item 12 for the loan period listed in Item 11.

Note to Borrower: Apply only for the amount you will need to pay educational costs this year, keeping in mind your ability to repay your loan(s). You may borrow up to the estimated cost of education at the school you or the student will attend minus any estimated financial assistance that has been or will be awarded during the period of enrollment.

Item 11: Enter the beginning and ending dates of the academic period for which this loan is to be used.

Item 12: If the borrower is the parent of a dependent undergraduate student, enter the student’s last name, first name, and middle initial.

Item 13: If the borrower is the parent of a dependent undergraduate student, enter the student’s nine-digit Social Security Number. This loan cannot be processed without the student’s Social Security Number.

Item 14: If the borrower is the parent of a dependent undergraduate student, enter the date of the student’s birth. Be careful not to enter the current year.

Items 15-22 are to be completed only by the school. This information is to be certified by a financial aid administrator or other school official authorized to certify financial aid forms. If certification information is transmitted electronically, the School Certification form does not have to be submitted.

Item 15: Indicate whether the graduate or professional student borrower or the dependent undergraduate student is (or plans to be) enrolled at least half time or full time. A graduate or professional student borrower who is enrolled (or planning to enroll) less than half time, or the parent of a dependent undergraduate student who is enrolled (or planning to enroll) less than half time, is not eligible for a Federal PLUS Loan.

Item 16: Enter the date the student is expected to complete the program at your school. If you are unsure of the actual completion date in the future, enter the last day of the month.

Item 17: Enter the dates covered by the cost of attendance. These dates must coincide with actual term starting and ending dates. At a school without academic terms, these dates must coincide with the student’s program of study if that is less than an academic year in length, or the academic year.

Item 18: Enter the grade level of the graduate or professional student borrower or the dependent undergraduate student. Select the proper grade level indicator using the standard grade level codes provided:

Code	Grade Level
1	Freshman/First Year (including proprietary school programs that are less than one year in duration)
2	Sophomore/Second Year
3	Junior/Third Year
4	Senior/Fourth Year
5	Fifth Year/Other Undergraduate (including sixth year undergraduate and continuing education students)
A	First Year Graduate or Professional
B	Second Year Graduate or Professional
C	Third Year Graduate or Professional
D	Beyond Third Year Graduate or Professional

Item 19: Enter the maximum amount of PLUS Loan the borrower is eligible to receive for the academic period covered in Item 17. This amount cannot exceed the cost of attendance minus other financial aid.

Item 20: Enter the disbursement dates for this loan as determined in accordance with the Act.

Item 21: Your signature acknowledges that you have read and agree to the provisions in the School Certification. You must sign the certification and print your name and title.

Item 22: Enter the date of certification.

Paperwork Reduction Notice

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a currently valid OMB control number. The valid OMB control number for this information collection is 1845-0069. The time required to complete this information is estimated to average 0.15 hours (9 minutes) per response, including the time to review instructions, search existing data resources, gather and maintain the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to:

U.S. Department of Education

Washington, DC 20202-4537