DRAFT 02/07/2011
W
OMB
No. 1845-0103 Form
Approved Exp.
Date xx/xx/xxxx
Federal Direct PLUS Loan Request for Supplemental Information
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.
This is a request for supplemental information in connection with your application for a Federal Direct PLUS Loan (Direct PLUS Loan) through the William D. Ford Federal Direct Loan (Direct Loan) Program. The information that you provide will be sent to the school(s) that you identify in the School and Loan Information section of the request, and will be used by the school(s) to process your application for a Direct PLUS Loan. You should complete this Direct PLUS Loan Request for Supplemental Information (Direct PLUS Loan Request) only if you are instructed to do so by the school. Some schools may have a different process for obtaining the additional information needed to process your Direct PLUS Loan application.
This Direct PLUS Loan Request is used for the purpose of collecting information that will be used by the school(s) you identify to process your application for a Direct PLUS Loan and provides you the option of completing other actions as described below. Before you can receive a Direct PLUS Loan, you must complete a Direct PLUS Loan Application and Master Promissory Note (Direct PLUS Loan MPN). The Direct PLUS Loan MPN explains all of the terms and conditions of Direct PLUS Loans and constitutes your legally binding agreement to repay all Direct PLUS Loans that you receive under the Direct PLUS Loan MPN. If you have not previously completed a Direct PLUS Loan MPN, you may do so on this site after you complete the Direct PLUS Loan Request.
The Direct PLUS Loan Request gives you the option of authorizing the school to use your loan funds to satisfy other educationally related charges after tuition and fees, and room and board have been paid. You are not required to provide this authorization.
If you are a parent borrower, the Direct PLUS Loan Request also allows you to:
Designate whether the school pays any credit balance to the student or to you.
Request a deferment while the student is in school
Request an additional deferment for 6 months after the student ceases to be enrolled at least half time.
1. Social Security Number
[POPULATED FROM PIN SITE]
2. Name
[POPULATED FROM PIN SITE]
3. Date of Birth
[POPULATED FROM PIN SITE]
4. Citizenship Status
APPEARS ONLY IF A BORROWER SELECTS “PARENT PLUS” BEFORE BEGINNING THE DIRECT PLUS LOAN REQUEST PROCESS; ALREADY POPULATED IF THERE IS AN EXISTING COD RECORD WITH THIS INFORMATION
U.S. Citizen or National
“U.S. Citizen” includes citizens of the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, and the Northern Mariana Islands. “National” includes not only all U.S. citizens, but also citizens of American Samoa and Swain’s Island.
Permanent Resident/Other Eligible Non-Citizen
Alien Registration Number: _______________________
“Permanent Resident” means someone who can provide documentation of this status from the U.S. Citizenship and Immigration Services (USCIS). “Other Eligible Non-Citizen” includes individuals who can provide documentation from the USCIS 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.
Neither of the above
If you are not a U.S. Citizen or National, or a Permanent Resident/Other Eligible Non-Citizen, you are not eligible to receive a Direct PLUS Loan.
5. Default Certification
APPEARS ONLY IF THE BORROWER SELECTS “PARENT PLUS” BEFORE BEGINNING THE DIRECT PLUS LOAN REQUEST PROCESS
If you are in default on any loan received under the Direct Loan Program, the Federal Family Education Loan (FFEL) Program, or the Federal Perkins Loan (Perkins Loan) Program (including National Direct Student Loans), you are not eligible to receive a Direct PLUS Loan unless you have made satisfactory repayment arrangements with the loan holder to repay the amount owed. Check the box below to certify that you meet this requirement.
I am not in default on a loan received under the Direct Loan Program, the FFEL Program, or the Perkins Loan Program (including National Direct Student Loans), or if I am in default, I have made satisfactory arrangements with the loan holder to repay the amount owed.
IF APPLICANT DOES NOT CHECK THE DEFAULT CERTIFICATION BOX, THE FOLLOWING MESSAGE APPEARS AND THE APPLICANT IS NOT ALLOWED TO PROCEED:
“To continue with the Direct PLUS Loan Request process, you must certify that you are not in default on a loan made under the Direct Loan Program, the FFEL Program, or the Perkins Loan Program, or if you are in default, that you have made satisfactory arrangements with the loan holder to repay the amount owed. If you do not meet this requirement, you are not eligible to receive a Direct PLUS Loan. Contact your school’s financial aid office for information on other financial aid options that may be available to you.”
7. Permanent Address
ALREADY POPULATED IF THERE IS AN EXISTING COD RECORD WITH THIS INFORMATION
Enter your permanent address (number, street, apartment number, or rural route number and box number, then city, state, zip code). A temporary school address is not acceptable.
8. Is your mailing address different from your permanent address?
NOT REQUIRED IF DIFFERENT MAILING ADDRESS (SEE #9) IS ALREADY POPULATED
Yes
No
9. Mailing Address
REQUIRED ONLY IF APPLICANT ANSWERS ‘YES’ TO #8; ALREADY POPULATED IF THERE IS AN EXISTING COD RECORD WITH THIS INFORMATION
Enter your complete mailing address, including city, state, and zip code.
10. Area Code/Telephone Number
ALREADY POPULATED IF THERE IS AN EXISTING COD RECORD WITH THIS INFORMATION
Enter the area code and telephone number at which you can most easily be reached. If you do not have a telephone, enter N/A.
11. E-Mail Address (optional)
Enter your preferred e-mail address for receiving communications. You are not required to provide this information. If you do, we may use your e-mail address to communicate with you. If you do not have an e-mail address or do not wish to provide one, enter N/A.
12. Employer Name OR I am not employed
ALREADY POPULATED IF THERE IS AN EXISTING COD RECORD WITH THIS INFORMATION
Enter your employer’s name. If you are self-employed, enter the name of your business.
13. Employer Address
ALREADY POPULATED IF THERE IS AN EXISTING COD RECORD WITH THIS INFORMATION
Enter your employer’s address (street, city, state, zip code). If you are self-employed, enter the address of your business.
Authorization for School to Use Loan Funds to Satisfy Other Charges
14. Your Direct PLUS Loan will be applied to your or (if you are a parent borrower) the student’s school account to pay for tuition and fees, and room and board. By checking the box below, you may authorize the school to use your Direct PLUS Loan to satisfy other educationally related charges that you or (if you are a parent borrower) the student incurred at the school. Examples of other charges that may be paid with your authorization include, but are not limited to, library fines, campus parking tickets, lab fees, and charges for minor damage to school property.
You are not required to provide this authorization. If you provide this authorization, you may revoke or modify the authorization at any time by contacting the school.
I authorize the school to use my Direct PLUS Loan to pay for other educationally related charges that I or (if I am a parent borrower) the student incur at the school, as described above.
THE STUDENT INFORMATION SECTION IS PRESENTED ONLY TO APPLICANTS WHO IDENTIFY THEMSELVES AS PARENTS WHEN THEY LOG IN TO COMPLETE THE DIRECT PLUS LOAN REQUEST
15. Student’s Name (first name/middle initial/last name/suffix)
ALREADY POPULATED IF THERE IS AN EXISTING COD RECORD WITH THIS INFORMATION
16. Student’s Social Security Number
ALREADY POPULATED IF THERE IS AN EXISTING COD RECORD WITH THIS INFORMATION
17. Student’s Date of Birth
ALREADY POPULATED IF THERE IS AN EXISTING COD RECORD WITH THIS INFORMATION
Enter the student’s date of birth in mm/dd/yyyy format (for example, for June 16, 1990 enter 06/16/1990.
18. Student’s Permanent Address
ALREADY POPULATED IF THERE IS AN EXISTING COD RECORD WITH THIS INFORMATION
Enter the student’s complete permanent mailing address, including city, state, and zip code.
19. Student’s Area Code/Phone Number
ALREADY POPULATED IF THERE IS AN EXISTING COD RECORD WITH THIS INFORMATION
Enter the area code and telephone number at which the student can most easily be reached. If the student does not have a telephone, enter N/A.
20. Request for Deferment While Student is in School
Do you want to defer repayment of your Direct PLUS Loan while the student on whose behalf you obtained the loan is enrolled at an eligible school on at least a half-time basis?
If you check Yes below, your servicer will contact you shortly before your Direct PLUS Loan enters repayment. A Direct PLUS Loan enters repayment on the date the final disbursement of the loan is made. At this time, your servicer will:
Provide you with the complete terms and conditions of the deferment; and
Give you the opportunity to cancel your deferment request and begin making payments on your loan.
Unless you cancel your deferment request, your servicer will grant a deferment on your Direct PLUS Loan that will begin on the date your Direct PLUS Loan enters repayment, and will end on the date the student ceases to be enrolled on at least a half-time basis or, if you request the additional deferment period described below, six months after the student ceases to be enrolled on at least a half-time basis.
During the deferment period, you will not be required to make any payments on your Direct PLUS Loan. However, interest will continue to accrue. You will receive interest statements during the deferment period and may pay the accruing interest at any time. Any interest that you do not pay will be capitalized (added to your loan principal balance) at the end of the deferment period. Capitalization will increase your loan principal amount and the total cost of your loan.
If you check No below, the first payment on your Direct PLUS Loan will be due within 60 days after the date of the last disbursement of the loan. Your servicer will notify you of your payment due date and payment amount. If you later change your mind and decide that you wish to defer payments while the student is in school, you may request a deferment at any time while the student remains enrolled on at least a half-time basis.
Yes
No
21. Request for 6-Month Post-Enrollment Deferment
Do you want to defer repayment of your Direct PLUS Loan for an additional 6 months beginning on the date the student ceases to be enrolled on at least a half-time basis?
If you check Yes below, your servicer will contact you shortly before your Direct PLUS Loan enters repayment. A Direct PLUS Loan enters repayment on the date the final disbursement of the loan is made. At this time, your servicer will:
Provide you with the complete terms and conditions of the deferment; and
Give you the opportunity to cancel your deferment request and begin making payments on your loan.
Unless you cancel your deferment request, your servicer will grant a deferment on your Direct PLUS Loan that will begin on the date the student ceases to be enrolled on at least a half-time basis and will end six months after that date.
During the deferment period, you will not be required to make any payments on your Direct PLUS Loan. However, interest will continue to accrue. You will receive interest statements during the deferment period and may pay the accruing interest at any time. Any interest that you do not pay will be capitalized (added to your loan principal balance) at the end of the deferment period. Capitalization will increase your loan principal amount and the total cost of your loan. If you also requested a deferment while the student is enrolled in school on at least a half-time basis, unpaid interest that accrues during both deferment periods will be capitalized only once, at the end of the additional 6-month deferment period.
If you check No below and you requested a deferment while the student is enrolled on at least a half-time basis, the first payment on your Direct PLUS Loan will be due within 60 days after the date the student ceases to be enrolled on at least a half time basis. Your servicer will notify you of your payment due date and payment amount. If you later change your mind and decide that you wish to defer payments for an additional six months after the student ceases to be enrolled on at least a half-time basis, you may request a deferment at any time while the student remains enrolled on at least a half-time basis.
Yes
No
22. Credit Balance Option
Your Direct PLUS Loan will first be applied to the student’s school account to pay for tuition and fees, room and board, and, if you provide authorization, other educationally related charges. Any loan amount that remains after these charges have been paid is called a credit balance. You may choose to have the school pay the credit balance directly to you or to the student.
If there is a credit balance after your Direct PLUS Loan has been applied to the student’s school account, to whom do you want the school to pay the credit balance?
Me
The Student
23. Identify the school(s) at which you are requesting a Direct PLUS Loan. You may specify up to three schools. If your school is not listed, contact your school’s financial aid office for information on how to request a Direct PLUS Loan.
U.S. Schools
DROP-DOWN MENU LISTING DOMESTIC SCHOOLS
Non-U.S. Schools
DROP-DOWN MENU LISTING FOREIGN SCHOOLS
24. Specify a reason for submitting this Direct PLUS Loan Request:
New (I am submitting a new Direct PLUS Loan Request)
Change (I am requesting a change to the loan amount specified in a previously submitted PLUS Loan Request.)
IF ‘CHANGE’ IS SELECTED, A DROPDOWN BOX APPEARS DISPLAYING THE BORROWER’S PREVIOUS PLUS LOAN REQUEST REFERENCE NUMBERS:
Please select the PLUS Loan Request you want to modify:
Previous Loan Reference Number: _________________ More Information
More Information [LINK]
IF BORROWER SELECTS ‘MORE INFORMATION’ LINK, THE FOLLOWING TEXT IS PRESENTED:
The loan reference number(s) that displays is for your previous PLUS Loan Request(s). Your loan reference number(s) was also sent to you by e-mail when you submitted your original Direct PLUS Loan Request if you opted to receive your correspondence electronically. You can also obtain your Loan Reference Number and review your previous PLUS Loan Request(s) by choosing “Completed Loan Requests” on the left navigation bar.
25. Loan Amount Requested
For each academic year, you may borrow up to – but not more than – the school’s cost of attendance, minus the amount of other financial assistance that you receive (if you are a graduate or professional student) or that the student receives (if you are a parent borrower). The school determines the cost of attendance based on federal guidelines. It is important not to borrow more than you can afford to repay, even if you are eligible to borrow more.
I want to borrow the maximum Direct PLUS Loan amount for which I am eligible, as determined by the school.
I would like to specify a loan amount: $ _______________ (may not exceed the school’s cost of attendance, minus other financial assistance that I or the student receive(s)).
I do not know the amount I want to borrow. I will contact the school.
IF THE BORROWER SELECTS”I WOULD LIKE TO SPECIFY A LOAN AMOUNT IN CONJUNCTION WITH A NEW PLUS LOAN REQUEST, THE ABOVE FIELD WILL DISPLAY.
IF THE BORROWER SELECTS “I WOULD LIKE TO SPECIFY A LOAN AMOUNT” IN CONJUNCTION WITH A REQUEST FOR A CHANGE TO A PREVIOUSLY SUBMITTED PLUS LOAN REQUEST, THE FIELD WILL DISPLAY AS:
I would like to specify a new total loan amount
Total Loan Amount Requested: $ _______________ (may not exceed the school’s cost of attendance, minus other financial assistance that I or the student receive).
26. Loan Period
Specify the loan period for which you are requesting a Direct PLUS Loan:
More Information [LINK]
IF THE ‘MORE INFORMATION’ HYPERLINK IS SELECTED THE FOLLOWING APPEARS:
The loan periods displayed are those that your school most commonly uses. If you do not see a loan period that coincides with the period for which you are requesting a Direct PLUS Loan, you may choose “Other” if your school has opted to participate in that option. If you choose “Other,” you will be asked to enter the beginning and ending dates (month and year) of your requested loan period. If you do not know the loan period for which you want to borrow please contact your school’s financial aid office.
Loan Period Requested [DROPDOWN MENU WITH SCHOOL-SPECIFIED LOAN PERIOD DATES AND OPTION TO CHOOSE ‘OTHER.’]
IF ‘OTHER’ IS SELECTED FROM THE DROPDOWN MENU, THE FOLLOWING APPEARS:
Requested Loan Period Start Date
Month [DROPDOWN MENU] Year: [DROPDOWN MENU]
Requested Loan Period End Date
Month [DROPDOWN MENU] Year [DROPDOWN MENU]
In 1999, Congress enacted the Gramm-Leach-Bliley Act (Public Law 106-102). This Act requires that lenders provide certain information to their customers regarding the collection and use of nonpublic personal information.
We disclose nonpublic personal information to third parties only as necessary to process and service your loan and as permitted by the Privacy Act of 1974. See the Privacy Act Notice below. We do not sell or otherwise make available any information about you to any third parties for marketing purposes.
We protect the security and confidentiality of nonpublic personal information by implementing the following policies and practices. All physical access to the sites where nonpublic personal information is maintained is controlled and monitored by security personnel. Our computer systems offer a high degree of resistance to tampering and circumvention. These systems limit data access to our staff and contract staff on a “need-to-know” basis, and control individual users’ ability to access and alter records within the systems. All users of these systems are given a unique user ID with personal identifiers. All interactions by individual users with the systems are recorded.
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 §451 et seq. of the Higher Education Act (HEA) of 1965, as amended (20 U.S.C. 1087a et seq.) and the authorities for collecting and using your Social Security Number (SSN) are §§428B(f) and 484(a)(4) of the HEA (20 U.S.C. 1078-2(f) and 1091(a)(4)) and 31 U.S.C. 7701(b). Participating in the William D. Ford Federal Direct Loan (Direct Loan) Program and giving us your SSN are voluntary, but you must provide the requested information, including your SSN, to participate.
The principal purposes for collecting the information on this form, including your SSN, are to verify your identity, to determine your eligibility to receive a loan or a benefit on a loan (such as a deferment, forbearance, discharge, or forgiveness) under the Direct Loan Program, to permit the servicing of your loan(s), and, if it becomes necessary, to locate you and to collect and report on your loan(s) if your loan(s) become delinquent or in default. We also use your SSN as an account identifier and to permit you to access your account information electronically.
The information in your file may be disclosed, on a case-by-case basis or under a computer matching program, to third parties as authorized under routine uses in the appropriate systems of records notices. The routine uses of this information include, but are not limited to, its disclosure to federal, state, or local agencies, to private parties such as relatives, present and former employers, business and personal associates, to consumer reporting agencies, to financial and educational institutions, and to guaranty agencies in order to verify your identity, to determine your eligibility to receive a loan or a benefit on a loan, to permit the servicing or collection of your loan(s), to enforce the terms of the loan(s), to investigate possible fraud and to verify compliance with federal student financial aid program regulations, or to locate you if you become delinquent in your loan payments or if you default. To provide default rate calculations, disclosures may be made to guaranty agencies, to financial and educational institutions, or to state agencies. To provide financial aid history information, disclosures may be made to educational institutions. To assist program administrators with tracking refunds and cancellations, disclosures may be made to guaranty agencies, to financial and educational institutions, or to federal or state agencies. To provide a standardized method for educational institutions to efficiently submit student enrollment status, disclosures may be made to guaranty agencies or to financial and educational institutions. To counsel you in repayment efforts, disclosures may be made to guaranty agencies, to financial and educational institutions, or to federal, state, or local agencies.
In the event of litigation, we may send records to the Department of Justice, a court, adjudicative body, counsel, party, or witness if the disclosure is relevant and necessary to the litigation. If this information, either alone or with other information, indicates a potential violation of law, we may send it to the appropriate authority for action. We may send information to members of Congress if you ask them to help you with federal student aid questions. In circumstances involving employment complaints, grievances, or disciplinary actions, we may disclose relevant records to adjudicate or investigate the issues. If provided for by a collective bargaining agreement, we may disclose records to a labor organization recognized under 5 U.S.C. Chapter 71. Disclosures may be made to our contractors for the purpose of performing any programmatic function that requires disclosure of records. Before making any such disclosure, we will require the contractor to maintain Privacy Act safeguards. Disclosures may also be made to qualified researchers under Privacy Act safeguards.
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. Public reporting burden for this collection of information is estimated to average 0.5 hours (30 minutes) per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Education, 400 Maryland Ave., SW, Washington, DC 20210-4537 or email [email protected] and reference OMB Control Number 1845-0103. Note: Please do not return the completed Direct PLUS Loan Request to this address.
If you have any comments or concerns regarding the status of your individual submission of this form, write directly to:
U.S. Department of Education
Common Origination and Disbursement School Relations Center
Attn: Applicant Services
PO Box 9002
Niagara Falls, NY 14302
27. Credit Check Authorization
For the loan or loans that I am requesting by completing this Direct PLUS Loan Request for Supplemental Information, I authorize the U.S. Department of Education to check my credit history for the purpose of determining my eligibility for the loan(s), and to report information about my loan eligibility to persons and organizations permitted by law to receive that information.
Your Direct PLUS Loan Request for Supplemental Information cannot be processed unless you authorize the U.S. Department of Education to check your credit history. One of the eligibility requirements for receiving a Direct PLUS Loan is that you must not have an adverse credit history, unless you meet certain other requirements. The results of your credit check will be sent to the school(s) that you have selected.
28. Adverse Credit Determination
[THIS ITEM APPEARS ONLY IF CREDIT CHECK RESULTS IN ADVERSE CREDIT DETERMINATION]
Based on the results of your credit check, we are unable to approve your application for a Direct PLUS Loan. [APPLICANT MAY CLICK HYPERLINK TO VIEW RESULTS OF CREDIT CHECK] However, you may still receive a Direct PLUS Loan if you obtain an endorser, or if you document to the satisfaction of the U.S. Department of Education that there are extenuating circumstances related to your adverse credit history.
Indicate how you want to proceed by checking the appropriate box below. Your response will be reported to the school(s) that you listed.
I want to obtain an endorser.
An endorser is someone who agrees to repay your Direct PLUS Loan if you do not repay the loan. If you are a parent borrower, the endorser may not be the student on whose behalf you are requesting a Direct PLUS Loan.
I want to provide documentation of extenuating circumstances.
I do not want to pursue a Direct PLUS Loan at this time.
Undecided.
Submit Direct PLUS Loan Request for Supplemental Information [DATE OF SUBMISSION IS RECORDED IN SYSTEM]
[FOLLOWING TEXT APPEARS AFTER APPLICANT CLICKS ON ‘SUBMIT’]
By checking this box, I certify that (1) the information I have provided on this Direct PLUS Loan Request for Supplemental Information is true, complete, and correct to the best of my knowledge and belief and is made in good faith, and (2) I have read and understood the entire Direct PLUS Loan Request for Supplemental Information, including the Important Notices.
| File Type | application/msword |
| File Title | SECTION A: BORROWER INFORMATION |
| Author | jon.utz |
| Last Modified By | James Hyler |
| File Modified | 2011-04-15 |
| File Created | 2011-04-15 |