XXXX ASLRP Loan Information Continuation Form

OMB Number 1105-0086. Expires 11/30/2013
LOAN INFORMATION CONTINUATION PAGE
NAME:

Loan

SSN:
Amount of outstanding balance:
Date of above outstanding balance:
Loan holder/servicing organization
(complete name, payment address,
telephone number)

$

Loan identification number
Type of Loan (e.g., Stafford, Direct)
Payment amount and frequency
(e.g., monthly/quarterly/annually)

$

per

Due date of the next payment
Amount you personally paid
between Jan 1 and Dec 31, 2012
Amount ASLRP paid on your behalf
in FY 2012
Amount due in 2013

Loan

Amount of outstanding balance:
Date of above outstanding balance:

$
$
$

$

Loan holder/servicing organization
(complete name, payment address,
telephone number

Loan identification number
Type of Loan (e.g., Stafford, Direct)
Payment amount and frequency
(e.g., monthly/quarterly/annually)

$

Due date of the next payment

Amount you personally paid
between Jan 1 and Dec 31, 2012
Amount ASLRP paid on your behalf
in FY 2012
Amount due in 2013

$
$
$

per