Federal Stafford Loan Master Promissory Note (Page 3 of 8) in pdf

Guarantor, Program, or Lender Identification

Federal Family Education Loan Program (FFELP)

Federal Stafford Loan

Master Promissory Note

Instructions and Notices

Instructions for Completing Promissory Note

This is a Master Promissory Note under which you may receive multiple subsidized and unsubsidized Federal Stafford Loans over a maximum ten year period.

Except for interest charges the federal government pays on your behalf on subsidized Federal Stafford Loans while you are in school and during your grace and

deferment periods, you are responsible for paying interest on the principal amount of your loans from the date of disbursement until the loans are paid in full.

Use a dark ink ball point pen or typewriter. Do not complete this form in pencil. If an item has been completed for you and any part of it is incorrect, cross out the

incorrect information and print the correct information. Incorrect, incomplete, or illegible information may cause your loan to be delayed.

If a reference does not have a telephone or an e-mail

that issued your driver's license followed by the

Item 1: Enter your last name, then your first name and

address or does not wish to provide an e-mail address,

driver's license number. If you do not have a driver's

middle initial.

write N/A. If you provide an e-mail address for a

license, enter N/A.

Item 2: Enter your nine-digit Social Security Number.

reference, the lender or holder of your loan(s) may use it

Item 7: Enter your preferred e-mail address if you have

If this item has been completed for you, review it for

to communicate with the reference. All requested items

one. You are not required to provide this information. If

correctness. If it is incorrect, cross out the entire

must be completed or your loan(s) will be delayed.

you do, we may use your e-mail address to communicate

incorrect number and print the entire correct Social

Item 11: Your school will notify you of the amount

Security Number in this box. Your loan(s) cannot be

with you. If you do not have an e-mail address or do not

of subsidized and unsubsidized Federal Stafford loans

wish to provide one, write N/A.

processed without a Social Security Number. Read the

you are eligible to receive for this and subsequent

Privacy Act and the Financial Privacy Act Notices below

Item 8: Enter the name and address of the lender from

academic periods. You may decline a loan or request a

before completing this item.

which you wish to borrow. If you do not have a lender,

lower amount by contacting your lender or school.

contact your school's financial aid office, a bank or other

Item 3: Enter your permanent home street address,

Additional information is included under "Loan

financial institution, or the guarantor or program listed on

apartment number, city, state, and zip code. If you have

Cancellation" in the Borrower's Rights and

this form for information on lenders willing to make loans

a Post Office Box and a street address, list both. A

Responsibilities Statement.

to students attending your school.

temporary school address is not acceptable.

Item 12: Check this box only if you want to make

Item 9: If you know the lender code, enter it here.

Item 4: Enter the area code and telephone number for

interest payments while in school.

Otherwise, leave this item blank.

the address listed in Item 3. If you do not have a

Items 13, 14, and 15: Read these items carefully.

telephone, enter N/A.

Item 10: Enter the requested reference information for

Item 16: Sign your legal name, including your first

two adults who do not share a common address. The first

Item 5: Using only numbers, enter the month, day, and

name, middle initial, and last name. Use a dark ink

reference should be a parent (if living), legal guardian, or

four-digit year of your birth, (For example, for June 24,

ballpoint pen, if you are completing a paper copy of

an adult relative. References with addresses outside the

1982, you would enter 06/24/1982). Be careful not to

this MPN.

enter the current year.

U.S. are not acceptable. Both references must be

completed in full.

Item 17: Enter the date you are signing this MPN.

Item 6: Enter the two-letter abbreviation for the state

Important Notices

Privacy Act Notice

programs, to private parties such as relatives, present

Financial Privacy Act Notice

and former employers, business and personal associates,

The Privacy Act of 1974 (5 U.S.C. 552a) requires that

Under the Right to Financial Privacy Act of 1978

to credit bureau organizations, to educational and financial

the following notice be provided to you:

(12 U.S.C. 3401-3421), the U.S. Department of

institutions, to guaranty agencies and to contractors in

Education will have access to financial records in your

The authority for collecting the requested information

order to verify your identity, to determine your eligibility to

student loan file maintained by the lender in compliance

from and about you is §428(b)(2)(A) et seq. of the

receive a loan(s) or a benefit on a loan(s), to permit the

with the administration of the Federal Family Education

Higher Education Act of 1965, as amended (20 U.S.C.

servicing or collection of your loan(s), to counsel you in

Loan Program.

1078(b)(2)(A) et seq.) and the authority for collecting

repayment efforts, to enforce the terms of the loan(s), to

and using your Social Security Number (SSN) is

Paperwork Reduction Notice

investigate possible fraud and to verify compliance with

§484(a)(4) of the HEA (20 U.S.C. 1091(a)(4)).

federal student financial aid program regulations, to locate

According to the Paperwork Reduction Act of 1995,

Participating in the Federal Family Education Loan

you if you become delinquent in your loan payments or if

no persons are required to respond to a collection of

Program (FFELP) and giving us your SSN is voluntary,

you default, to provide default rate calculations, to provide

information unless it displays a currently valid OMB

but you must provide the requested information,

financial aid history information, to assist program

control number. The valid OMB control number for this

including your SSN, to participate.

administrators with tracking refunds and cancellations, or

information collection is 1845-0006. The time required

to provide a standardized method for educational

The principal purposes for collecting the information

to complete this information is estimated to average 1.0

institutions efficiently to submit student enrollment status.

on this form, including your SSN, are to verify your

hours (60 minutes) per response, including the time to

identity, to determine your eligibility to receive a loan or

review instructions, search existing data resources,

In the event of litigation, we may send records to the

a benefit on a loan (such as a deferment, forbearance,

gather and maintain the data needed, and complete and

Department of Justice, a court, adjudicative body,

discharge or forgiveness) under the FFELP, to permit

review the information collection. If you have any

counsel, party, or witness if the disclosure is relevant and

the servicing of your loan(s), and, if it becomes

comments concerning the accuracy of the time

necessary to the litigation. If this information, either alone

necessary, to locate you and to collect on your loan(s)

estimate(s) or suggestions for improving this form,

or with other information, indicates a potential violation of

if your loan(s) become delinquent or in default. We also

please write to the U.S. Department of Education,

law, we may send it to the appropriate authority for action.

use your SSN as an account identifier and to permit you

Washington, DC 20202-4651.

We may send information to members of Congress if you

to access your account information electronically.

ask them to help you with federal student aid questions.

If you have questions regarding the status of your

In circumstances involving employment complaints,

The information in your file may be disclosed to third

submission of this form, contact the lender,

grievances, or disciplinary actions, we may disclose

parties as authorized under routine uses in the

guarantor, or program identified in the upper right-

relevant records to adjudicate or investigate the issues. If

appropriate systems of records. The routine uses of this

hand corner of this form.

provided for by a collective bargaining agreement, we may

information include its disclosure to federal, state, or

local agencies, to other federal agencies under

disclose records to a labor organization recognized under

computer matching programs, to agencies that we

5 U.S.C. Chapter 71. Disclosures may also be made to

qualified researchers under Privacy Act safeguards.

authorize to assist us in administering our loan

Federal Stafford Loan Master Promissory Note Page 3

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