Master Promissory Note
OMB No. 1845-0068
Form Approved
Direct PLUS Loans
Exp. Date 04/30/2019
William D. Ford Federal Direct Loan Program
WARNING: Any person who knowingly makes a false statement or misrepresentation on this form or any accompanying document is subject to penalties that may include
fines, imprisonment, or both, under the U.S. Criminal Code and 20 U.S.C. 1097.
BEFORE YOU BEGIN
Before you begin, read the Instructions on page 15 of this Master Promissory Note.
BORROWER INFORMATION
1.
7.
I am a (check one):
Area Code/Telephone Number
Graduate or Professional Student
8.
Citizenship Status (to be completed by parent borrowers only -- check one)
Parent of a Dependent Undergraduate Student
U.S. Citizen or National
(1)
Permanent Resident/Other Eligible Non-Citizen
2.
(2)
Name and Permanent Address (see Instructions)
If (2), Alien Registration Number
3.
9.
Employer's Name and Address
Social Security Number
4.
Date of Birth (mm-dd-yyyy)
5.
Driver's License State and Number
6.
10.
Email Address (optional)
Work Area Code/Telephone Number
REFERENCE INFORMATION
List two persons with different U.S. addresses who do not live with you and who have known you for at least three years. If you are a parent borrower, do not list the student.
11.
First Name:
Middle Initial:
Last Name:
Permanent Address (Street, City, State, Zip Code):
Email Address (optional):
Area Code/Telephone Number:
Relationship to You:
12.
First Name:
Middle Initial:
Last Name:
Permanent Address (Street, City, State, Zip Code):
Email Address (optional):
Area Code/Telephone Number:
Relationship to You:
SCHOOL INFORMATION - TO BE COMPLETED BY THE SCHOOL
13.
School Name and Address
14.
School Code/Branch
15.
Identification No.
DEPENDENT UNDERGRADUATE STUDENT INFORMATION - TO BE COMPLETED ONLY IF YOU ARE A PARENT BORROWER
16.
Dependent Undergraduate Student's Name (first, middle initial, last)
17.
Social Security Number
18.
Date of Birth (mm-dd-yyyy)
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