Direct Parent Plus Loan Application Form - 2017-2018

2017-18 Direct Parent PLUS Loan Application Form

Loan Period

: (select one) ___2017-18 Academic Year ___2017 Fall Semester only ___2018 Spring Semester only ___2017 Summer Term only

Loan Amount Requested:

$_______________________ (4.276% origination fee will be deducted before disbursement)

Student Information

S

tudent’s Name___________________________________________________________

Student SSN or ID _________________________

Student Date of Birth ______________________

Parent Borrower Information

Parent Borrower’s Name________________________________________________________ Parent SSN __________________________________

Parent Date of Birth _____________________

Citizenship Status: _____ US Citizen _____ Eligible Noncitizen (Alien ID # A_________________)

Street Address ____________________________________________________ City ________________________ State ______ Zip _____________

Phone Number _______________________________ Email address ________________________________________________________________

1. Direct PLUS Loan Credit Approval: A credit evaluation is required for approval of a PLUS

In the event my credit is DENIED:

Loan. This is done by the U.S. Department of Education when NSU submits your loan

____I will add an endorser (credit-worthy co-

request or credit authorization to them for processing. If your PLUS Loan is denied, you

signer) or appeal the credit denial OR

may either appeal the credit denial, add a credit-worthy co-signer, or we may award your

____Allow the student to be considered for

student additional Unsubsidized Direct Loan.

Additional Unsubsidized Direct Loan

2. I authorize NSU to apply the Direct Parent PLUS Loan proceeds to my student’s account, and to forward any amount

Yes______

that exceeds University charges to my dependent with notification to me of the amount refunded. (With this

No______

authorization, a more timely electronic disbursement may be applied to meet your student’s expenses.)

3. I authorize NSU to use my PLUS Loan to pay for all direct educational expenses such as tuition, fees, books, housing,

Yes______

and meal plan as well as any other educationally-related charges such as library fines, parking expenses, late payment

No______

charges, and minor prior-year school charges that may be billed to my student’s account.

4. First time Direct PLUS Loan Borrowers Only: A Direct PLUS Loan Master Promissory Note (MPN) must be completed

Date Completed

the first time you borrow a Direct PLUS Loan at Log in using your FSA ID, not your student’s,

____________

and select “Complete Loan Agreement (Master Promissory Note)”. Be sure to select the correct version - PLUS MPN

for Parents. Note: Do not choose “Apply for a Direct PLUS Loan”. NSU does not use this option.

Privacy Act Disclosure Notice

The Privacy Act of 1974 (5 U.S.C. 552a) requires that the following notice be provided to you. The authority for collecting the information requested on this form is §451

et seq. of the Higher Education Act of 1965, as amended. Your disclosure of this information is voluntary. However, if you do not provide this information, you cannot be

considered for a Direct PLUS. The information on this form will be used to determine your eligibility for a Direct PLUS. The information in your file may be disclosed to

third parties as authorized under routine uses in the Privacy Act notices called “Title IV Program Files” (originally published on April 12, 1994, Federal Register, Vol. 59 p.

17351) and “National Student Loan Data System” (originally published on December 20, 1994, Federal Register, Vol. 59 p. 65532). Thus, this information may be disclosed

to federal and state agencies, private parties such as relatives, present and former employers and creditors, and contractors of the Department of Education for purposes

of administration of the student financial assistance program, for enforcement purposes, for litigation where such disclosure is compatible with the purposes for which

the records were collected, for use by federal, state, local, or foreign agencies in connection with employment matters or the issuance of a license, grant, or other benefit,

for use in any employee grievance or discipline proceeding in which the Federal Government is a party, for use in connection with audits or other investigations, for

research purposes, for purposes of determining whether particular records are required to be disclosed under the Freedom of Information Act, and to a Member of

Congress in response to an inquiry from the congressional office made at your written request. Because we request your social security number (SSN), we must inform

you that we collect your SSN on a voluntary basis, but section 484(a)(4) of the HEA (20 U.S.C. 1091 (a)(4)) provides that, in order to receive any grant, loan, or work

assistance under Title IV of the HEA, a student must provide his or her SSN. Your SSN is used to verify your identity, and as an account number (identifier) throughout

the life of your loan(s) so that data may be recorded accurately.

My signature below authorizes NSU to send my information to the U.S. Department of Education and its agents to obtain a report of my credit record

and use that information to determine my Direct PLUS Loan eligibility. I understand that I will be notified in writing of the results of the credit check

with respect to my loan application.

________________________________________________________

___________________________________________

Parent Borrower’s Signature

Date

Return to: Northern State University * Financial Aid Office * 1200 S. Jay St. * Aberdeen, SD 57401

Phone: 1-800-678-5330 * Fax: 1-605-626-2587 * Email: finaid@northern.edu