Parent Pre-Approval And Acceptance Form For Federal Direct Plus Loan Processing (Page 2 of 2) in pdf

2017-2018

Parent Pre-Approval and Acceptance Form for Federal Direct PLUS Loan Processing

ONLY ONE

parent applicant may be reported on this form. Print information legibly. Please note that

SKIPPED ITEMS WILL DELAY PROCESSING

PART A: Credit Check or Application Request

(Select ONE

Option)

NOTE: If both options below are checked or left unchecked, the Office of Financial Aid will assume the parent is applying for the PLUS Loan without an endorser/extenuating circumstance.



Credit Check Request Only -

Option 1

I do NOT wish to apply for the PLUS loan. If my credit is approved, take no further action. If my credit is

denied, allow the student to be considered for additional Federal Unsubsidized Stafford Loan.



Option 2

Apply for the PLUS Loan

– I am requesting the Office of Financial Aid use the data provided on this form to apply for the PLUS loan.



Endorser/Extenuating Circumstance

– If my credit is denied, I plan to pursue an endorser (creditworthy co-signer) or appeal the credit

decision with the Department of Education. PLUS Loan Counseling will be a requirement for the Parent at

PART B: Student Information

(Do NOT Leave

Blank)

U 0 0

1. Student Name:

2. Student UID:

4. Student Date of Birth

3. Student SSN:

(Month/Day/Year):

PART C: Parent Information

(For ONE Parent Applicant to Complete

ONLY)

5. Parent Name:

7. Parent Date of Birth (Month/Day/Year):

6. Parent SSN:

8. Parent Address:

9. City:

10. State:

11. Zip Code:

12. Parent Phone Number:

13. Parent Email Address:



14. Parent U.S. Citizenship Status (check one):

Citizen/National

Eligible Non-Citizen

Additional documentation required. See Below.

PART D: Loan Information

16. Enter Your Requested Dollar Amount: (The amount processed will not exceed the student’s cost of attendance minus

Do NOT Leave Blank

the student’s estimated financial aid.)

PLEASE NOTE:

Parent PLUS loan funds will be evenly split over the terms the student

.00

is enrolled at least half-time up to the cost of attendance. Students must enroll at least half-time to receive federal loans.

PART E: Parent Acceptance, Certification, and Authorizations

Signing of this document by anyone other than the parent whose information is provided above is a forgery punishable by law. By signing and checking Option 2, leaving options 1 and 2 blank,

or checking options 1 and 2 (see Part A), I certify my acceptance of a Federal Direct Parent PLUS Loan (PLUS Loan) in the amount requested above to assist with the student’s (see Part B)

educationally-related expenses at Wright State University (WSU). In regards to the student’s charges, I also authorize WSU to (1) pay for allowable miscellaneous charges/fines other than tuition, fees

and room and board; (2) pay outstanding charges from the prior award year; and (3) hold funds to pay for future charges if future charges are due, and I acknowledge I may change one or more of these

three authorizations by contacting Raider Connect at (937) 775-4000. I certify that all the information on this form is correct to the best of my knowledge. I authorize WSU to complete a mandatory

electronic credit check (pre-approval) with the U.S. Department of Education to ensure that I am a creditworthy applicant. I authorize WSU to initiate PLUS Loan processing in my name and to

share the above information with the U.S. Department of Education and its agents for the purpose of PLUS Loan borrowing. In the case of a credit denial, I understand that I will be notified in writing of the

credit denial to the address provided on this form. 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 information is voluntary. However, if you do not provide this information, you cannot be considered for a

Direct PLUS Loan. The information on this form will be used to determine your eligibility for a PLUS Loan. 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 the Title IV of the HEA, a student must provide his or her SSN. Your SSN is used to verify your identity, and

as account number an (identifier) throughout the life of your loan(s) so that data may be recorded accurately.

PLEASE SIGN WITH INK PEN

17. Parent Applicants Signature

18. Today’s Date:

(This message will not appear when printed)

*Parent applicant must also submit copies of the front and back of his/her Resident Alien Card I-551, I-94 Arrival-Departure Record, Alien Registration Receipt Card I-151, or other

acceptable documentation. Contact Raider Connect if you have questions.

FOR OFFICE USE ONLY

 LNPCNO

 LNPCOK

DEFAULTED

DISCHARGED

Decision Date:

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