The Private Education Loan Applicant Self-Certification is a critical document designed to comply with Section 155 of the Higher Education Act of 1965, as amended, and Section 128(e)(3) of the Truth in Lending Act. It mandates that lenders must obtain a signed self-certification from the applicant before dispersing a private education loan. This form plays a significant role in the application process for those seeking financial assistance for their education beyond federal, state, or institutional aid. It ensures that applicants are informed about the availability of free or lower-cost federal, state, or school student financial aid before taking a private loan and are made aware of how a private loan may affect their eligibility for other types of financial aid. Applicants are advised to first submit a Free Application for Federal Student Aid (FAFSA) to explore eligible federal grants, loans, and work-study programs. The form requires detailed information about the cost of attendance and estimated financial assistance, aiming to prevent borrowers from reducing their eligibility for more advantageous financial aid options. Furthermore, it serves as a declaration by the applicant, certifying the accuracy of the provided information and acknowledging the implications of obtaining a private education loan.
| Question | Answer |
|---|---|
| Form Name | Private Form |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | education loan form pdf, loan applicant self certification form, education loan form, loan certification template |
Private Education Loan Applicant
This space for lender use only
OMB No.
OMB Approved
Exp. Date 8/31/2022
________________________________________________________________________________________________
Important: Pursuant to Section 155 of the Higher Education Act of 1965, as amended, (HEA) and to satisfy the requirements of Section 128(e)(3) of the Truth in Lending Act, a lender must obtain a
Instructions: Before signing, carefully read the entire form, including the definitions and other information on the following page. Submit the signed form to your lender.
SECTION 1: NOTICES TO APPLICANT
Free or
education loan. To apply for Title IV federal grants, loans and
A private education loan may reduce eligibility for free or
You are strongly encouraged to pursue the availability of free or
financing options.
SECTION 2: COST OF ATTENDANCE AND ESTIMATED FINANCIAL ASSISTANCE
If information is not already entered below, obtain the needed information from the school’s financial aid office and enter it on the appropriate line. Sign and date where indicated. See Section 5 for definitions of financial aid terms.
A. |
Student’s cost of attendance for the period of enrollment covered by the loan |
$____________________ |
B. |
Estimated financial assistance for the period of enrollment covered by the loan |
$____________________ |
C. Difference between amounts A and B |
$____________________ |
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WARNING: If you borrow more than the amount on line C, you risk reducing your eligibility for |
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free or |
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SECTION 3: APPLICANT INFORMATION
Enter or correct the information below.
Full Name and Address of School ________________________________________________________________________________________________________
Applicant Name (last, first, MI) ___________________________________________________ |
Date of Birth (mm/dd/yyyy) _____/_____/__________ |
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Permanent Street Address __________________________________________________________________ |
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City, State, Zip Code __________________________________________________________________ ____________________ |
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Area Code / Telephone Number Home ( |
) ____________________________ |
Other ( |
) ____________________________ |
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Period of Enrollment Covered by the Loan (mm/dd/yyyy) |
From _____ / _____ / _______ to _____ / _____ / _______ |
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If the student is not the applicant, provide the student’s name and date of birth.
Student Name (last, first, MI) ____________________________________________________ Student Date of Birth (mm/dd/yyyy) _____/_____/__________
SECTION 4: APPLICANT SIGNATURE
I certify that I have read and understood the notices in Section 1 and, that to the best of my knowledge, the information provided on this form is true and correct. Signature of Applicant ____________________________________________________________________ Date (mm/dd/yyyy) _______________________
SECTION 5: DEFINITIONS
Cost of attendance is an estimate of tuition and fees, room and board, transportation, and other costs for the period of enrollment covered by the loan, as determined by the school. A student’s cost of attendance may be obtained from the school’s financial aid office.
Estimated financial assistance is all federal, state, institutional (school), private, and other sources of assistance used in determining eligibility for most Title IV student financial aid, including amounts of financial assistance used to replace the expected family contribution. The student’s estimated financial assistance is determined by the school and may be obtained from the school’s financial aid office.
A lender is a private education lender as defined in Section 140 of the Truth in Lending Act and any other person engaged in the business of securing, making, or extending private education loans on behalf of the lender.
A period of enrollment is the academic year, academic term (such as semester, trimester, or quarter), or the number of weeks of instructional time for which the applicant is requesting the loan.
A private education loan is a loan provided by a private education lender that is not a Title IV loan and that is issued expressly for postsecondary education expenses, regardless of whether the loan is provided through the school that the student attends or directly to the borrower from the private education lender. A private education loan does not include (1) An extension of credit under an
Title IV student financial aid includes the Federal Pell Grant Program, the Federal Supplemental Educational Opportunity Grant (FSEOG) Program, the Federal
Assistance for College and Higher Education (TEACH) Grant Program. To apply for Title IV federal grants, loans, and
SECTION 6: PAPERWORK REDUCTION NOTICE
Paperwork Reduction Notice: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a currently valid OMB control number. The valid OMB control number for this information collection is
If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, DC
If you have any comments or concerns regarding the status of your individual submission of this form, contact your lender.