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Alternative Student Loan Undergraduate Loan

Provided by Act Education Loans
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A Ser vice of the Student Loan Network

Please print and complete the application in blue or black ink and return by mail to:

T Student Loan Net

The Network
15 Cottage Avenue, Suite 501
Quincy, MA 02169

If you need help, please call us toll-free at:

(866) 229-8900

Why Act now?

The Act Education Loan is the smart choice for your private student loan needs.
• Competitive interest rates
• Preliminary approval in minutes
• Fast, convenient application processing so you can have your money in as few as 5 days
• Cover the cost of going to school, not just the tuition

Your loan can be used for tuition, books and supplies, computers, living expenses, and can even apply to
previous school balances!

With the Act Education Loan, there are no application or out-of-pocket fees and no obligations.

How to Act now

• Use a blue or black ink pen.
• Complete all applicable fields.
• If you make a mistake, do not use white-out, simply draw a line through the error and write the
correct information next to it.
• When possible, use a permanent mailing address instead of a PO Box.
• Be sure to sign and date your application!

The Education Resources Institute, Inc. (“TERI”) is the guarantor of the Act Education Loan.

apply online at www.Alter nativeStudentLoan.com

 Alter native Student Loan Application

Student Information Alimony, child support, or separate maintenance incomes do not have to be revealed
if you do not wish to have them considered as a basis for repaying this obligation.
Student’s Full Name (First/Last)
Social Security # Date of Birth / / Gross Income $ Monthly Annual
Mo. Day Year
Permanent (Home) Address
Other Income $ Source:
City State Zip
Do you Own Rent Other (if other, please explain):
Home Phone ( ) Years There
E-Mail Address
Rent/Mortgage $ (including home equity)
Would you like your Promissory Note made available online? Yes No
Please select password for online access Reference (Nearest friend or relative not living with you, must be different
Mailing Address (if different from Permanent Address) from reference listed in student applicant section)
Name

City State Zip Address

City State Zip
Have you ever defaulted on a student loan or declared bankruptcy?
(if yes, please explain on separate page) Yes No Home Phone ( )

Are you a United States citizen or permanent resident? Yes No

Have you ever borrowed through TERI before? Yes No
Student’s Employer (only if working full-time while in school)
School Name
Employer Years There
City State Zip
Business Phone ( ) Are you self-employed? Yes No
Occupation/Position School Code

Years with previous employer (if current less than 2 years) Loan is for: Current/Upcoming Year Previous Year
Grade Level (year): 1st 2nd 3rd 4th 5th
Alimony, child support, or separate maintenance incomes do not have to be revealed
if you do not wish to have them considered as a basis for repaying this obligation. Academic Period: From: / / To: / /
Mo. Day Year Mo. Day Year
Gross Income $ Monthly Annual
Expected Graduation Date:
Other Income $ Source:

Do you Own Rent Other (if other, please explain):

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Return this application to:
Rent/Mortgage $ (including home equity)
Reference (Nearest friend or relative not living with you, must be different The Student Loan Network
from reference listed in co-signer section) 15 Cottage Avenue, #501
Name
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Address
Phone: 866-229-8900
City State Zip
Fax: 617-328-0615
Home Phone ( )
Co-signer Information
Co-signer’s Full Name (First/Last) All Applicants Sign Below
Social Security # Date of Birth / / Disclosure Statement: To the best of my knowledge, everything disclosed on this form is true and complete. I
Mo. Day Year authorize the Lender, its agent, TERI, and/or my school to gather credit information about me. A consumer
Current Address report (credit report) may be obtained from a consumer-reporting agency (credit bureau) in connection with this
Application. If I request (1) I will be informed whether or not consumer reports were obtained, and (2) if reports
City State Zip were obtained, I will be informed of the names and addresses of the credit bureaus that furnished the reports. If
the Application is approved, a consumer credit report may be requested or used in connection with renewals or
Home Phone ( ) Years There extensions of any credit for which I have applied, reviewing my loan, taking collection action on my loan, or
legitimate purposes associated with my loan. I further authorize my school to receive, provide, and confirm
E-Mail Address information regarding my attendance, financial aid, or status as may be relevant to consideration of this
application. I understand that the proceeds of this loan must be used for educational purposes. This application
Previous Address
and supporting documentation remain the property of the Lender. I further understand that if this application is
City State Zip approved, it will be subject to the terms and conditions of the credit agreement.
Important information about procedures for opening a new account: To help the government fight the funding of
Have you ever defaulted on a student loan or declared bankruptcy? terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and
(if yes, please explain on separate page) Yes No record information that identifies each person who opens an account.
What this means for you: When you open an account, we will ask for your name, address, date of birth, and
Are you a United States citizen or permanent resident? Yes No other information that will allow us to identify you. We may also ask to see your driver's license or other
identifying documents.
Employer Years There
Student’s Signature Date
Business Phone ( ) Are you self-employed? Yes No

Occupation/Position By signing this application below, you certify that you intend to (i) apply for joint credit and (ii) be jointly
liable with the Student for this loan.
Years with previous employer (if current less than 2 years)
Co-signer’s Signature Date

a p p l y o n l i n e a tUndergraduate
www.Alter na Loan 2005
tiveStudentLoan.com