2910 BEDFORD AVE. BROOKLYN, NEW YORK 11210. TELEPHONE (718) 951-4785.

FAX (718) 951-4778 REQUEST FOR WILLIAM D. FORD FEDERAL DIRECT LOAN PROGRAM

BORROWER / STUDENT DATA: (Please print clearly) *Incomplete Applications will be returned Name: _________________________________________________________________ Social Security # _______-______-______ Last First MI

____________________________________________________________________________________________________________ Permanent Address Apt# City State Zip Contact Information : Daytime Tel. # ( ) ___________________________ Date of Birth: Email address_________________________________ ______/________/________ MM DD YY

Indicate only the number of credits you expect to take for each semester to be covered by this loan application: You are strongly urged to apply for the full academic year. If you register for less than the credits indicated below your loan could be subject to a reduction in award. All students must be matriculated and registered for a minimum of six credits within their division. Requested loan amounts are divided into equal, but separate disbursements according to the indicated loan periods. Summer 12: Summer session one: _________credits Summer session two: _________credits Students year in college for 2012-2013 academic year: ( ) Freshmen
(027 credits)

Fall 12:

_________ credits

Spring 13: _________ credits ( ) Sophomore (

(2860 credit)

) Junior/Senior
(61 and more)

) Grad

Please indicate your expected graduation date (required) _______/________

MM YY

Loan Type: ( X ) Subsidized* ( ) If not qualified for subsidized, I will accept my loan in Unsubsidized Requested Loan Amount $_____________________________ *Undergraduate students will automatically be considered for subsidized loans *Graduate students do not qualify for subsidized loans Did you transfer to Brooklyn College within this 2012-2013 academic year? ( )Yes ( )No If yes, did you have any student loans at the previous school? ( )Yes ( )No

APPLICATION CERTIFICATION: Your signature below certifies that you understand that this request is not a PROMISSORY NOTE. You must sign an electronic Master Promissory Note online at http://studentloans.gov using your federal PIN #. Please note that your eligibility for the William D. Ford Federal Direct loan will be determined by the Office of Financial Aid based on Federal eligibility and need requirement.

Student Signature ___________________________________________ Date _____________________

Rights and Responsibilities Summary Checklist Entrance Counseling

I understand that I have a right to the following (check all boxes as you read): Written information on my loan obligations and information on my rights and responsibilities as a borrower A grace period and an explanation of what this means A disclosure statement, received before I begin to repay my loan, that includes information about interest rates, fees, the balance I owe, and the number of payments Deferment of repayment or forbearance for certain defined periods, if I qualify and if I request deferment or forbearance Prepayment of my loan in whole or in part anytime without an early-repayment penalty A copy of my MPN either before or at the time my loan is disbursed Documentation that my loan is paid in full I understand I am responsible for: Completing exit counseling before I leave school or drop below half-time enrollment Repaying my loan even if I do not complete my academic program, I am dissatisfied with the education I received, or I am unable to find employment after I graduate Notifying my school and the Direct Loan Service Center if I: Move or change my address; Change my name; Withdraw from school or drop below half-time enrollment; Transfer to another school; Fail to enroll or re-enroll in school for the period for which the loan was intended; Change my expected graduation date; or Graduate. Making monthly payments on my loan after my grace periods ends, unless I have a deferment or forbearance and repayment options will be provided during exit counseling. Notifying the Direct Loan Service Center of anything that might alter my eligibility for an existing deferment or forbearance. I have received entrance counseling materials for Direct Subsidized Loan and Direct Unsubsidized Loan borrowers. I have read and I understand my rights and responsibilities as a borrower. I understand that I have a loan from the federal government that must be repaid. __________________________________ Students Name (Please Print) __________________________________ Students Signature ______-_____-_______ Students Social Security # ____________________ Date