CAREER TRAINING LOAN APPLICATION WORKSHEET SallieMae Date
Section A: Borrower Information
Last Name First MI
Street City
State Zip
Years: Months: Home: Cell:
Length of time at present Address: Phone Number:
Prior Address (only if at present adress less than 1 year)
Email Address:
Social Security No. Date of Birth
U.S Citizen Non Citizen PermanentResident Driver's State Number
Citizenship License
Yes No
Have you ever defaulted on an Education Loan? Borrower Relationship to Student
Borrower Employment and Household Information
Present Employer Name: Occupation
Street Time at Present Employer: ____Years ______Months
City Work Phone
State Zip
Borrower's Primary Gross Income $ per
Additional Income $ per Source
Total Household Income $ per
Do you have one or more account(s) listed below? Yes No Monthly Mortgage or Rent Amount $
Checking $ Savings,CD's,Money Market,Retirement or Investments $
Live w/parents Own Rent Other
Residence Type If own, approximate home value $
Borrower's References
Last Name First Name MI
Reference #1 Relationship to Borrower
Address City State Zip Phone
Last Name First Name MI
Reference #2 Relationship to Borrower
Address City State Zip Phone
Section B: Student and Enrollment Information for Mt Nittany Institute of Natural Health
Last Name First MI
MTTP HHPT YTTP MBFT Enrollment Beginning Date Ending Date
Program Period
Loan Tuition AdditionalExp$ Total Repayment Years
Requested $ $ Term
Repayment Interest Only Payments $10 Deferred Payments Date of 1st mm/dd/yyyy
Yes / No Months______ OR Yes / No # of Months______
Options Disbursement
GPA_____ on Scale of_________ Outstanding Student Loans: Federal $ Private $
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Borrower Signature Date
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Section C: Co-Signer Information
Last Name First MI
Street City
State Zip
Length of time at present Address: Years: Months: Phone Number: Home: Cell:
Prior Address (only if at present adress less than 1 year)
Email Address:
Social Security No. Date of Birth
U.S Citizen Non Citizen PermanentResident Driver State Number
Citizenship License
Have you ever defaulted on an Education Loan? Yes No Co-Signer Relationship to Borrower
Co-Signer's Employment and Household Information
Present Employer Name: Occupation
Address: Street Time at Present Employer: ____Years ______Months
City Work Phone
State Zip
Co-Signer Primary Gross Income $ per
Additional Income $ per Source
Total Household Income $ per
Do you have one or more account(s) listed below? Yes No
Checking $ Savings,CD's,Money Market,Retirement or Investments $
Live w/parents Own Rent Other
Residence Type If own, approximate home value $
Monthly Mortgage or Rent Amount $ Outstanding Student Loans: Federal $ Private $
Co-Signer's References
Last Name First Name MI
Reference #1 Relationship to Co-Signer
Address City State Zip Phone
Last Name First Name MI
Reference #2 Relationship to Co-Signer
Address City State Zip Phone
This application will be submitted to Sallie Mae for approval. I/we authorize Sallie Mae to use credit information previously obtained in
connection with this application and to make such credit inquiries in connection with this application as it deems reasonable. I/we authorize
and instruct any person or consumer reporting agency to furnish to Sallie Mae any information that it may have or obtain in response to such credit
inquiries and agree that such information, along with this application, shall remain Sallie Mae's property whether or not a loan is approved. All
information set forth in this application is declared to be a true representation as to the facts, made for the purposes of obtaining the loan requested,
and any willful misrepresentation in this application may result in criminal action. As a condition to obtaining this loan, I/we authorize and consent to
the lender, any other lender for loans that may be offered to me in the future, any subsequent holder of the loans, any school, or any of their agents
to share and release information pertinent to this application or loan. In addition, Sallie Mae and its affiliates may share credit and other information
about me/us with each other for marketing and administrative purposes to the extent permitted by applicable law.
(See Sallie Mae privacy policy for your rights to limit the sharing of this information.)
Cosigner Signature Date
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