Perkins Loan Application 2010-20

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					                                       Cuyahoga Community College                                                   PERK 11
                                       Student Financial Assistance Office
                                                                                                          Staff Initials_____
                                       FEDERAL PERKINS LOAN
                                       REQUEST FORM
  It is important that you understand your rights and responsibilities with regards to Federal Perkins loan(s). Your
  signature and initials on each statement below means that you understand and agree to honor your responsibilities
  under any Perkins loan provided to you.


          Student “My Tri-C” ID number:
                                           S
          Student LAST name (one letter or dash or space per box)             Student FIRST name                             MI



  Student Driver’s License: (STATE) _______ (NUMBER) ____________________


  Loan Period: (select all terms for which you wish to use loan funds)              Summer             Fall                 Spring
  Expected credits of enrollment for Summer 2010: ________                Fall 2010: ________        Spring 2011: ________

  Perkins Loan Amount Requested*
                                       $ ,                   .00          Current Major: __________________________

  * Your loan award will be processed based on eligibility, but may not exceed $3,000 annually or $1,500 per semester.


  INITIAL I UNDERSTAND THE FOLLOWING INFORMATION REGARDING MY PERKINS LOAN:
  HERE:
  _______1. The loan(s) may be used only for educational expenses and must be repaid.
  _______2. My Federal Perkins loan is NOT the same as any Federal Direct student loan (subsidized or unsubsidized) that I may
             receive.
  _______3. Acceptance of a Perkins loan(s) does not preclude me from receiving other forms of aid, such as grants, scholarships or
             work-study for which I am eligible. However, the total awarded from all sources may not exceed my cost of attendance.
             In the event that aid is received exceeding the cost of attendance, I understand that my Perkins loan may be reduced.
  _______4. Cuyahoga Community College holds the Promissory Note to my Federal Perkins loan(s); therefore, any debt is owed to
             Cuyahoga Community College, Student Accounting Office, 700 Carnegie Avenue, Cleveland, OH 44115.
  _______5. Payments should be made payable to Cuyahoga Community College and should include my Tri-C ID. Payments and
             communications should be sent to the billing agency, Educational Computer Systems, Inc. (ECSI). ECSI can be
             contacted via mail at 181 Montour Run Road, Coraopolis, PA 15108, via telephone at 888-549-3274 or via their website
             at www.ecsi.net.
  _______6. I am responsible for informing Cuyahoga Community College and ECSI of any changes in my name, address, or
              telephone number.
  _______7. My loan amount(s) and payment history, including any default, will be reported to national credit bureaus at least once
             annually.
  _______8. Depending on my loan amount(s), my minimum payment will be at least $40 per month if I am a new borrower with no
             outstanding balance as of 10/1/1992.
  _______9. I may prepay all of any part of my loan(s) at any time without penalty and reduce the total interest as result of my
              prepayments.
  ______10. My first payment is due one month after my nine (9) month grace period ends. My grace period begins when I withdraw,
             graduate, or cease to be enrolled at least half time as a student at Cuyahoga Community College.
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                                              Cuyahoga Community College                                                    PERK 11
                                              Student Financial Assistance Office
                                                                                                                 Staff Initials_____
  INITIAL           I UNDERSTAND THE FOLLOWING INFORMATION REGARDING MY PERKINS LOAN:
  HERE:
  ______11.        Federal Perkins loan(s) are eligible for consolidation. For further information on consolidation, contact ECSI at 888-
                   549-3274.
  _____12.         Under certain circumstances, military personnel may have their loans repaid by the Secretary of Defense. This is a
                   recruitment program and not applicable to prior military service. For further information, I can contact my local military
                   recruiter.
  _____13.         I may be assessed late fees if I fail to pay all or any part of an installment when due.
  _____14.         My loan(s) may be declared in default and the total balance immediately due if I fail to make any loan payments as
                   agreed or if I fail to submit proper deferment or cancellation forms on time.
  _____15. The college may take the following actions against me if I am delinquent or in default on my loan(s):
                   1.   Place a hold on my student account restricting registration, transcripts, diplomas, and financial aid.
                   2.   Initiate legal proceedings against me to collect on my loan(s).
                   3.   Assign my loan(s) to the Ohio Attorney General’s Office and/or a commercial collection agency or to the U.S.
                        Department of Education.
                   4.   Assess all reasonable costs to me for the collection of my loan(s) including collection/litigation costs
                   5.   Report my delinquent loan status and other relevant information to national credit bureaus


  PLEASE PROVIDE THE FOLLOWING REQUIRED REFERENCES:
  Parents, Guardian, Spouse or Next of Kin:

  Full Name:                                                                    Full Name:

  Relationship:                                                                 Relationship:

  Address:                                                                      Address:



  Telephone:                                                                    Telephone:


  Two additional people who have known you for at least three years. They must reside at different U.S. addresses.
  Full Name:                                                                    Full Name:

  Relationship:                                                                 Relationship:

  Address:                                                                      Address:



  Telephone:                                                                    Telephone:



               Student Signature:             _______________________________________                         Date:   __________

                                  Please complete and return to the Student Financial Assistance Office
                               EASTERN CAMPUS               METROPOLITAN CAMPUS                 WESTERN CAMPUS
                               Student Services 1600        Student Services 209                Student Services 224
                               4250 Richmond Road           2900 Community College Ave.         11000 Pleasant Valley Rd.
                               Highland Hills, OH 44122     Cleveland, OH 44115                 Parma, OH 44130




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