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CLAREMONT McKENNA COLLEGE Person

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					                                 CLAREMONT McKENNA COLLEGE
                      Personal Information Form for College and Perkins Loans
(Please Print)


Last Name, First Name, MI: __________________________________________________________________________
ID Number: _______________________________ Date of Birth: __________________________________________
Permanent Home Address: __________________________________________________________________________
                           __________________________________________________________________________
Home Phone #: __________________________ Driver’s License # & State: __________________________________
Class (Fr. – So. – Jr. – Sr.): __________________ Exp. Grad. Date: __________________________________________
If Married, Spouse Name: _________________ If Married, Maiden Name: __________________________________
U.S. Citizen? _________ If not, Permanent Resident? _________ Perm. Res. Visa #: __________________________


If Father/Mother’s home address/home phone # is the same as student, write, “Same as Student,” on the
appropriate line. If not, complete the home address/home phone # section with the correct information. If
parents’ work address/phone # is same as home, write, “Same as Home,” on the appropriate line.

Father’s Name: ____________________________________________        Home Phone #: ________________________
Home Address: ____________________________________________________________________________________
Work Address/Phone #: ____________________________________________________________________________
Mother’s Name: Home Phone #: _____________________________________________________________________
Home Address: ____________________________________________________________________________________
Work Address/Phone #: ____________________________________________________________________________


All information in the following section must be completed in order for your loan(s) to be processed. You must
provide three different and complete addresses of people not living with you. Sending in an incomplete form will
only delay the disbursement of your loan(s).

Name of Other Relative: ____________________________________ Home Phone #: __________________________
Home Address: ____________________________________________________________________________________
Name of Personal Reference: ________________________________ Home Phone #: __________________________
Home Address: ____________________________________________________________________________________
Name of Personal Reference: ________________________________ Home Phone #: __________________________
Home Address: ____________________________________________________________________________________



Student Signature: _____________________________________________ Date: ______________________


PLEASE COMPLETE CO-SIGNER INFO BELOW IF YOU ARE APPLYING FOR A COLLEGE LOAN
Name of Co-Signer: __________________________________________________________________________
Social Security Number: __________________________ Driver’s License # & State: ____________________

				
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posted:3/12/2011
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