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Federal Direct Parent Loan Program (PLUS) Certification Request Form 2011-2012

Student’s Information: Name:

___________________________________

VID #: ____________________

D a y t i m e P h o n e : ( _ _ _ _ _ ) _ _ _ _ - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Date of Birth:

____/____/_______

Parent’s Information: Name

:

SSN#:

____________________________________

______________________

Address:

____________________________________________________________________________________

Street

City

State

ZIP

State of Legal Residence:

________

Driver’s License #:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Issuing State:

________

Daytime Phone: (

_ - _ _ _ _ ) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

D a t e o f B i r t h : _ _ _ _ / _ _ _ _ / _ _ _ _ _ _ _

Parent’s Citizenship Status (check one):

___

US Citizen

___

Permanent Resident of the US

Alien # A____________

Loan Request Information:

Amount Requesting: $

Your loan will be certified for your maximum eligibility based on

federal guidelines up to the amount you request whichever is less. The loan is determined by taking the Cost of Attendance Estimated Financial Aid.

Fall Only

Fall & Spring

Fall, Spring

&Summer

Term Requesting Loan for (pick one):

  • Spring &Summer

  • Spring Only

  • Summer Only

I authorize the school to pay the credit balance to the student (Check One): If you answer YES any balance will be made payable to the student and mailed to the student’s address on record at Valencia Community College. If you answer NO any balance will be mailed to the parent’s address

on this form.

YES

NO

______

______

I understand I am borrowing a federal loan and it must be repaid. Furthermore, I understand the financial decision on approval of the PLUS loan is dependent upon a credit check performed by the U.S. Department of Education and their final decision cannot be controlled by Valencia.

If my loan funds are not disbursed within 90 days of the approval of my PLUS loan, I grant permission for a new credit check to be

performed.

_ _ _ _ _ _

YES

______

NO

I certify the information provided is true and correct to the best of my knowledge.

__________________________________________________ Signature of PARENT Borrower

_____________________________ Date

** Notification of Social Security Number Collection and Usage: Your social security number will be used for a credit check and for reporting to the National Student Loan Data Service.

Submit this form to: Valencia College, Office of Student Financial Assistance, 1800 S. Kirkman Road, Mail Code 4-17 ♦ Orlando, Florida 32811

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