NURSE FACULTY LOAN PROGRAM (NFLP)
(to be completed by the borrower)
This form must be completed in its entirety and returned to the Financial Aid Office, IWU-National & Global, before an NFLP loan offer is made.
WARNING: Any person who knowingly makes a false statement or misrepresentation in a NFLP transaction, bribes or attempts to bribe a Federal official,
fraudulently obtains a NFLP loan or commits any other illegal action in connection with a Federal NFLP loan is subject to a fine or imprisonment under Federal
statute.
SECTION I
1a. APPLICANT NAME
(Last) (First) (M.I.)
2. SOCIAL SECRUITY NUMBER (SSN)
1b. OTHER NAMES USED
(Last) (First) (M.I.)
3. DATE OF BIRTH (Month/Day/Year)
4. CURRENT ADDRESS (Number, Street, Apartment Number, City, State, Zip Code)
5. DAYTIME PHONE (Area Code/Number)
( )
6. EMAIL ADDRESS
7. EMPLOYER REIMBURSEMENT (If $0 put $0)
AMOUNT $__________________ per ________________
8. DRIVER’S LICENSE NUMBER AND STATE
9. ELIGIBILITY
Indiana Wesleyan University requires that all students apply for
the NFLP loan must complete the Free Application for Federal
Student Aid (FAFSA).
I have completed the 2017-2018 FAFSA and the information
has been submitted to IWU.
Yes I will complete it before the NFLP deadline
10. EDUCATION LEVEL:
MASTER’S DOCTORAL
DEGREE PROGRAM: _________________________________________________
EXPECTED GRADUATION DATE: ________________________________________
11. LOAN AMOUNT REQUESTED
$____________________________
If you wish to receive your full eligibility write MAX. The requested amount is not
guaranteed.
12. PERSONAL REFERENCES -- Friend(s) and Relative(s)
1) NAME:_________________________________________________ ADDRESS:____________________________________________________
____________________________________________________
2) NAME:_________________________________________________ ADDRESS:____________________________________________________
____________________________________________________
SECTION II
13. ACKNOWLEDGEMENT
I, the above named applicant, have been informed that I must agree to the service obligation associated with the Nurse Faculty Loan Program in order to be
eligible to receive a loan under this program.
THE ABOVE INFORMATION IS CORRECT AND COMPLETE, AND I HEREBY AUTHORIZE VERIFICATION AS REQUIRED BY THE SCHOOL.
Printed Name _____________________________________________________________
Signature_________________________________________________________________ Date _____________________________
Submit your completed application to:
Indiana Wesleyan University • Financial Aid Office, IWU-National & Global
1900 West 50
th
Street • Marion, IN 46953
Email: IWUfinaid@indwes.edu • Fax: (765) 677-2030
