WILKES UNIVERSITY
REQUEST FOR EMERGENCY LOAN
I, __________________________________, WIN # _____________________
(Please Type or Print)
Am requesting a short-term emergency loan for the Goldman-Robert Hall Loan
fund, in the amount of $___________________________ for the purpose of:
________________________________________________________________
________________________________
Signature of Student
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Home Address
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City, State and Zip Code
ACKNOWLEDGEMENT AND TERMS OF LOAN
I, ___________________________, acknowledge the receipt of $____________
as proceeds for the Goldman-Robert Hall emergency loan as indicated above. I
understand that this loan bears no interest, but is to repaid as quickly as
possible. I also authorize the use of may FEDERAL TITLE IV Financial Aid funds
to pay this loan, if appropriate.
______________________________
Signature of Student
Rev. 1.0.120106