FINANCIAL AID OFFICE
Financial Aid Office * 96-045 Ala Ike Street * Pearl City, 96782
Phone: 808 455-0606 * Fax: 808 453-6371 * Website: www.leeward.hawaii.edu/finaid * MyUH Services: https://myuh.hawaii.edu
2019-2020 Federal Direct PLUS Loan Request Form
_____________________________________________ _____________________ _________________
Student’s Last Name First Name UH ID/Username Phone Number
Parent Borrower Information (to be completed by the parent applying for the PLUS Loan):
Parent’s Last Name First Name MI Parent’s Social Security Number
__________________ ____________________________________ _______________________________
Parent’s Date of Birth Parent’s Email Address Parent’s Phone Number
Parent’s Permanent Address City State Zip Code
Parent’s Mailing Address City State Zip Code
Parent’s Driver’s License Number Parent’s Legal State of Residence
Parent’s U.S. Citizenship Status: Citizen Eligible Non-Citizen: __________________________
Alien Registration Number
I am requesting for a loan amount of: $ _______________
In addition to the PLUS Loan Request Form, you must also complete the following:
1. 2019-2020 Free Application for Federal Student Aid (FAFSA) and submit all required documents requested by our
2. Direct PLUS Loan Request (application) and sign the PLUS Master Promissory Note (MPN) online at:
I certify/understand all of the following (parent must initial after reading each statement):
_____ THIS IS A LOAN THAT MUST BE REPAID.
_____ I am the parent of the student listed above
_____ I am not in default on any loan or have made satisfactory arrangements to repay any defaulted loan.
_____ The student (my child) must be enrolled at least half-time status (6 credits).
_____ A loan fee of approximately 4% of the loan will be automatically deducted from each loan disbursement.
_____ There will be two loan disbursements, one at the beginning and the second at the mid-point through the loan period.
_____ I authorize Leeward CC to process my PLUS loan for my child’s educational expenses and if there is any refund, please
release it to (please check ONE box only):
My child, the student listed above Me; the parent borrower, at the above mailing address
_____ All the information provided above are true and correct to the best of my knowledge.
Parent’s Signature: __________________________________________________ Date: __________________________
Student’s Signature: _________________________________________________ Date: __________________________
Electronic signatures or digital signatures will NOT be accepted.
University of Hawai'i institutions do not discriminate on the bases of age, race, sex, color, national origin, or disability in its programs and
activities. For more information or inquiries regarding these policies, please contact the individual campus Title IX Coordinator. UH Title IX
Coordinators' names and contact information are available at: https://www.hawaii.edu/titleix/help/coordinator/