Los Angeles Southwest College
Financial Aid Office
Los Angeles Southwest College - Financial Aid Office
Student Services Building Room 104
Phone (323) 241 5338 · Fax (323) 241 5463 · firstname.lastname@example.org
Loan Data Form
Social Security Number Student ID Number
Last Name First Name Birthdate (mm/dd/yyyy)
Address City State Zip Code
Cell Phone Alternative Phone Email Address
Only borrow what you need (we strongly encourage you to borrow less than the annual limit). You should consider your expenses and
your income (including financial aid) to determine this amount. You may wish to review the “Entrance Counseling Guide for Direct Loan
Borrowers” to get a better idea of how much you will have to repay.
How much do you need to borrow? (You must enter an amount) $
By checking the boxes I certify that I read and understand that
This is a loan and must be repaid with accrued interest.
This loan is to be used for educationally related expenses.
I must have a signed Master Promissory Note (MPN) to receive this loan, and collection of all debts acquired under this MPN is fully
enforceable in a court of law.
I must immediately notify the holder of my loan if my status changes and that failure on my part to adhere to the terms and
conditions of my loan may result in default and may affect my rights as a student loan borrower.
My loan(s) will be originated for the loan period that I may be eligible for and that the loan(s) may be prorated if my educational
goal at Los Angeles Southwest College will be completed in less than a full academic year.
I must be enrolled in at least six (6) approved units for my loan request to be certified. This means that if I had to appeal for an
extension for Financial Aid and if my petition has been approved, only the classes listed on my Student Educational Plan may be
counted in the approved units.
My loan will be cancelled if my enrollment is less than six (6) approved units at the time of my loan disbursement.
I have visited the National Student Loan Data System at www.nslds.ed.gov. I have attached a printout of my past loan activity and I
am aware of my student loan balance.
Borrower Request and Certification:
The information contained on this loan request is true and correct to the best of my knowledge. I understand that I am requesting a loan that MUST BE
REPAID. This includes principal, accrued interest and any fees. I’ve read and understand the documents and eligibility requirements for this loan. I
understand that Los Angeles Southwest College will not certify my loan if my documentation is incomplete or I fail to meet all of the eligibility requirements.
Please note: Any loan borrowed by the student or parent will be submitted to the National Student Loan Database System
(NSLDS) and will be accessible by guaranty agencies, lenders and schools determined to be authorized users of the data