Financial Aid Office SUNY Plattsburgh 101 Broad Street Plattsburgh, NY 12901-2681
Tel: (518) 564-2072 Toll-Free: (877) 768-5976 Fax: (518) 564-4079 email:
Revised: 12/01/2019 PLUSCC
Student Name: ___________________________ Banner ID or NetID: ____________________________
This form authorizes SUNY Plattsburgh to check the credit of a parent in terms of their eligibility for a Federal
Parent Plus Loan.
Are you the custodial parent?
Parent Social Security Number
Parent Borrower Last Name
Parent Borrower First Name
Parent Borrower Address
Zip Code
Parent Borrower Date of Birth (mm/dd/yyyy)
Home Telephone #
By signing below, I consent to the U.S. Department of Education and its agents obtaining a report of my credit record and
using the information from that report in determining whether to issue a Direct PLUS Loan to me. I understand that I will
be notified in writing of the results of the credit check with respect to my loan application.
Parent Ink Signature Date
If the PLUS Loan is denied due to credit, the student is eligible to borrow an additional unsubsidized federal student loan.
Freshmen and sophomores may request up to $4,000 more for the year, and juniors and seniors may request up to
$5,000 more for the year. How much additional unsubsidized loan is the student requesting?
Student Ink Signature Date
Privacy Act Disclosure Notice
The Privacy Act of 1974 (5 U.S. C. 552a) requires that the following notice be provided to you. The authority for collecting the information requested on
this form is §451 et seq. of the Higher Education Act of 1965, as amended. Your disclosure of this information is voluntary. However, if you do not
provide this information, you cannot be considered for the PLUS Loan. The information on this form will be used to determine your eligibility for a Direct
PLUS Loan. The information in your file may be disclosed to third parties as authorized under routine uses in the Privacy Act notices called “Title IV
Program Files” (originally published on April 12, 1994, Federal Register, Vol 59 p. 17351) and “National Student Loan Data System” (originally published
on December 20, 1994, Federal Register, Vol. 59 p. 65532). Thus, this information may be disclosed to federal and state agencies, private parties such
as relative, present and former employers or creditors, and contractors of the Department of Education for purposes of administration for the student
financial assistance program, for enforcement purposes, for litigation where such disclosure is compatible with the purposes for which the records were
collected, for use by federal, state, local or foreign agencies in connection with employment matters or the issuance of a license, grant, or other benefit,
for use in any employees grievance or discipline proceeding in which the Federal Government is a party, for use in connection with audits or other
investigations, for research purposes, for purposes of determining whether particular records are required to be disclosed under the Freedom of
Information Act, and to a Member of Congress in response to any inquiry from the congressional office made at your written request. Because we
request your social security number (SSN), we must inform you that we collect your SSN on a voluntary basis, but section 484(a)(4) of the HEA (20 U.S.
C. 1091(a)(4)) provides that, in order to receive any grant, loan, or work assistance under Title IV of the HEA, a student must provide his or her SSN.
Your SSN is used to verify your identity, and as an account number (identifier) throughout the life of your loan(s) so that data may be recorded