Fillable CampusCache Textbook Request Promissory Note (Mat-Su College)

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CampusCache Textbook Request Promissory Note (Mat-Su College)

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The CampusCache Textbook Request Promissory Note (Mat-Su College) form is 1 page long and contains:

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File type: PDF

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__________________________________________
CampusCache
8295ECollegeDr•PalmerAK99645
Textbook Request Promissory Note
SEMESTER: Spring Summer Fall 20___
Student ID# _______________________________
Name: ____________________________________
Last First MI
Mailing Address: ___________________________
Phone Number: ____________________________
Amount requested
(including shipping est): ____________
Date of Birth: ______________________________
Driver’s License #: __________________________
SSN: _____________________________________
Email: ____________________________________
Employment Information
Most Recent Employer: ______________________ Position: __________________________________
Address: __________________________________ Phone: ___________________________________
Please provide three references.
Reference Name: ___________________________
R
eference Name: ___________________________
Current Phone: _____________________________
Current Phone: _____________________________
Relationship
:_______________________________
R
elationship:_______________________________
Reference Name: ___________________________
Current Phone: _____________________________
Relationship:_______________________________
How will you pay for tuition and fees if Financial Aid is not received?
_________________________________________________________________________________________
ATTENTION:
I a
uthorize UAA/MSC to make whatever inquiries it deems necessary in c
onnection with the review of information concerning my
ability to repay. If I violate this agreement with UAA/MSC, I understand that a hold may be placed on my account and that late fees
may be added to my balance due. I understand that if my account still has a balance due 90 days after the end of the semester, I will be
sent to a collection agency with collection fees added to my total debt. If my debt is over 180 days delinquent, and regardless of
payment plan status, the University may garnish my Permanent Fund Dividend under Alaska Statutes 14.40.251 and 43.23.190.
Student Signature: _____________________________________ Date: _________________________
OfficeUseOnly
SFI2HRS:Admitted: Y /NODS/PDS FinAidEligibleCredits: _____ Tuition/FeesTotal:________
SubLoan: ________ SEOG:$ ________ Scholarship:$________
UnSubLoan: ________ PellGrant:$________ UAGrant: $________ Other:$________
Notes:
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CampusCache Textbook Request Promissory Note (Mat-Su College)

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Completed 30 January 2021

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