Created October 2018
Edison State Community College
2020-2021 Alternative Loan Certification Request
Name: __________________________________________________________ SSN: _______________________________
(Last, First, Middle)
Student ID: ___________________________
You may qualify for federal or state aid in place of or in addition to a private loan. It is recommended you speak with a Financial Aid
counselor to discuss your options as receiving a private loan may affect your eligibility for free or low-cost federal, state, or
institutional aid.
1. Obtain pre-approval from alternative education lender.
2. Name of lender that pre-approved your alternative education loan: ____________________________________
3. Do you live at home with your parents? Yes No
4. Do you have children for which you provide more than 50% of their support? Yes No
5. Please list the number of children under the age of 12 for whom you will be paying childcare costs during the
terms for which you wish to borrow:
6. Amount you wish to borrow: $ _________________________________
7. Anticipated Graduation Date:
May August December of Year: _________________
8. Did you complete a self-certification form? Yes No
*Contact your lender for details.
9. I plan to be enrolled in: (select one option for ALL of the terms for which you wish to borrow)
Summer 2020 Fall 2020 Spring 2021
6-11 credit hours 6-11 credit hours 6-11 credit hours
12 or more credits hours 12 or more credit hours 12 or more credits hours
Borrower Signature: ______________________________________________________ Date: ____________________
FOR OFFICE USE ONLY:
Degree Seeking: Grade Level: FR SOPH
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