Fillable ElectronicLNNOTE Distributed (Orange County Community College)

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ElectronicLNNOTE Distributed (Orange County Community College)

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*LNNOTE*
115 South Street Middletown, NY 10940 (845)341-4190 fax (845)341-4194
1 Washington Center Newburgh, NY 12550 (845) 562-245 fax (845)220-4062
www.sunyorange.edu
2015-2016
LOAN NOTES
Date:___/__/____
I, ____________________________ would like to:
(print name)
accept my 2015-2016 subsidized student loan for $
decline my 2015-2016 subsidized student loan for $
2015-2016 subsidized student loan was not offered
accept my 2015-2016 unsubsidized student loan for $
decline my 2015-2016 unsubsidized student loan for $
2015-2016 unsubsidized student loan was not offered
Electronic Certification Agreement. By providing your “electronic” student signature, student ID # and by selecting the “Accept" button, you
consent that all of the information reported is complete and correct.
Student: Accept ___ Student Signature:_____________________________________________Date:____/____/______
WARNING: If you purposely give false or misleading information on the worksheet, you may be fined, be sentenced to jail, or
both.
*1516*
Id# A
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ElectronicLNNOTE Distributed (Orange County Community College)

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Completed 20 July 2020

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