Fillable Ineligible Plus Borrower Form (California State University Channel Islands)

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Ineligible Plus Borrower Form (California State University Channel Islands)

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FA-15 / 18-19 Page 1 of 1
2018-2019 Ineligible Borrower Form
Parent Loan for Undergraduate Student (PLUS)
PLEASE RETURN THIS FORM TO THE CSU CHANNEL ISLANDS FINANCIAL AID & SCHOLARSHIPS OFFICE
One University Drive, Camarillo, California 93012-8599 financial.aid@csuci.edu www.csuci.edu/financialaid Tel: (805) 437-8530
Student Last Name
Student First Name
MI
CSUCI ID Number
Student Phone Number
If your parent is unable to complete a Parent PLUS Loan Application due to one of the reasons listed below, you may be eligible to borrow an
additional Federal Unsubsidized Direct Loan. In order for you to receive the additional loan, you must complete this form with your parent and submit
the requested documentation confirming your parent(s) ineligible status. If two parents are listed on your 2018-2019 Free Application for Federal
Student Aid (FAFSA), you must submit a form for each parent. This form is not to be used if your parent(s) credit was denied. If you have
questions, please contact the Financial Aid & Scholarships office.
Parent Borrower Information
Parent Last Name
Parent First Name
MI
Parent Street Address
City
State
Zip
Relationship to Student
Parent Telephone Number
Parent Email Address
Reason for Ineligibility
Check the statement below that applies to the parent(s) situation:
Citizenship Status (no documentation required):
Parent is not a U.S. citizen, permanent resident or able to provide evidence from the U.S. Citizenship and Immigration Service that they are
in the United States for other than a temporary purpose with the intention of becoming a citizen or permanent resident.
Federal Default Status (no documentation required, status will be verified on NSLDS):
Parent is in default on a federal education loan.
Federal Overpayment (no documentation required, status will be verified on NSLDS):
Parent owes an overpayment of a federal education grant that they received in error.
Bankruptcy:
A condition of the parent’s bankruptcy judgement prohibits them from accumulating further debt.
o Provide a copy of your court documents verifying this.
Incarceration:
Parent is incarcerated.
o Please attach documentation verifying your parent(s) incarceration. (Parent Signature Not Required)
Income limited to Public Assistance or Disability Benefits:
Parent income is limited to public assistance or disability benefits.
o Provide copy of agency determination for 2016 (e.g. CalWorks, SSDI, HUD, etc.)
The student and parent must sign and date below. Each person signing this worksheet certifies that all of the information reported on this form is
true and accurate to the best of their knowledge.
F19IPL
WARNING:
If you purposely give false or
misleading information on this
form, you may be fined, sentenced
to jail or both.
Student Signature (electronic signatures not accepted)
Date
Parent Signature (electronic signatures not accepted)
Date
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Ineligible Plus Borrower Form (California State University Channel Islands)

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Completed 22 July 2020

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