Signature Date
Please return this form to: MSU Northern, Financial Aid Office, PO Box 7751 Havre,
MT 59501 Fax Number: 406-265-3519
MSU-Northern does not discriminate on the basis of race, color, national origin, age, sex, or disability.
LOAN REQUEST FORM
2019-2020
Name:_________________________________ SS/I.D.#:______________________
I am seeking a degree at: MSU Northern:
(Please mark only ONE) ___Havre ___Great Falls ___Other
I am Currently a: ___ Freshman ___ Sophomore ___ Junior ___ Senior ___ Graduate
____ I wish to increase my loan amount due to a change in grade level
I am requesting an additional: ___ Federal Direct Subsidized Stafford Loan
___ Federal Direct Unsubsidized Stafford Loan
Amount:___________
(amount will be split equally between budgeted semesters)
Please INITIAL the following statements to acknowledge that you have read
and understand the following statements:
____ I understand that I will not receive my loan proceeds in the form of a check or a State warrant
unless my financial aid funds exceed the amount I owe the school for educational expenses, including
bookstore charges
____ I understand that the Office of Financial Aid will credit my student account with loan proceeds for
the amount owed for educational charges, including bookstore charges, and that any credit balance will
be available through the Business Office.
____ I acknowledge that the Federal Direct Stafford loan funds I receive electronically through the
school are proceeds of a loan, which I must repay, to the Department of Education according to the
terms of the Promissory Note.
____ I understand that my loan processor will keep approximately 1% (for an origination fee) of my
total loan disbursement before it is sent to the school.
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