PERKINS LOAN INFORMATION SHEET
The information on this form will not be used to determine your financial eligibility for this loan. This form must be
completed in its entirety and returned to the Perkins Loan Collection Office. (PLEASE PRINT)
Student’s Name _________________________________ LSU ID __________________________________
Birth Date______________________________________ Driver’s License Nbr/State ___________________
Email Address #1 _______________________________ Email Address #2 __________________________
PERMANENT ADDRESS LOCAL ADDRESS
Street______________________________________ Street____________________________________
City/State___________________________________ City/State_________________________________
Zip Code ___________________________________ Zip Code _________________________________
Phone #____________________________________ Phone # _________________________________
EMPLOYER: _______________________________________________________________________________
(Company Name and Street Address)
Father’s Name ______________________________ Mother’s Name ____________________________
Street _____________________________________ Street____________________________________
City/State __________________________________ City/State_________________________________
Zip Code___________________________________ Zip Code _________________________________
Phone # ___________________________________ Phone #__________________________________
Grandparent’s Name__________________________ Your Spouse’s Name________________________
Street _____________________________________ Spouse Employment ________________________
City/State __________________________________ Spouse’s Parent’s Name_____________________
Zip Code___________________________________ Street____________________________________
Phone # ___________________________________ City/State_________________________________
Zip Code___________ Phone # _______________
SIBLINGS OVER 18 NOT LIVING AT HOME
Name _____________________________________ Name ___________________________________
Street _____________________________________ Street____________________________________
City/State __________________________________ City/State_________________________________
Zip Code___________________________________ Zip Code _________________________________
Phone # ___________________________________ Phone #__________________________________
PERSONAL REFERENCES: (Neighbor, Relative, Pastor)
Name _____________________________________ Address: _________________________________
Name _____________________________________ Address: _
________________________________
THE ABOVE INFORMATION IS CORRECT AND COMPLETE, AND I HEREBY AUTHORIZE VERIFICATION AS
REQUIRED BY LSU.
______________________________________ _______________________________________
Signature Date
