Fillable Private Loan, Education Plan (University of California, San Diego)

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Private Loan, Education Plan (University of California, San Diego)

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Student Information
extension.ucsd.edu
Private Loan, Education Plan
PLEASE TYPE OR PRINT CLEARLY
Please complete and return this form to the Financial Assistance Coordinator to complete the loan certifica-
tion process. We cannot certify your loan without this completed form.
Students can request the cost of the program and a maximum of $2,000.00 for a computer. Full-time stu-
dents please contact the Financial Assistance Coordinator for an estimate at unex-finasst@ucsd.edu.
For Oice Use Only
Received by
Date
Questions? Contact Student Services
Phone (858) 534-3400, Option 2
Email unex-finasst@ucsd.edu
Submit your completed form by:
Mail UC San Diego Extension
ATTN: FA Coordinator
9500 Gilman Drive, Dept. 0176-H
La Jolla, CA 92093-0176
Email unex-finasst@ucsd.edu
Fax (858) 534-8527
STUDENT I.D. NUMBER IF KNOWN
LAST NAME FIRST NAME M.I.
NAME OF LENDER LOAN AMOUNT REQUESTED
Education Plan
Provide information about the program you are applying to.
PLEASE SELECT ONE: ¨ Full-time program (3 months) ¨ Part-time program (6 months)
PROGRAM NAME
START DATE MM/DD/YY END DATE MM/DD/YY
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Private Loan, Education Plan (University of California, San Diego)

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Completed 10 August 2021

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