Fillable Reference Page DIRECTIONS: Please type or print legibly. (Jacksonville State University)

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Reference Page DIRECTIONS: Please type or print legibly. (Jacksonville State University)

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Reference Page
Student Name _________________________ Student # ______________________ Loan Type ______
DIRECTIONS: Please type or print legibly. If listing “P.O. Box” for any reference, please also
list the street address. We MUST have references listed with COMPLETE addresses and phone
numbers.
Please update the address and telephone number of the co-signer(s) of your loan(s)
(if additional space is needed please use back side of form)
___________________________________________ ___________________________________________
Name Name
___________________________________________ ____________________________________________
Street Address Street Address
___________________________________________ ____________________________________________
City, State, Zip Code City, State, Zip Code
__________________________________________ ___________________________________________
Area Code/Telephone Number Area Code/Telephone Number
Borrower’s Parents
Father Mother ( if different)
___________________________________________ ___________________________________________
Name Name
___________________________________________ ____________________________________________
Street Address Street Address
___________________________________________ ____________________________________________
City, State, Zip Code City, State, Zip Code
__________________________________________ ___________________________________________
Area Code/Telephone Number Area Code/Telephone Number
List two relatives with a U.S. address, different from yours, who will know your whereabouts for at
least three years
___________________________________________ ___________________________________________
Name Name
___________________________________________ ____________________________________________
Street Address Street Address
___________________________________________ ____________________________________________
City, State, Zip Code City, State, Zip Code
__________________________________________ ___________________________________________
Area Code/Telephone Number Area Code/Telephone Number
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Reference Page DIRECTIONS: Please type or print legibly. (Jacksonville State University)

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Completed 23 July 2020

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