Fillable STUDENT EDUCATION LOAN FUND of LIVERMORE (SELF) LOAN

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STUDENT EDUCATION LOAN FUND of LIVERMORE (SELF) LOAN

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  • 5 check-boxes
  • 114 other fields

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File type: PDF

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Rev 12/15
STUDENT EDUCATION LOAN FUND of LIVERMORE (SELF)
LOAN APPLICATION INSTRUCTIONS
Applications must be email-dated or postmarked no later than July 1.
ELIGIBILITY: THE APPLICANT MUST BE A RESIDENT OF LIVERMORE, CA OR
A GRADUATE OF A LIVERMORE (CA) HIGH SCHOOL
Application Check List
The first four items below can be submitted either by emailing them to: daviddarlington@att.net or by ordinary mail to:
David Darlington
The Student Education Loan Fund of Livermore
2547 Regent Rd.
Livemore, CA 94550
Emailable or mailable items:
Download this Application from www.selfloans.org follow these instructions, and complete the forms on your computer. You may
to need download Adobe Acrobat Reader for free to work with this form on your computer. The form should expand to provide as
much space that you need for each answer. Identify your co-responsible cosigner providing their relation to you, and their mailing
address, telephone numbers, and email address. Persons accepting loans must have a co-responsible cosigner over the age of 25
who can accept responsibility for the loan if the applicant fails to do so.
Two (2) letters or emails of reference from someone other than family or relatives
Write a statement of 150 words or less indicating any special circumstances to be considered by the application committee.
Tell us how you heard about SELF
Mailable only:
Provide by mail official transcripts from your high school and the last school that you attended or are attending. Contact the
school and have them send the transcript directly to;
David Darlington
The Student Education Loan Fund of Livermore
2547 Regent Rd.
Livemore, CA 94550
All information submitted will be kept strictly confidential.
Deadline:
Applications must be email-dated or postmarked no later than July 1. However, applications at other times of the year may be
considered under special circumstances; contact David Darlington at 925-606-7042 or email daviddarlington@att.net
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Completing and Sending the PDF Form
The application form has been set up so you can complete the form in Acrobat Reader. Please save the completed form
using a unique name such as: {yournameapp}.pdf and send the saved file to SELF using the “Email to SELF” button on
the saved form. You must save the form before sending it to us or it will be blank.
The document can be sent as attachment to an email using either your desktop software or webmail. You will be asked
to choose.
Desktop software:The software will create an email with the attachment, ready for you to send. You should review this
email prior to sending.
Webmail: You must save the file then open your webmail and manually create an email with the attachment. Please
use email address: daviddarlington@att.net
Please make sure you have the version of Acrobat Reader that allows you to use these functions.
Rev 12/15
Loan Awards:
Loan checks will normally be conveyed in August after review of the applications and signing of the loan contract by the student and
the cosigner
Annual Loan Reconfirmation Statement
Following the Application Form, you will find the annual Loan Reconfirmation Statement form. Submit this each April 15, NOT NOW.
Do so by email to: mailto:roger.everett@sbcglobal.net
or mail to SELF:
Student Education Loan Fund of Livermore
P. O. Box 2475
Livermore, CA 94551-2475
Rev 12/15
STUDENT EDUCATION LOAN FUND of LIVERMORE (SELF)
LOAN APPLICATION
Applications must be email-dated or postmarked no later than July 1.
_____________________________________________________________________________________________
Applicant Name (Last, first, middle) Date of Birth Age Sex (M/F) Marital Status Annual Income
I am: a graduate of a high school: in Livermore. a Livermore resident; a US citizen .
Yes No Yes No Yes
Home address (Street, City, State Zip) Main Telephone
_____________________________________________________________________________________________
Social Security Number Drivers License State/Number Email Address
_____________________________________________________________________________________________
Name of Father or Guardian Address
_ .
Primary Phone Alternate Phone Email Address
_____________________________________________________________________________________________
Name of Mother or Guardian Address
_ .
Primary Phone Alternate Phone Email Address
_ .
Name of Cosigner (may be parent) Address
_ .
Primary Phone Alternate Phone Email Address
_____________________________________________________________________________________________
Name-1 two people who will always Address Primary Phone Email Address
_____________________________________________________________________________________________
Name-2 know where you are Address Primary Phone Email Address
_____________________________________________________________________________________________
Student’s High School City, State Entered(Mo/Yr) Graduated (Mo/Yr)
_____________________________________________________________________________________________
College or Institution you are attending or plan to attend City, State Entry date
_____________________________________________________________________________________________
Current Status (high school year, college year, or post college year) Expected Graduation(Mo/Yr)
_____________________________________________________________________________________________
For what occupation are you preparing? Major Subjects
List awards or honors have you received and when.
Award Date Received
________________________________________________________________________ ___________
_ ____
Rev 12/15
Extracurricular activities in which you participate and organizations to which you belong.
List employment experience. Give name and address of employer and approximate dates employed.
Employer Dates Employed
List any financial aid or scholarships now held, giving name, amount and period held.
Source Amount Period
Estimate School Year Cost; = Tuition/Fees: + Room/Board: + Other Expenses: .
SELF Loan Amount requested:___________ _ ($1,000; $1,500; $2,000; or $2,500)
I hereby declare that I have read all the statements on this application and that to the best of my knowledge and belief they are
correct. I am aware that a co-responsible cosigner is required for the loan that I may receive from SELF.
____________________________________________ ________________________________________________
Applicant Signature Date Co-Signer Signature Date
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LOAN RECONFIRMATION STATEMENT
STUDENT EDUCATION LOAN FUND
P. O. Box 2475
Livermore, CA 94550
Due Date April 15 each year
Date Submitted________________________
Name:___________________________________________
Date of First Loan:________________________________
Total Loan Amount Repaid Balance Due
____________ _____________ ___________
Name__________________________________Parent/CosignerName_________________________
Address________________________________Address__________________________________
City___________________________________City_____________________________________
Phone_________________________________ Phone___________________________________
Email Address ____________________________Email Address_______________________________
School ________________________________ School Status ______________________________
Expected or Actual Date to Complete Education Program _____________________
Loan Information is Correct and I Reconfirm the Obligation: ____Yes ____No
Signature:__________________________________________________ Date:_____________
Comments:___________________________________________________________________
We would appreciate you or your cosigner confirming the above loan information by April 15
each year, also please provide the contact information requested and return this form.
Please note that the loan contract which you signed stipulates that 25% of your loan balance is due by
the 13th month after you complete or terminate your post high school education. Successive 25%
repayments are required during each of the following 3 years. If you complete the repayments on
schedule there is no interest due on the loan. Payments which are delinquent will be assessed interest at
the rate specified in your loan contract (3 or 6%) per annum. If for any reason the required payments are
not made on schedule, the entire loan balance plus interest becomes due and payable 4 years from the
due date of the first payment. You have agreed to report on an annual basis the information
requested above. Please note our mailing address at the top of this form.
If you have any questions about your loan please contact:
Dianna Geyer (925) 4699-2467(H) diannageyer2467@yahoo.com For payment questions
Roger Everett (925) 443-5565(H) roger.everett@sbcglobal.net Student Contact
David Darlington (925) 606-7042 daviddarlington@att.net For loan applications
Margaret Miller (925) 447-6980(H) mmiller1435@gmail.com Contract Manager
NOTICE: Please fill
out and return this
statement even if no
payment is due. May
be completed by co-
signer/parent.
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STUDENT EDUCATION LOAN FUND of LIVERMORE (SELF) LOAN

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Completed 21 April 2021

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