HTML Preview Federal Family Education Loan Note Sample page number 1.
10. References: You must provide two separate references with different U.S. addresses. The first reference should be a parent (if living) or legal guardian. Both references must be completed in full.
Name A. B.
Permanent Address
City, State, Zip Code
E-mail Address
Area Code/Telephone Number ( ) ( )
Relationship to Borrower
2. Social Security Number
4. Home Area Code/Telephone Number
( )
6. Driver’s License State and Number
State #
Borrower Information
Please print neatly or type. Read the instructions carefully.
1. Last Name First Name MI
3. Permanent Street Address (If P.O. Box, see instructions.)
City State Zip Code
WARNING: Any person who knowingly makes a false statement or misrepresentation on this form
is subject to penalties which may include fines, imprisonment, or both, under the United States
Criminal Code and 20 U.S.C. 1097.
9. Lender Code, if known
Borrower Certifications and Authorizations
Read carefully before signing below.
I UNDERSTAND THAT I MAY RECEIVE ONE OR MORE LOANS UNDER THIS MPN, AND THAT I MUST REPAY ALL LOANS THAT I RECEIVE UNDER THIS MPN.
16. Borrower’s Signature
Federal Family Education Loan Program (FFELP)
Federal Stafford Loan
Master Promissory Note
Guarantor, Program, or Lender Identification
8. Lender Name City State Zip Code
Promise to Pay
Additional MPN provisions follow
5. Date of Birth (Month/Day/Year)
7. E-mail Address
In this Master Promissory Note (MPN), “lender” refers to, and this MPN benefits, the original lender and its successors and assigns, including any subsequent holder of this MPN.
11. Requested Loan Amount: I request a total amount of subsidized and unsubsidized loans
under this Master Promissory Note not to exceed the allowable maximums under the
Higher Education Act. My school will notify me of the type(s) and amount(s) of loan(s)
that I am eligible to receive. I may cancel my loan or request a lower amount by
contacting my lender or school. Additional information about my right to cancel a loan
or request a lower amount is included in the Borrower’s Rights and Responsibilities
Statement and Disclosure Statements that have been or will be provided to me.
12. Interest Payments (Optional):
❒ I want to pay unsubsidized interest while I am in school.
OMB No. 1845-0006
Form approved
Exp. date 2-29-2008
13. Under penalty of perjury I certify that:
A. The information I have provided on this Master Promissory Note and as updated by
me from time to time is true, complete, and correct to the best of my knowledge and
belief and is made in good faith.
B. I will immediately repay any loan proceeds that cannot be attributed to educational
expenses for attendance on at least a half-time basis at the school that certified my
loan eligibility.
C. (i) I do not now owe an overpayment on a Federal Pell Grant, Supplemental
Educational Opportunity Grant, or a Leveraging Educational Assistance Partnership
Grant (formerly State Student Incentive Grant); or, if I owe an overpayment, I have
made repayment arrangements with the holder to repay the amount owed. (ii) I am
not now in default on any loan received under the Federal Perkins Loan Program
(including NDSL loans), the Federal Direct Loan Program, or the Federal Family
Education Loan Program (“FFELP” as defined in the Borrower’s Rights and
Responsibilities Statement); or (iii) I am in default on a loan, and I have made
satisfactory arrangements with the holder of the defaulted loan.
14. For all subsidized and unsubsidized Federal Stafford Loans (as described in the
additional MPN provisions and the Borrower’s Rights and Responsibilities Statement)
I receive under this Master Promissory Note, and for certain other loans as described
below, I make the following authorizations:
A. I authorize my school to certify my eligibility for loans under this Master
Promissory Note.
B. I authorize my school to transfer loan proceeds received by electronic funds transfer
(EFT) or master check to my student account.
C. I authorize my school to pay to the lender any refund that may be due up to the full
amount of the loan(s).
D. I authorize the lender, the guarantor, or their agents, to investigate my credit record
and report information concerning my loan status to persons and organizations
permitted by law to receive such information.
E. I request and authorize my lender to: (i) during the in-school and grace periods of any
loans made under this Master Promissory Note, defer and align the repayment of
principal on all of my FFELP loans that are in repayment status; and (ii) add unpaid
interest that accrues on all my FFELP loans to the principal balance of such loans
(“capitalization”) including such loans made under this Master Promissory Note,
during forbearance periods, and for unsubsidized loans, during in-school, grace, and
deferment periods as provided under the Act. “Capitalization” will increase the
principal balance on my loans and the total amount of interest charges I must pay.
F. I authorize the release of information pertinent to my loans: (i) by the school, the
lender, and the guarantor, or their agents, to the references on the applicable loans
and to members of my immediate family unless I submit written directions otherwise;
and, (ii) by and among my schools, lenders, guarantors, the Department of
Education, and their agents.
G. So that the loans requested can be approved, I authorize the Department of Education
to send any information about me that is under its control, including information from
the Free Application for Federal Student Aid, to the school, the lender, and to state
agencies and nonprofit organizations that administer financial aid programs under
the FFELP.
15. I promise to pay to the order of the lender all loan amounts disbursed under the terms of this MPN, plus interest and other charges and fees that may become due as provided in this
MPN. I understand that multiple loans may be made to me under this MPN. I understand that by accepting any disbursements issued at any time under this MPN, I agree to repay
the loans. I understand that, within certain time frames, I may cancel or reduce the amount of any loan by refusing to accept or by returning all or a portion of any disbursement that
is issued. Unless I make interest payments, interest that accrues on my unsubsidized loans during in-school, grace, and deferment periods will be added as provided under the Act to
the principal balance of such loans. If I do not make any payment on any loan made under this MPN when it is due, I will also pay reasonable collection costs, including but not
limited to attorney’s fees, court costs, and other fees. I will not sign this MPN before reading the entire MPN, even if I am told not to read it, or told that I am not required to read it.
I am entitled to an exact copy of this MPN and the Borrower’s Rights and Responsibilities Statement. My signature certifies I have read, understand, and agree to the terms and
conditions of this MPN, including the Borrower Certifications and Authorizations printed above, the Notice About Subsequent Loans Made Under This MPN, and the Borrower’s
Rights and Responsibilities Statement.
17. Today’s Date
(Month/Day/Year)