STUDENT LOAN INFORMATION (Please Print)

Transcription

1 STUDENT LOAN INFORMATION (Please Print) NAME (LAST) (MI) (FIRST) STUDENT ID PERSONAL INFORMATION Social Security #: Local Address: City, State, Zip: Permanent Address: City, State, Zip: Home Phone #: Work Phone #: Cell Phone #: DOB: Class of : Year: Gender (please circle one): Female Male PARENT/GUARDIAN INFORMATION Fathers Name: Home Phone #: Occupation: Employer: Mothers Name: Home Phone #: Occupation: Employer: RELATIVE INFORMATION OVER 18 NOT LIVING AT HOME Name: Home Phone #: Relationship: (over) PERSONAL REFERENCES/INDIVIDUALS

2 You must provide 2 references/individuals that are not immediate family, students, or professors who will most likely know your address. Name: Home Phone #: Relationship: Name: Home Phone #: Relationship: Borrower Signature Date NEOMED PO BOX St. Rt. 44 Rootstown OH

3 NEOMED Alice B Taggert Student Loan Master Promissory Note I,, promise to pay NEOMED, hereinafter called the lender located at 4209 St. Rt. 44, Rootstown OH 44272, the sum of such amounts as may from time to time be advanced to me together with all attorney s fees, collection agent costs, and other related costs and charges for the collection of any amount not paid when in default according to the terms of this Promissory Note. I further understand and agree that: I. Repayment: 1. I promise to repay the principal over a period beginning three (3) months after the date I cease to be a full time student at the Northeast Ohio Medical University (NEOMED), and ending ten (10) years later. 2. I may, however, request that the repayment period start at an earlier time. 3. I promise to repay the principal over the course of the repayment period in equal monthly installments. 4. I shall repay the principal on this loan at the rate of $40 per month even though the monthly rate that would be established under paragraph II 1is less than that amount. 5. A schedule of repayment will be attached to and made part of this note. II. Prepayment: 1. I may at my option and without penalty prepay all of any part of the principal, at any time. 2. Amounts that I repay in the academic year in which the loan is made will be used to reduce the amount of the loan and will not be considered a prepayment. 3. If I repay more than the amount due of any installment, the excess will be used to repay principal unless I designate it as an advance payment of the next regular installment. III. Default: 1. If I fail to make a scheduled repayment of any installment on time, the entire unpaid indebtedness including any applicable late charges or collection costs may become due and payable immediately. Legal action could be taken against me, including collection by a collection agency. 2. I understand that if I default on my loan repayments the lender may disclose that I have defaulted, along with other relevant information, to credit bureau organizations -1 of 3

4 IV. Deferment: 1. There is NO DEFERMENT on the Alice B. Taggert Loan. V. Death and Disability Cancellation: 1. If I should die or become permanently and totally disabled, the entire amount of this loan shall be cancelled. VI. Change in Name, Address, and Social Security Number: 1. I am responsible for informing the lender of any change in my name, address, or social security number. VII. Penalty Charge 1. If I fail to make timely payment of all or any part of a scheduled installment, I promise to pay the charge assessed against me by the lender. 2. No charge may exceed $1 for the month or part of the month by which the installment is late, and $2 for each month or part of month thereafter. Notice About Subsequent Loans Made Under This Master Promissory Note This Note authorized the Institution to disburse multiple loans during the multi-year term of this Note upon the Borrower s request and upon the Institution s determination of the Borrower s loan eligibility. Subsequent loans may be made under the Note for the same or subsequent periods of enrollment at this Institution. The Institution however, may at its discretion, close this Note at any time and require the Borrower to sign a new Note for additional disbursements. If the Institution chooses to make subsequent loans under this Note, no such loans will be made after the earliest of the following dates: (i) the date this Institution receives the Borrower s written notice that no further loans may be made disbursed under this note; (ii) the date of withdrawal from the Institution by the Borrower.. NOTICE: The Institution must require security or endorsement if the borrower is a minor and if, under the applicable State law, the Note signed by him or her would not create a binding obligation. The Institution may not require security or endorsement in any other circumstances. The institution shall supply a copy of this Note to the Borrower. -2 of 3 -

5 I Agree to the terms and conditions of this Promissory Note. I accept the use of this form as my Master Promissory Note for the Alice B. Taggert Loan received under the NEOMED Student Loan Program. Signature of Borrower Date PLEASE PRINT THE FOLLOWING INFORMATION CLEARLY Social Security #: Permanent Address: City, State, Zip: Date of Birth : -3 of 3

6 NEOMED S Alice B Taggert Statement of Rights and Responsibilities Name SSN Your NEOMED Alice B. Taggert Loan is a serious legal obligation. Therefore, it is important that you understand your rights and responsibilities regarding this obligation. When you, the student borrower, sign this statement, it means that you understand your responsibilities, and that you agree to honor them. 1. I understand that I must immediately notify NEOMED of any changes regarding my name, address, telephone, social security number, enrollment status, and if I drop below half time by calling and/or writing the Accounting Department, (330) , NEOMED Accounting Department, 4209 St. Rt. 44, Rootstown, OH I understand that when I graduate or withdraw from NEOMED I must arrange for an Exit Interview by calling the Accounting Department at (330) I understand that if I am unable to make the monthly payment on my NEOMED Taggert Student Loan, I must contact the Accounting Department at (330) I further understand that I must respond in a timely manner to the any and all communication from NEOMED. 4. I understand that my NEOMED Alice B. Taggert Loan will be considered in default if I do not make a scheduled payment when due under the repayment schedule established by NEOMED. I further understand that if my NEOMED Taggert Student Loan has defaulted, NEOMED may at its option declare the entire amount of my unpaid loan plus late charges and collection charges immediately due and payable. 5. I understand that if my NEOMED Alice B. Taggert Loan has defaulted, NEOMED may assign this debt to a collection agency and I will be responsible for all reasonable collection costs, attorney fees and/or litigation costs. My wages may be garnished; my income tax refunds may be used to offset my defaulted loan. I understand that a hold will be placed on my academic transcripts, and I will be unable to register for classes at NEOMED. 6. I understand the eligibility for this loan has been based on my FAFSA for the current academic year and availability of funds. Accepting this loan does not guarantee future funding. Future funding will be based on need obtained from future FAFSA s and fund availability, Furthermore I understand that accepting this loan may affect future eligibility for other forms of student financial assistance. 7. I authorize NEOMED to release my current and previous loan status to potential credit inquires. I also authorize NEOMED to contact any school, which I any attend to obtain information concerning my enrollment status, dates and current address. This is a loan, which I must repay. I attest I understand my rights and responsibilities and will adhere to them. Signature Date

7 NEOMED Alice B Taggert Loan Program Truth-In-Lending Statement Borrowers Name: Annual Percentage Rate The cost of your credit as a yearly rate. Amount Financed The amount of credit provided to you Prior to Repayment During Repayment Award Year Award Amount 0% 0% % 0% Previous Yearly Awards 0% 0% Cumulative Amount - I understand my first payment will be due at the end of three (3) month grace period, and my minimum monthly payment will be at least $40.00 per month. I understand the maximum repayment period is ten (10) years; therefore my monthly payment amount may be larger depending on the total size of my NEOMED Taggert Student Loan. Please refer to estimated chart below - This Alice B Taggert Loan is subject to delinquency and default charges as specified in the promissory note. - The borrower may prepay all or any part of the principal at any time without penalty. - This loan can NOT be consolidated with various other Federal Student Loans. - There is no deferment on the Alice B Taggert Loan. - This loan will be reported monthly to a National Credit Bureau or bureaus. Total Principal Amount Borrowed and Projected Monthly Payment Amount Principal Payment Principal Payment Principal Payment Principal Payment Principal Payment $ $ $1,000 $ $5, $9,000 $96.00 $12,000 $ , , , , , , , , , , , , , , , , , , , , , , , , , , , , Current Borrower s Contact: Send Payments and Correspondence To: Accounting Department (330) NEOMED c/o ECSI 181 Montour Run Road Coropolis, PA Signature of Borrower Date:

8 Northeast Ohio Medical University 4209 St. Rt. 44, Rootstown, OH FINAL LOAN DISCLOSURE Additional Fees: Returned Check Charge: $25 Late Fees: Foundation Loan and Alice B Taggert Loan - $1 for the month or part of the month by which the installment is late; and $2 for each month or part of the month thereafter. Primary Care Loan 6 percent on loans more than 60 days past due. Loan for Disadvantaged Students 6 percent on loans more than 60 days past due. Right to Cancel: You have a right to cancel this transaction, without penalty, within 3 days of the postmark of this mailing. No funds will be disbursed to you until after this time. You may cancel by contacting the Accounting Department at , or by at jkovach1@neomed.edu. For immediate disbursement of funds please sign below to acknowledge receipt of your final loan disclosure. Signature of Recipient: Date: