Student Loan E ntrance Interview Information
Federal Regulation: Due Diligence (57l210(b) REQUIRES that an entrance interview be completed BEFORE the disbursement of any funds.
*****The following questions M UST be completed B E F OR E the Perkins loan can be disbursed to you.*****
Name _________________________________________________
Last
First
Soc. Sec. # ________________________
Middle
Permanent Address __________________________________________________________________________
Street
City
State
Zip
Local Address ___________________________________________________________________________________
Street
City
Home Phone ____________________
State
Work Phone ____________________
Home E-Mail ____________________________
Zip
Birth Date _____________________
Work E-Mail ____________________________
Expected Graduation Date __________________ College Major(s) ____________________________________
Employer's Name & Location ______________________________________________________________________
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Spouse Name ___________________________________________
Employer __________________________
Spouse's Parent Name ____________________________________
Address _______________________________________________
Employer ___________________________
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The following parent information is for address verification only.
Borrower's Parent ________________________________________
Home Phone ___________________________
Parent's Address _________________________________________
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List three references, other than the names already listed above, who will most likely know your address.
1. ___________________________________________________________________________________________
Name
Address
Phone
2. ______________________________________________________________________________________________
Name
Address
Phone
3. _______________________________________________________________________________________________
Name
Address
Phone
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I certify that the above information is correct and complete and I hereby authorize verification by the university.
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Signature of Student Borrower
_____________________________
Date