Academic Year 2016-2017
Clear Form
JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH
Financial Aid Office
615 N. Wolfe Street, Suite E1002
Baltimore, MD 21205-2179
Phone: (410) 955-3004
Fax: (410) 955-0464
E-Mail: [email protected]
http://www.jhsph.edu/financial-aid
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Private Education Loan Application
This application is for students who want to apply for alternative loans from private lending institutions and do not wish to complete the
Federal Financial Aid application process. International students, students classified as special student limited, and students enrolled on a less-thanhalf-time basis (1-5 credits per term) are eligible to apply for alternative loans. See lenders’ websites for specific eligibility requirements, interest
rates, and repayment terms. Submit this form to the Financial Aid Office after your loan has been approved by your lender.
Name
Current Address
(Street)
E-Mail Address
Department
Degree Program
(City)
Telephone Number (
(State)
(Zip)
)
Internet Based Program (Yes/No)
Anticipated Enrollment Status – Complete for each term of enrollment at the Bloomberg School of Public Health.
Summer I (Summer Institutes)
Summer Term
1st Term
2nd Term
Winter Intersession
3rd Term
4th Term
Anticipated Credits Per Term
Choose # of credits:
(05/23/16 - 08/26/16)
Choose
Choose ## of
of credits:
credits:
(07/05/16 - 08/26/16)
Choose # of credits:
(09/01/16 - 10/26/16)
Choose # of credits:
(10/27/16 - 12/22/16)
Choose # of credits:
(01/09/17 - 01/20/17)
Choose # of
of credits:
credits:
(01/23/17 - 03/17/17)
Choose
#
of
credits:
(03/27/17 - 05/19/17)
Note: A private loan will be certified for your entire period of enrollment with a few exceptions. Also, loan disbursements will be prorated
on a per term basis. Most lenders have a four disbursement limit.
Lender’s Name: ___________________________________________________________________________________
Will you receive financial support (tuition, insurance, or fees) from the School or your academic department in 2016-2017?
Yes/No
If yes, list amount or percentage of financial support per year: $
If you are a JHU or a JHH employee, will you receive tuition remission or other financial support from Johns Hopkins in 2016-2017?
Yes/No
Will you receive any other financial support (such as a scholarship from an outside agency) in 2016-2017? Yes/No _______
If yes, list the source and the amount. Include any aid not previously listed on this form. Do not include stipends.
_______________________________________________________________________________________________________
*
*
*SIGNATURE (REQUIRED)
DATE (MM/DD/YYYY)
Document may be faxed upon completion to 410-955-0464
or you may scan and email as an attachment to [email protected].