Private Education Loan Form

Please submit this form to notify Student Financial Services of your intended enrollment and the amount you wish to borrow in private loan funding.

Student Information
Name Name First Last
Student Id Number
Must be 7 digits. Currently Entered: 0 digits.
Email Address
Academic Information
Do you attend an on-campus program or an online program?

Do you attend an on-campus program or an online program? On Campus Program Online Program
Health Insurance: If you will be enrolled in 9 credits or more during one of the terms this academic year, will you be waiving the mandatory Health Insurance charge?

Health Insurance: If you will be enrolled in 9 credits or more during one of the terms this academic year, will you be waiving the mandatory Health Insurance charge? Yes No
Private Loan Application Year
I have been approved for a Private loan for the:

I have been approved for a Private loan for the: 2024-2025 academic year 2025-2026 academic year
Enrollment Plans

Please enter the number of credits for which you will enroll at Simmons during each semester. Enter 0 if you will not enroll.
Fall 2024 - Number of Credits
Fall 2025 - Number of Credits
Spring 2025 - Number of Credits
Spring 2026 - Number of Credits
Summer 2025 - Number of Credits
Summer 2026 - Number of Credits
Loan Allocation

Please remember that it is always better, in the long run, to minimize the amount you borrow.
Please indicate the way you would like your loan to be allocated per semester. We will honor your request if it is within your budget for that term

For Example, if approved for a $10,000 loan, you could split it in any way you request, as long as it fits within your budget. Such as:

Fall 2022 - $2,000
Spring 2023 - $4,000
Summer 2023 - $4,000

or

Fall 2022 - $5,000
Spring 2023 - $5,000
Summer 2023 - $0
Agreements
I acknowledge that by signing this form I understand and agree to the following statements

I acknowledge that by signing this form I understand and agree to the following statements I must first be approved for a private loan and complete all required loan documentation with my lender before my funding can disburse. There is a limit to the amount of private loan funding I can borrow toward non-billed costs each year. All information provided is complete and accurate to the best of my knowledge. I will promptly submit any additional documentation requested by Student Financial Services. Omitting or misreporting information on this form may result in a change or delay to my financial aid. I will immediately notify SFS in writing if any information on this form changes and understand the change may impact my eligibility for aid. In the event that I do not notify SFS of a change in my enrollment plans, my actual enrollment will be reviewed at the beginning of the term and my financial aid will be adjusted at that time, if necessary.
Today's Date Today's Date / MM / DD YYYY
Student's Signature

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

Private Education Loan Form

Private Education Loan Form

Student Information

Academic Information

Private Loan Application Year

Enrollment Plans

Loan Allocation

Agreements