Loan Application Form

Student Loan Application Form
Applicant Information
Title:
Name*

First NameLast Name
Social Security No.*
Birth Date*

MonthDayYear
E-mail*
Phone*

Area CodePhone Number
Mobile

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Do you own or rent the listed location?*

OwnRent
How long have you lived at the above address?*
List Years and Months
Employment Information
Present Employer*
Occupation*
Salary*
Gross pay, before deductions
Supervisor
Name of the person you report to
Phone Number

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employed from:*

MonthDayYear
Starting date
Employed to:*

MonthDayYear
Enter today's date if still there
Co-Signer (Optional)
Name

First NameLast Name
Social Security No.
Birth Date

MonthDayYear
Email
example@example.com
Phone Number

Area CodePhone Number
Mobile

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Co-Signer Employment Information (Optional)
Present Employer
Occupation
Salary
Gross pay, before deductions
Supervisor
Phone Number

Area CodePhone Number
Employed from:

MonthDayYear
Date
Employed to:

MonthDayYear
Date
Monthly Income
Monthly Salary
Take Home
Other Income
Total Combined
Total Income*
Total of All Monthly Income
Monthly Expenses
Loans
All Outstanding Loans
Credit Cards
Total of All Monthly Payments
Mortgage/Rent
Monthly
Bills
Utilities, Insurance, Etc.
Other Debts
All Others
Total Expenses*
Total of All Monthly Expenses
Bank Information
Institution*
Bank, Credit Union, Savings and Loan
Type of accounts you hold (check all that apply)*

CheckingSavings
Have you ever filed for bankruptcy?*

YESNO
Have you ever defaulted in payment of credit before?*

YESNO
Comments:
I certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. Furthermore, I hereby authorize the financial institutions listed in this loan application to release necessary information to Welding Certification Center in order to verify the informationcontained herein.*

YES
Authorization to Obtain Consumer Credit Report
I authorize Welding Certification Center (“WCC”) to obtain a consumer credit report on me. WCC will use the consumer credit report to confirm my residency and determine whether my credit is eligible to support a student loan. Upon request, WCC will provide me with thename and address of the Consumer Reporting Agency contacted to supply thereport. I understand that credit inquiries have the potential to impact mycredit score. I hereby release WCC, including its employees, agents orrepresentatives from any and all liability for furnishing such information. I also release WCC from any and all liability for conducting such an investigation. A photocopy, scan or facsimile copy of this Authorization and Release will be treated as though it were the original.*

YES
Terms of Acceptance and Signatures
Applicant
I, the applicant for this Student Loan Application, warrant the truthfulness of the information provided in this application.
Electronic Signature*

First NameLast Name
I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.*

YES
Co-Signer
I, the co-signer for this Student Loan Application, warrant the truthfulness of the information provided in this application.
Electronic Signature

First NameLast Name
I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.

YES
Should be Empty:

Student Loan Application Form

Applicant Information

Employment Information

Co-Signer (Optional)

Co-Signer Employment Information (Optional)

Monthly Income

Monthly Expenses

Bank Information

Authorization to Obtain Consumer Credit Report

Terms of Acceptance and Signatures