San Diego State University
Student Account Services - Short Term Loan Application
Reference Information (to be completed by the student)
Employer: Company Name & Phone #: _________________________________( ) _____ - __________
Address: ______________________________________________________________________________
Street City State Zip Code
Parent or Nearest Relative’s Full Name & Phone #: _____________________________( ) _____ - _____
Address: ______________________________________________________________________________
Street City State Zip Code
Other Reference’s Full Name & Phone # (Another Household): ____________________( ) _____ - _____
Address: _______________________________________________________________________________
Street City State Zip Code
Short Term Loan Terms and Agreement: (to be read and signed by the student)
I understand and agree that this is a binding contract requiring repayment of an educational loan, a form of financial aid assistance. I
hereby certify that, to the best of my knowledge, all information furnished on this application is complete and accurate. I agree to
pay a $15.00 service charge as a part of this Short Term Loan. I understand that I am required to update my WebPortal account with
all address changes and agree to provide any additional documents requested in support of this application until the loan is
completely paid in full. I recognize that my failure to repay this loan on time may result in this institution withholding all services
from me, the assessment of late charges, and interest at 10% per annum on delinquent amounts owing. I authorize the Student
Account Services Office to deduct any amounts owing from my Financial Aid award to repay the Short Term Loan, if applicable. I
consent to the release of information concerning this extension of credit when necessary to collect a delinquent payment. Upon such
delinquency this information may be released to credit bureaus and other entities reasonably necessary to aid in the collection of the
delinquent repayment. I understand that this debt could be referred to collection agencies and that I will be responsible for all
attorneys’ fees and other reasonable collection costs.
____________________________________________________________ ______________________________________
Signature of Applicant Date
For Office Use Only:
Date Application Received: ________________ Approved / Denied Date: ________________
Reason for Denial _______________________________________________________
Signature of Approver: ___________________________________________
Loan Fund Used: ___________________________________ Loan Amount: _______________________
Comments: ____________________________________________________________________________
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