Borrower Information

Please read the Rights and Responsibilities Summary Checklist on page two.

I have completed the Direct Loan On-Line Exit Counseling session for subsidized Federal Direct Stafford/Ford Loan and Federal Direct Unsubsidized Stafford/Ford loan borrowers. I have read, and understand, my rights and responsibilities as a borrower as listed on the Rights and Responsibilities Summary Checklist. I also understand that I must repay my loan according to the terms of the promissory note.

Student Information (please print clearly)
Name (last, first, middle initial)
RAY, ROBERT T
Social Security Number, Date of Birth
600581273 / 02071976  

Home Address (street, city, state, zip code)
3641 WEST GARFIELD     PHOENIX, AZ 85009
Home Area Code/Telephone Number
602-272-7701
Driver's License (state and number)
Employer After Leaving School (if known)

Employer's Area Code/Telephone Number

Employer's Address (street, city, state, zip code)


References: You must list two persons, with different U.S. Addresses, who will know your whereabouts for at least three years.

Name

1.

1.

2.

 

 
City, State, Zip Code    

Area Code/Telephone Number

   

 

____________________________________________ __________________
Student Signature Date

(Complete and submit to your school)

Rights and Responsibilities Summary Checklist

I understand that I have a right to the following (check off each box as you read):
Written information on my loan obligations and information on my rights and responsibilities as a borrower
a grace period and an explanation of what this means
a disclosure statement received before I begin to repay my loan(s), that includes information about interest rates, fees, the balance I owe, and the number of payments
deferment of repayment for certain defined periods, if I qualify and if I request it
forbearance, if I qualify and if I request it
prepayment of my loan in whole or in part any time without an early-repayment penalty
a copy of my promissory note either before or at the time my loan is disbursed
documentation that my loan(s) are paid in full

I understand I am responsible for:

attending exit counseling before I leave school or drop below half-time enrollment
repaying my loans even if I do not complete my academic program (under certain circumstances), I am dissatisfied with the education I received, or I am unable to find employment after I graduate 

notifying my school and the Direct Loan Services Center if I

move/change my address
change my name
withdraw from school or drop below half-time enrollment
 transfer to another school
fail to enroll or reenroll in school for the period for which the loan was intended

change my expected date of graduation

graduate

making monthly payments on my loan(s) after I leave school, unless I have a deferment or a forbearance
notifying the U.S. Department of Education's Direct Loan Servicing Center of anything that might alter my eligibility for an existing deferment.

I have reviewed the On-Line Exit Counseling Session for Direct Subsidized Loan and Direct Unsubsidized Loan borrowers.  I have read and I understand my rights and responsibilities as a borrower.

I understand that I have received a loan(s) from the federal government that must be repaid.

 RAY, ROBERT T                  600581273 

Student's Name (Please Print)

Social Security Number

______________________________________________________________________

_________________

Student's Signature Date