Ph: (617) 228-2275
Fax: (617) 228-3407
Bunker Hill Community College
Financial Aid Office
Federal Direct PLUS Loan Request Form Room B-213/ Main Lobby
2015-2016
Student Information:
*You are required to file a FAFSA for 2015-2016 to receive this loan. The student must be considered Dependent
by federal FAFSA guidelines in order for you to be eligible for this loan, and be enrolled at minimal 6 credits.
Student Full Name: (Last)__________________First______________________Middle Initial____________
Student Social Security Number :______________________ Student Date of Birth (mm/dd/yyyy)_________________
Student’s Email: _______________________ Student’s Phone number:__________________________
Parent Information:
I have already completed a Direct PLUS LOAN eMPN for this student at www.studentloans.gov
Name:( Last)__________________First______________________
Middle Initial________________
Social Security Number:____________________________ Date of Birth (mm/dd/yyyy)_________________________
Permanent Address: _______________________________City______________________State_______Zip_________
Parent’s Email:__________________________________ Parent’s Phone Number:____________________________
Parent Relationship to Student:
Father
Mother
Step-father
Step-mother
US Citizenship Status:
US Citizen or
Permanent Resident or Eligible Alien.
If you are Permanent or Eligible Alien, please provide your Alien Registration Number:A#_______________________ and
a copy of Front and Back of your Alien Card.
I am requesting:$ ________________________* . I would like my loan amount split between:
Fall 2015 & Spring 2016
Fall 2015 only
Spring 2016 only
Summer 2016 only
*Actual amount disbursed is less a 4.2% loan processing fee.
Please be aware that your requested loan amount may be adjusted based on other financial aid awarded, previous borrowing,
cost of attendance, grade level, and academic requirements.
Parent Authorizations: Your signature authorizes the initiation of the mandatory credit review required for the Parent PLUS Loan. In addition, the
Privacy Act of 1974 (5 U.S.C.552a) requires that the following notice be provided to you. The authority for collecting the information requested on this
form is section 451 et. Seq. of the Higher Education Act of 1965, as amended. Your disclosure of information is voluntary. However, if you do not provide
this information, you cannot be considered for a Parent PLUS Loan. The information on this form will be used to determine your eligibility for a Parent
PLUS Loan.
If my Plus Loan is credit denied, I want to utilize the additional $4k/year of Unsub loan.
If the Parent PLUS loan results in an overage to my student’s Bursar account, I request that a refund be issued and sent
directly to
the borrower (parent)
the above named student
Parent Signature_______________________________________________________________ Date_______________