UNLV Emergency Promissory Note
You must complete a promissory note before you can receive your emergency loan. Required items are marked with a red asterisk (*). You cannot participate in any emergency loan program unless this form is completed in full. You are applying for a LOAN.

Emergency Loan Promissory Note
University of Nevada, Las Vegas


Students Name: Im Student   SSN: 222-22-2222

Loan Type: Emergency Loan

Loan Amount $50.00

  Principal sum and service charge shall become due and payable on 04/01/2003.

For Value received, I promise to pay to the order of the Board of Regents University of Nevada, Las Vegas, the sum of $50.00, plus an agreed to service charge of $5.00. Delinquent notes will be charged an additional $10.00 per hundred late fees. I understand that failure to pay this note on or before the due date of 04/01/2003 shall result in (1) denial of further loans, (2) withholding of transcripts, grades, records, etc. (3) denial of registration, (4) possible disqualification from the University of Nevada, Las Vegas, (5) withholding of any check made payable to me by UNLV who will apply said check to the emergency loan fund, (6) may report this loan to a credit bureau and (7) possible legal action may be taken against me to collect this loan. I further understand that collection costs at 34% of the principal, service charge and late fee will be my responsibility. I will be responsible for all fees associated with the collection of an emergency loan that is past due including but not limited to attorney fees and court costs. All future emergency loan requests will be denied if this emergency loan is forwarded to a collection agency. Notes delinquent more than 90 days, I understand that I will be responsible for interest that I may be charged at 12% per annum. This loan will become due and payable prior to withdrawal, cancellation or graduation from UNLV, regardless of the due date. Receipt of other types of assistance is dependent on the repayment of any existing loans. As signer of this note, I severally waive presentment for payments, notice of nonpayment, protest, and notice of protest and diligence in bringing suit against any party hereto. If this note should be placed in the hands of an attorney or collection agency, I agree to pay the attorney's fees and all other costs of collection of any unpaid balance still due and owing.

Electronic Signature
Certification:* [X] I have read, understand and agree to be bound by the Terms and Conditions of this loan.
  [X] I certify that all the information I have provided is true and correct.
Signature:* Im A Student
(type your full, legal name as your electronic signature)

If you need help completing this form, please contact your school.

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