Emergency Loan Applications

Change Application Status

Application Status (School Use Only)

Status:
Reason:
Approved Amount:
Approved Fund:
Approved Due Date:
Operator:
Reviewed:	(eastern)

Kansas University Endowment Association
Application For Short-Term
Emergency University Loans

Application

Student Information
Social Security Number:*	-- --
Student ID#:
First Name:^*
Middle:
Last:^*
Date of Birth:^*	/ /
Driver License:	State:
College/Department:^*
Major: ^*
Credits this semester: ^*
GPA: ^*

Student Permanent Address
Address: ^*
City/State/Zip: ^*
Home Phone: ^*
Cell Phone:
Other Phone:
Email: ^*

Student Local Address
	[Same As Permanent] [Clear Fields]
Address: ^*
City/State/Zip: ^*
Home Phone: ^*
Cell Phone:
Other Phone:
Email: ^*

Your KU Status

Academic Level:
Applying for Semester:
Hours Enrolled:
Graduation Date:	/ /
	I am an International Student (No Cosigner required - Short Term Loan)
Transferred:	If you are in your first semester at KU, did you transfer from another institution of higher education?
	Yes No
	Where did you graduate from High School?
City:	State:
County:
Disburse Method:	If approved, by what means would you like the funds dispersed? (If the Student is NOT currently enrolled payment will AUTOMATICALLY be made directly to the University of Kansas)
	Electronic Transfer directly to Your Student Account at the University of Kansas Electronic Transfer to a Checking/Savings Account (EFT Section MUST be completed) Check (please allow for 5 days additional processing time)

Cosigner Information
A parent is required to Cosign Each Loan Unless you are an International Student
	Check this box to indicate you are required to have a cosigner
Relationship: ^*
Social Security Number: *	-- --
First Name: ^*
Middle:
Last: ^*
Date of Birth:	/ /
Address: ^*
City/State/Zip: ^*
Home Phone: ^*
Cell Phone:
Other Phone:
Other Phone:
Email:
	Check this box to affirm that your co-signer realizes the nature of his/her obligation and that he/she will be required to repay this loan in the event you fail to do so?

Father or Guardian
Relationship: ^*
First Name: ^*
Middle:
Last: ^*
Address: ^*
City/State/Zip: ^*
Home Phone: ^*
Cell Phone:
Other Phone:
Other Phone:
Email:

Mother or Guardian
Relationship: ^*
First Name: ^*
Middle:
Last: ^*
	[Same Address As Father/Guardian]
Address: ^*
City/State/Zip: ^*
Home Phone: ^*
Cell Phone:
Other Phone:
Other Phone:
Email:

1st Reference (No Students Please)
Relationship: ^*
First Name: ^*
Middle:
Last: ^*
Address: ^*
City/State/Zip: ^*
Home Phone: ^*
Cell Phone:
Other Phone:
Other Phone:
Email:

2nd Reference (No Students Please)
Relationship: ^*
First Name: ^*
Middle:
Last: ^*
Address: ^*
City/State/Zip: ^*
Home Phone: ^*
Cell Phone:
Other Phone:
Other Phone:
Email:

Loan Information
Amount Requested: ^*
Purpose of Loan: ^*
How will you Repay Loan: ^*
When will you Repay Loan: ^*	/ /

Banking (ACH) Information
Authorization:	I authorize the lender (or their authorized agent) to deposit the amount of this loan (less any service fees) into the financial institution specified below. I authorize the lender (or their authorized agent) to withdraw payments, as they become due, from the financial institution specified below, until this debt is paid in full.
Bank Name:
Account Holder Name:
ABA/Routing Number:	[Where to Find]
Account Number:	[Where to Find]
Account Type:	Checking Savings
By checking this box, I affirm: I am authorized to withdraw funds against the account provided above. Performing withdrawls without the account holder's expressed permission is a criminal offense. I understand that submitting incorrection information to avoid payment of this debt is an act of fraud and a Federal offense. I agree that I will be assessed a fee if my bank fails to honor this transaction for any reason (e.g., insufficient funds, invalid account numbers, etc.) I understand that all incidents or suspicions of fraud are immediately reported to our bank and to the FBI.

Access Information
Important! You must select a password. Passwords are case-sensitive! You will need to enter it twice and both must match. You will need this password in order to review or modify this application. You will also need this password to sign your promissory note (if your application is approved). If you forget this password, you can have it sent to the student email address(es) above. Be sure those are correct! You will receive an confirmation message containing full details when you complete this application. You WILL NOT be able to progress past the application step without your password. If you cannot remember or retrieve your password, You will be forced to start the application process all over from scratch!
Password: ^*
Again: ^*

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

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