Department of Finance and Budget
Loan Office
Admin. 140, Box 2201
South Dakota State University
Brookings, SD 57007-1829
Phone: 605-688-6183
Fax: 605-688-6944
PERSONAL DATA SHEET
It is a Federal requirement that I complete exit counseling and provide all the required information my
school requests if I cease half-time enrollment, withdraw or graduate.
Date of graduation or withdrawal from SDSU: __________________________________________
Curriculum/Major: ________________________________________________________________
Will you be continuing your education? _______________________________________________
If so, WHAT UNIVERSITY/SCHOOL? ________________________________________________
Future Career Plans:______________________________________________________________
BORROWER’S INFORMATION
NAME:_______________________________
PERMANENT MAILING
ADDRESS____________________________
TYPE OF STUDENT LOAN:
Perkins______Stafford_______Nursing_______HPL______
Nursing Faculty Loan_____
City__________________________________
SOCIAL SECURITY NUMBER:________________________
State________________________Zip______
BIRTHDATE:______________________________________
Telephone No:(___)_____________________
Cell Phone No:(___)____________________
DRIVER’S LICENSE
STATE AND NUMBER:______________________________
E-Mail:_________________________________
SPOUSE:_________________________________________
Spouse’s Employer: _______________________________
PARENT/GUARDIAN INFORMATION
Name:____________________________
Address_____________________________________
Telephone_(___)____________________
____________________________________________
Name:____________________________
Address_____________________________________
Telephone_(___)_____________________
____________________________________________
MAILING REFERENCES (other than parents who will know your address)
1.Name____________________________
Address_____________________________________
Telephone_(___)___________________
____________________________________________
2.Name____________________________
Address_____________________________________
Telephone_(___)___________________
____________________________________________
3.Name____________________________
Address_____________________________________
Telephone_(___)___________________
____________________________________________
I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE IS TRUE AND CORRECT
Name________________________________
Date________________________________________
I understand that:
____ 1. I must inform South Dakota State University immediately of any change in my name, address, or telephone number.
____ 2. I know the full amount of my loan and I must repay my loan on a timely basis even if I did not complete my
education and/or am not satisfied with my education, or cannot find a job in my field.
____ 3. I understand I must make payments on my loan even if I do not receive a bill or repayment notice. Billing
statements are sent to you as a convenience.
____ 4. I understand the minimum monthly payment will be $40.00. However, it may be more if the amount
borrowed is sufficient to require larger payments. This loan must be repaid in a 10-year repayment
period. The interest rate is specified on my promissory note.
____ 5. I must contact South Dakota State University prior to the due date, if payment cannot be made for any
reason.
____ 6. I may accelerate or make payments prior to the due date without penalty. This can reduce the total
amount of interest I will be required to pay over the life of the loan.
____ 7. I must submit timely certification when requesting deferment, postponement and/or cancellation
benefits and notify SDSU of anything that might alter my eligibility for an existing deferment. The
appropriate form to request any of these privileges can be obtained from SDSU or our website.
____ 8. I authorize South Dakota State University to contact any school which I may attend or have attended
to obtain information concerning my student status, my year of study, my dates of attendance,
graduation or withdrawal, my transfer to another school, or my current address. This authorization is in
effect until my loan is paid in full.
____ 9. I understand my account is reported to a national credit bureau every month.
____10. If I fail to repay my student loan, I will be considered in default and the following may result: Subject
to late charges; additional interest; denied copy of transcripts; ineligible to receive any additional
federal or state financial aid funds; negative credit report; collection costs; entire unpaid amount will
become due and payable immediately; and wages garnished.
____11. Loan rehabilitation is available on a defaulted Perkins loan one time only, by requesting rehabilitation and making
consecutive, monthly, on-time payments, as determined by your school.
____12. A Consolidation Loan Program may be an option for me if my loans are from more than one lender.
This program allows me to consolidate student loan debt from various programs into one loan, usually
extending the payment period and lowering monthly payments. Interest rates and total interest paid
may be greater with consolidation. You will not receive cancellation benefits on a Perkins Loan if the Perkins Loan has
been consolidated.
____13. Department of Defense has a program which may repay a portion of student loans on the basis of specific military
service. Military deferment for more than 30 days but less than 3 years active duty during a war or terrorist
attack on loans given after July 1, 2001.
____14. You may request a copy of your promissory note at any time.
THIS IS A LOAN WHICH MUST BE REPAID
I understand that I will be contacted during the next few months by South Dakota State University, Loan Collections, Box 2201,
Brookings, SD 57007, 605-688-6183, with further information and instructions. I understand that my school and anyone servicing my
student loan may communicate with me at any of the numbers listed above or any number I provide to my school or to anyone
servicing my student loan in the future. I also agree that communication may be made to my telephone or mobile device using an autodialer, text message or pre-recorded message. If I dispute the terms of this loan in writing, Student Loan Collections does not resolve
the dispute. I may contact Student Ombudsman at (877) 557-2575 or www.ombudsman.ed.gov.
BORROWER’S
SIGNATURE ____________________________________________ DATE _________________________
INSTITUTION REPRESENTATIVE SIGNATURE: ______________________________________________
If I do not make payments when due, my loan may be declared in default. If I default, the Federal Government will take over my loan
and I will owe the Government. The Federal Government will actively pursue me for repayment of the debt, including the use o f
collection agents and reporting my default to consumer credit reporting agencies or to the Internal Revenue Service for purpose of
locating me or for income tax refund offset, and referred to the Department of Justice for litigation.
Revised 02/09/11
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