MOFELP
M issouri F amily E ducation L oan P rogram
Dear Student,
The Missouri Scholarship and Loan Foundation (MSLF) and the Higher Education Loan Authority of the
State of Missouri (MOHELA) are pleased to offer the Missouri Family Education Loan Program (MOFELP).
MOFELP is a private student loan program designed to provide borrowing options for Missouri students
who have financial need but may not meet the traditional credit requirements for private loans.
MSLF, the MOFELP lender, is a 501(c) (3) nonprofit organization that was founded in 2010 to provide
scholarships and low cost loans to students in the state of Missouri. MSLF is focused on helping Missouri
students and families obtain a higher education. MOHELA is the servicer for MOFELP loans.
The funds for MOFELP are limited for each academic year and are available on a first come, first served
basis. These funds, while available, will be used to make interest free MOFELP loans to students attending
Participating Schools* who meet the eligibility, underwriting and other requirements. These requirements are
summarized on the attached MOFELP Summary of Requirements.
Please read all of the enclosed information in its entirety. This is a loan that must be repaid, so make sure
you understand the terms of this loan before signing. All required documents must be turned into your
financial aid office. The financial aid office will certify certain information and forward the loan application
documents to MOHELA for processing.
We wish you the best in reaching your academic goals. If you have any questions or concerns, please contact
us at MOFELP/MOHELA, P.O. Box 4602, Chesterfield, MO 63006-4602, by phone at (800) 809-0964, or
by email at mofelp@mohela.com. MOFELP information is also available on our website, www.mohela.com.
Sincerely,
MOHELA, as agent for the Missouri Scholarship and Loan Foundation
*See list of participating schools on the attached MOFELP Summary of Requirements.
6-2015 V-4
Summary of Requirements
2015-2016
The Missouri Family Education Loan Program (“MOFELP”) is a “special purpose credit program” under the Federal Equal
Credit Opportunity Act. MOFELP is offered by the Missouri Scholarship and Loan Foundation (“MSLF”), a not-for-profit
organization, as defined under section 501(c) of the Internal Revenue Code of 1954, for the benefit of an economically
disadvantaged class of persons described in this summary.
As participants in a “special purpose credit program,” applicants for MOFELP loans are required to share one or more common
characteristics, which are the MOFELP eligibility requirements listed below. In addition to the MOFELP eligibility
requirements, applicants are also required to meet the MOFELP underwriting requirements, which are based on creditworthiness
of the applicants and any cosigners, as well as certain general MOFELP requirements.
As explained in the application instructions, you are required to submit your MOFELP application package to the student
financial aid office at the Participating School that you will be attending (see the list of Participating Schools below). The
financial aid office will provide information in the designated portions of the application and then submit the application package
to MSLF on your behalf. MSLF will then review the application package to determine if it meets the MOFELP general
requirements, eligibility requirements and underwriting requirements.
General MOFELP Requirements
Requirement of Completed Application. Each application will be given a priority designation based on when the application is
submitted and is complete. In other words, completed MOFELP applications are processed on a first come, first served basis. A
completed application includes all of the required documentation in the application package, with all required signatures and
information provided. If your application is not complete, it will be denied. You will have to submit a completed application
before it will be given a priority designation with regard to other applications to be considered for approval.
Funds Limitation. MOFELP has limited funding available, so there may not be enough money in the program to make loans to
all qualified applicants. Funds are allocated for loans to be made to applicants attending each Participating School. For the full
listing of Participating Schools, see the list at the end of this Summary of Requirements (the “Participating School list”). The
amount of funds for loans to students at each Participating School will be allocated as follows:
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For each Participating School in the Participating School list, the amount allocated will be based on the number of Pell
Grant eligible students at that school, and the amount will be allocated from MSLF’s primary MOFELP funding
source.
The allocations based on Pell Grant eligibility will begin July 1 and continue through March 31. From April 1 through
June 30, funds will be distributed on a first come, first served basis.
The first come, first served distributions beginning April 1 will be based on applications from other students attending
Participating Schools. The earlier your completed application is submitted, the greater the chance that there will be
MOFELP funds available.
MOFELP Special Purpose Program Eligibility Requirements. The following are the eligibility requirements for
a MOFELP loan.
Student Borrower Requirements. You (the student borrower) must:
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Be enrolled on a full-time basis as an undergraduate at a “Participating School” under MOFELP.
Be making satisfactory academic progress as determined by your Participating School.
Have an Expected Family Contribution (EFC) (as defined in the MOFELP Loan Application/Promissory Note) of
$12,000 or less for the current academic year.
Be at least 17 years of age.
Be a United States citizen and a permanent Missouri resident with your primary domicile located in Missouri.
Not have a bachelor’s degree.
P.O. Box 4602 ● Chesterfield ● MO ● 63006-4602
(800) 809-0964 ● MOFELP@MOHELA.COM
6-2015 V-4
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Have a composite score of at least 21 on ACT or 1500 on SAT; or have an overall cumulative Grade Point Average
(GPA) of 2.5 or higher on a 4.0 scale (or the equivalent on another scale) earned at the Participating School.
Not have a conviction for fraud.
Have an amount of Certified Academic Financial Need (as defined below)* to attend your Participating School of $500
or more.
Have an amount of Certified Academic Financial Need* that is equal to or greater than the amount you have requested
for a MOFELP loan in your application; provided that this requirement does not apply if you and your cosigner (if any)
agree to accept a MOFELP loan amount offered by MSLF that is equal to or less than your Certified Academic
Financial Need.
Not at any time have been more than 60 days delinquent on any MOFELP loan payment.
Meet the applicable credit underwriting criteria (or have a cosigner that meets the criteria) as described below.
*Certified Academic Financial Need is the dollar amount estimate for an academic period determined by the financial
aid office of your Participating School that is derived by subtracting the financial aid office’s estimate of “other
financial aid” utilized or to be utilized by you from the financial aid office’s estimate of “cost of attendance” at that
Participating School.
Cosigner Requirements. If you have a cosigner (see the explanation below), the cosigner must:
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Be a United States Citizen and be a permanent Missouri resident (with his or her primary domicile located in Missouri).
Be at least 18 years of age.
Not at any time have been more than 60 days delinquent on any MOFELP loan payment.
Not have a conviction for fraud.
MOFELP Underwriting Requirements
Underwriting Requirements. In addition to the eligibility requirements either you or your cosigner (if you have one) must meet
all of the following underwriting requirements:
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Have at least a two-year credit history according to a credit report for such person.
Have submitted on the Loan Application/Promissory Note two references with contact information (see Section 4 of the
Loan Application/Promissory Note).
Meet all other creditworthiness standards established from time to time by MSLF.
If it is determined that you, or you and your cosigner, if you apply with one, have less than two years of credit history, fail to
provide the required references and contact information, or fail to meet the other applicable creditworthiness standards, your
application will be denied, and if you wish to reapply, you will need to start the application process over and you may wish to
consider applying with a different cosigner.
Although a cosigner is not required for a MOFELP application to be complete, approval of a MOFELP loan application requires
that either you (the student applicant) or a cosigner meet the underwriting requirements, which may be difficult for some student
applicants to meet. In other words, if the student applicant does not meet the underwriting requirements, the application can still
be approved if a cosigner does meet those requirements, although that application would be denied if there was no cosigner.
If an application with no cosigner is denied due to not meeting the underwriting requirements, the student applicant will have to
begin the application process over again and re-apply, potentially with a cosigner who can meet the underwriting requirements to
obtain an approval. However, such a re-application would result in the applicant losing his or her place in the first come, first
served priority list. If both the student applicant and the cosigner do not meet the underwriting requirements, the application will
also be denied.
P.O. Box 4602 ● Chesterfield ● MO ● 63006-4602
(800) 809-0964 ● MOFELP@MOHELA.COM
6-2015 V-4
MOFELP PARTICIPATING SCHOOLS
Avila University
Missouri Western State University
Central Methodist University
Northwest Missouri State University
Columbia College
Park University
Cottey College
Rockhurst University
Culver-Stockton College
St Louis University
Drury University
Southeast Missouri State University
Evangel University
Southwest Baptist University
Fontbonne University
State Technical College of Missouri
Hannibal- LaGrange University
Stephens College
Harris-Stowe State University
Truman State University
Lincoln University
University of Central Missouri
Lindenwood University
University of Missouri-Columbia
Maryville University
University of Missouri-Kansas City
Missouri Baptist University
University of Missouri-St. Louis
Missouri Southern State University
Washington University
Missouri State University
Webster University
Missouri University of Science and Technology
Westminster College
Missouri Valley College
William Jewell College
William Woods University
P.O. Box 4602 ● Chesterfield ● MO ● 63006-4602
(800) 809-0964 ● MOFELP@MOHELA.COM
6-2015 V-4
Loan Application and Solicitation Disclosure Statement
Loan Interest Rate & Fees
2015-2016
Your Interest Rate during the life of the loan
Your interest rate will be
Your rate is fixed. This means that your rate will remain the same
for the life of your loan. Your interest rate will not be higher than
0%, regardless of whether you have a cosigner for this loan.
0.0%
Loan Fees
Application Fee: None. Origination Fee: None. Loan Guarantee Fee: None. Repayment Fee: None. Late Charge Fee: None.
Returned Check Fee: $25.00
Loan Cost Examples
On some other loans, the total amount you will pay will vary depending upon when you start to repay such loan. Because the Interest
Rate for your MOFELP loan is 0%, the total amount you will pay will equal the Amount Provided (see below). This example provides
estimates based upon three (3) different repayment options available to you while enrolled in school.
Repayment Option
(while in enrolled
in school)
Amount Provided
Interest Rate
Loan Term
(amount provided
directly to you or
your school)
(highest possible
rate)
(how long you
have to pay off
the loan)
1. Make $5.00/month KeepIn-Touch (KIT) payments.
Make $5.00 per month KIT
payments but defer Standard
payments while enrolled in your
Participating School at least halftime and during a grace period.
$5,000.00
0%
2. Make $25/monthly payment.
Pay $25/month while enrolled in
your Participating School at least
half-time and during a grace
period.
(this payment amount would be
optional for the borrower)
$5,000.00
0%
3. Make other monthly
payments exceeding the
mandatory $5.00 per
month KIT payments while
enrolled in your Participating
School at least half time and
during a grace period. (this
payment amount would be optional
for the borrower)
$5,000.00
0%
Initial deferral period while
student is enrolled in your
Participating School at
least half time, followed,
after a grace period , by a
10 year Standard
Repayment Period.
Initial deferral period while
student is enrolled in your
Participating School at
least half time, followed,
after a grace period , by a
10 year Standard
Repayment Period.
Initial deferral period while
student is enrolled in your
Participating School at
least half time, followed,
after a grace period , by a
10 year Standard
Repayment Period.
Total Paid Over
Loan Term
(excluding any
returned check fees)
$5,000.00
$5,000.00
$5,000.00
About This Example.
This repayment example includes repayment options prior to your entering the Standard Repayment Period, at which point your required monthly
payments will be an amortized amount, based on a 10 year period at 0% interest. This example is based on the actual interest rate during the Loan
Term but does not account for additional charges paid during the Loan Term. More information regarding payment deferral and forbearance options
during the Standard Repayment Period is available in the Application/Promissory Note. Such deferral or forbearance options (if chosen and approved)
will not increase the “Total Paid Over Loan Term,” due to the interest rate remaining at 0%.
P.O. Box 4602 ● Chesterfield ● MO ● 63006-4602
(800) 809-0964 ● mofelp@mohela.com
06-2015 V-4
Federal Loan Alternatives
Current Interest Rate by Program Type
You may qualify for a Federal
education loan.
(for disbursements made between 7-1-15 and
6-30-16)
Loan Program
Direct Loans
For Students
4.29% Fixed
Undergraduate subsidized and
unsubsidized
5.84% Fixed
Graduate unsubsidized
For additional information, contact your
school’s financial aid office or the
Department of Education at:
Direct PLUS Loans
for Parents and Graduate/
Professional Students
6.84% Fixed
www.federalstudentaid.ed.gov
Next Steps
1. Find Out About Other Loan Options.
Some schools have school-specific student loan benefits and terms not detailed on this form. Contact your school’s financial aid
office or visit the Department of Education’s web site at: www.federalstudentaid.ed.gov for more information about other loans.
2. To Apply for this Loan, Complete the Application/Promissory Note and the Self-Certification Form. You may
get the Application/Promissory Note and the certification form from your school’s financial aid office. If you are approved for this loan,
the loan terms will be available for 30 days (terms will not change during this period, except as permitted by law).
Reference Notes
Fixed Interest Rate
This loan has a fixed interest rate, which means that it will never change. On some other loans, the Interest Rate may be higher or
lower than the Annual Percentage Rate (APR) because APR considers certain fees you pay to obtain such loan, the Interest Rate,
and whether you defer (postpone) payments while you are in school. However, for your loan, the Interest Rate and the APR are each
equal to 0%.
Eligibility Criteria
Borrower Must:
• Be enrolled on a full-time basis as an undergraduate student at a “Participating School” under MOFELP.
• Be making satisfactory academic progress as determined by your Participating School.
• Have an Expected Family Contribution (EFC) of $12,000 or less for the current academic year.
• Be at least 17 years of age.
• Be a U.S. citizen and a permanent Missouri resident with your primary domicile located in Missouri.
• Not have a Bachelor’s degree.
• Have a composite score of at least 21 on ACT or 1500 on SAT; or have an overall cumulative Grade Point Average (GPA) of 2.5
or higher on a 4.0 scale (or the equivalent on another scale) earned at the Participating School.
• Not have a conviction for fraud.
• Be determined by your Participating School to have $500.00 or more of Certified Academic Financial Need (as defined in the
MOFELP Summary of Requirements) to attend your Participating School.
• Be determined by your Participating School to have an amount of Certified Academic Financial Need equal to or greater than the
amount you request for a MOFELP loan in your Application/Promissory Note; provided that this requirement does not apply if you
and your cosigner (if any) agree to accept a MOFELP loan amount offered by the Missouri Scholarship and Loan Foundation that
does not exceed your Certified Academic Financial Need amount.
• Not at any time have been more than 60 days delinquent on any MOFELP loan payment.
• Meet the applicable credit underwriting criteria
More information about loan eligibility
Cosigner (if any) Must:
• Be a U.S. citizen and a permanent Missouri resident with your primary domicile
located in Missouri.
• Not have a conviction for fraud.
• Be at least 18 years of age.
• Not at any time have been more than 60 days delinquent on any MOFELP loan payment.
• Meet the applicable credit underwriting criteria
Bankruptcy Limitations:
and repayment deferral or forbearance
options is available in the MOFELP
Application/Promissory Note and from
Missouri Scholarship and Loan
Foundation or its loan servicer, the
Missouri Higher Education Loan
Authority (MOHELA), at 1-800-809-0964,
mofelp@mohela.com, or
www.mohela.com.
• If you file for bankruptcy you may still be required to pay back this loan.
P.O. Box 4602 ● Chesterfield ● MO ● 63006-4602
(800) 809-0964 ● mofelp@mohela.com
06-2015 V-4
FACTS
WHAT DOES MISSOURI SCHOLARSHIP AND LOAN FOUNDATION (“MSLF”)
DO WITH YOUR PERSONAL INFORMATION?
Why?
Financial companies choose how they share your personal information. Federal law gives
consumers the right to limit some but not all sharing. Federal law also requires us to tell you how
we collect, share, and protect your personal information. Please read this notice carefully to
understand what we do.
What?
The types of personal information we collect and share depend on the product or service you
have with us. This information can include:

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How?
Social Security number and income
account balances and payment history
credit history and account transactions
All financial companies need to share customers’ personal information to run their everyday
business. In the section below, we list the reasons financial companies can share their
customers’ personal information; the reasons MSLF chooses to share; and whether you can limit
this sharing.
Reasons we can share your personal information
Does MSLF share?
Can you limit this sharing?
For our everyday business purposes—
such as to process your transactions, maintain
your account(s), respond to court orders and legal
investigations, or report to credit bureaus
Yes
No
For our marketing purposes—
to offer our products and services to you
Yes
No
For joint marketing with other financial companies
No
We don't share
For our affiliates’ everyday business purposes—
information about your transactions and experiences
No
We don't share
For our affiliates’ everyday business purposes—
information about your creditworthiness
No
We don't share
For our affiliates to market to you
No
We don't share
For nonaffiliates to market to you
No
We don't share
Questions?
Call (800)809-0964 or go to www.mohela.com.
1
10-2013 V-1
What we do
How does MSLF protect my personal
information?
To protect your personal information from unauthorized access
and use, we use security measures that comply with federal law.
These measures include computer safeguards and secured files
and buildings.
How does MSLF collect my personal
information?
We collect your personal information, for example, when you
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Why can’t I limit all sharing?
open an account or apply for a loan
pay your bills or pay us by check
give us your wage statements or show your driver’s license
We also collect your personal information from others, such as credit
bureaus, affiliates, or other companies.
Federal law gives you the right to limit only
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sharing for affiliates’ everyday business purposes—information
about your creditworthiness
affiliates from using your information to market to you
sharing for nonaffiliates to market to you
State laws and individual companies may give you additional rights to
limit sharing.
Definitions
Affiliates
Companies related by common ownership or control. They can be
financial and nonfinancial companies.

Nonaffiliates
Our affiliates include financial companies such as MOHELA.
Companies not related by common ownership or control. They can be
financial and nonfinancial companies.

Joint marketing
MSLF does not share with nonaffiliates so they can market to you.
A formal agreement between nonaffiliated financial companies that
together market financial products or services to you.

2
MSLF doesn’t jointly market.
10-2013 V-1
Instructions and Checklist
2015-2016
The proceeds of any Missouri Family Education Loan Program (“MOFELP”) loan must be used for educational purposes. The
Missouri Scholarship and Loan Foundation (“MSLF”) is the MOFELP lender, and the Higher Educational Loan Authority of the State
of Missouri (“MOHELA”) is the servicer of MOFELP loans. (For purposes of this “Instructions and Checklist” document, the terms
“you” and “your” refer to the student applicant and the terms “we” and “us” refer to MSLF.)
ELIGIBILITY
Student Applicant must:
 Be enrolled on a full-time basis as an undergraduate at a “Participating School” under MOFELP. (For the list of Participating Schools,
see the current MOFELP Summary of Requirements.)
 Be making satisfactory academic progress as determined by your Participating School.
 Have an Expected Family Contribution (EFC) (as defined in the Loan Application/Promissory Note) of $12,000 or less for the current
academic year.
 Be at least 17 years of age.
 Be a United States Citizen and a permanent Missouri resident with your primary domicile located in Missouri.
 Not have a bachelor’s degree.
 Have a composite score of at least 21 on ACT or 1500 on SAT; or have an overall cumulative Grade Point Average (GPA) of 2.5 or
higher on a 4.0 scale (or the equivalent on another scale) earned at the Participating School.
 Not have a conviction for fraud.
 Have an amount of Certified Academic Financial Need (as defined below) * to attend your Participating School of $500 or more.
 Have an amount of Certified Academic Financial Need* that is equal to or greater than the amount you requested for a MOFELP loan
in your application; provided that this requirement does not apply if you and your cosigner (if any) agree to accept a MOFELP loan
amount offered by MSLF that is equal to or less than your Certified Academic Financial Need.
 Not at any time have been more than 60 days delinquent on any MOFELP loan payment.
 Meet the applicable credit underwriting criteria (or have a cosigner that meets the criteria) as described below.
 If you have a cosigner, the cosigner must meet the eligibility requirements listed below.
*Certified Academic Financial Need is the dollar amount estimate for an academic period determined by the financial aid office of your
Participating School that is derived by subtracting the financial aid office’s estimate of “other financial aid” utilized or to be utilized by you from the
financial aid office’s estimate of “cost of attendance” at that Participating School.
WHEN TO APPLY

A Loan Application/Promissory Note must be received by MSLF no later than 30 days after the end of the academic period for which
you are applying. However, due to limited funds being available, earlier submissions receive priority for consideration if they are
complete. See the MOFELP Summary of Requirements for details.
HOW TO APPLY
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If you are viewing this application package from MOHELA’s website, you will need to print it all on paper.
Read the entire Loan Application/Promissory Note.
Complete all information requested in Sections 1 through 4 of the Loan Application/Promissory Note. All fields are required to be
completed, and any missing data could result in denial of the application.
Use black or blue ink and print clearly.
Sign and date the Loan Application/Promissory Note.
Complete and sign the Private Education Loan Applicant Self-Certification (“Self-Certification”).
If you have a cosigner, the cosigner must sign and date the Loan Application/Promissory Note and Self-Certification. See the section
below regarding cosigners.
06-2015 V-4
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Make a photocopy of the completed and signed Loan Application/Promissory Note and Self-Certification to keep for your records.
Submit the signed original (not a copy) Loan Application/Promissory Note and Self-Certification to the financial aid office at your
school. Applications cannot be submitted electronically.
If you would like loan payments to be automatically withdrawn from a bank deposit account, submit the Auto Debit Authorization
Agreement with the Loan Application/Promissory Note and Self-Certification, completed and signed as indicated.
Your school’s financial aid office will complete the School Certification and submit your Loan Application/Promissory Note and SelfCertification to MSLF on your behalf.
LOAN REQUEST (Section 2). Indicate the loan amount and semesters for which you are applying. The annual maximum aggregate loan
amount per borrower is $5,000, the minimum loan amount is $500, and the total maximum aggregate loan amount per borrower is $20,000. If
your loan is approved, the number and amount of disbursements will be determined by MSLF, which will take into account your loan request and
the certification of your school’s financial aid office. If your loan is approved, the amount of your loan will not exceed your Certified Academic
Financial Need as determined by your Participating School, even if such amount is less than your loan request. Each loan may be disbursed in
up to four disbursements.
COSIGNERS (Section 3). If you have less than two years of credit history or fail to meet certain creditworthiness standards established by
MSLF, a cosigner with at least two years of credit history who meets such creditworthiness standards is required. To have a credit history
requires having been provided credit (such as a credit card or a loan). Credit history and the other applicable credit standards may be difficult for
some students to meet. If you apply without a cosigner and it is determined that you have less than two years credit history or do not meet the
other applicable credit standards, your application will be denied. If your application is denied and you then wish to apply with a cosigner, you
will need to start the application process over. Because funds for loans under this program are limited and provided to qualifying applicants in
the order that completed qualifying applications are received, you may wish to consider applying with a cosigner from the beginning.
In addition to meeting the credit history and other creditworthiness standards as described above, any Cosigner must also meet the following
eligibility requirements:
 Be a United States Citizen and be a permanent Missouri resident (with his/her primary domicile located in Missouri).
 Be at least 18 years of age.
 Not at any time, have been more than 60 days delinquent on any MOFELP loan payment.
 Not have a conviction for fraud.
UNDERWRITING REQUIREMENTS. In addition to the eligibility requirements either you or your cosigner (if you have one) must meet all of the
following requirements:
 Have at least a two-year credit history according to a credit report for such person.
 Have submitted on the Loan Application/Promissory Note two references with contact information (see Section 4 of the Loan
Application/Promissory Note).
 Meet all other creditworthiness standards established from time to time by MSLF.
If it is determined that you, or you and your cosigner, if you apply with one, have less than two years of credit history, fail to provide the
required references and contact information, or fail to meet the other applicable creditworthiness standards, your application will be denied,
and if you wish to reapply, you will need to start the application process over and you may wish to consider applying with a different
cosigner.
REFERENCES (Section 4). List two persons, other than any cosigner provided in Section 3 of the Loan Application/Promissory Note, who are
not members of your own household (have a different address than you) who will always have direct knowledge of your whereabouts. We will
communicate with the references you provide in Section 4 if we are ever unable to contact you.
EMAIL. Email will be used whenever possible to communicate with you. Enter your preferred e-mail address for receiving communications.
You are not required to provide this information. If you do, MSLF and its agents may use your e-mail address to communicate with you. If you
do not have an e-mail address or do not wish to provide one, enter N/A where an e-mail address is requested. Please notify us if the email
address you provide on your application becomes invalid or is changed.
APPLICATION CHECKLIST. All submissions must be original, signed documents. Copies of documents are not acceptable. Make a copy of
the original, signed documents and keep the copy for your records. Submit the following to the financial aid office of your school.
_____
Loan Application/Promissory Note completed and signed by student applicant and cosigner, if applying with a cosigner.
_____
Private Education Loan Applicant Self-Certification, completed and signed by student applicant and cosigner, if applying with
a cosigner.
_____
Auto Debit Authorization Agreement completed and signed as indicated, if you want to authorize MSLF to automatically debit
a bank account to make your loan payments.
06-2015 V-4
Loan Application/Promissory Note
2015-2016
A copy of this Application/Promissory Note can be found at www.mohela.com
Print clearly in Pen or Type
Submit completed and signed application materials to Student’s Financial Aid Office
Section 1—Borrower/Student Information
1. Student’s Name
Last
First
2. Permanent Street Address
(P.O. Box not accepted)
Street
City
State
3. Mailing Address
(if different than above, include P.O. Box)
(
Zip
P.O. Box/Street
City
4. Telephone Numbers
Middle Initial
State
Zip
) _____________________________________
Home / Primary Number
(
)
Alternate Number
5. E-mail Address
(Lender or its loan servicer may notify Student about the application status at this e-mail address.)
6. Social Security Number ____________________________________________
7. Date of Birth
Month/Day/Year
8. U.S. Citizen?
Yes
No
10. Does Student have a composite score of at least 21 on the ACT, 1500 on the SAT or have an overall
9. Has Student ever been convicted of fraud?
Yes
No
11. Does Student have a Bachelor’s Degree?
Yes
No
cumulative GPA of 2.5 or higher on a 4.0 scale (or the equivalent on another scale) earned at the
current Participating School?
12. Participating School Attending
Yes
No
Name
City
State
Section 2— Loan Request
13. Loan Amount Requested: $_________________*, subject to decrease by the amount of any disbursement if
Student is not a full-time student at the Participating School when that disbursement is to be issued (Loan Amount
Requested can be up to $5,000; minimum $500. Loan may be made in more than one disbursement.)
*Note: The amount
requested should not be
changed. Any change to
the amount requested may
invalidate this Application.
06-2015 V-4
Page 1 or 4
14. Academic Year or Semester(s) for which loan is requested
Fall 2015
Spring 2016
Full Year 2015 -2016
Summer 2016
Section 3—Cosigner Information (A cosigner may improve chances of loan approval.
See Instructions for further details)
15. Cosigner’s Name
Last
First
Middle Initial
16. Social Security Number_________________________________________________
17. Date of Birth
Month/Day/Year
18. U.S. Citizen?
Yes
No
19. Has Cosigner ever been convicted of fraud?
20. Permanent Street Address
(P.O. Box not accepted)
No
Street
City
State
21. Mailing Address
(if different than above, include P.O. Box)
Zip
P.O. Box/Street
City
22. Telephone Numbers (
Yes
State
Zip
)
(
)
Home / Primary Number
Alternate Number
23. E-mail Address
(Lender or its loan servicer may notify Cosigner about the application status at this e-mail address.)
24. Employer___________________________________________________________
Name
(
)
Telephone Number
Address
City
State
Zip
Section 4—Reference Information (Provide 2 references who are not members of your own household and have different addresses.. See Instructions for further details)
Reference #1
25. Reference’s Name
Last
First
26. Permanent Street Address
(P.O. Box not accepted)
Middle Initial
Street
City
State
Country
Zip
27. E-mail Address
28. Telephone Numbers (
)
Home / Primary Number
29. Relationship to Borrower
Parent
Other Relative
(
)
Alternate Number
Guardian
Other (specify relationship):
Reference #2
30. Reference’s Name
Last
First
31. Permanent Street Address
(P.O. Box not accepted)
Middle Initial
Street
City
State
Country
Zip
32. E-mail Address
33. Telephone Numbers (
)
(
Home/Primary
34. Relationship to Borrower
6-2015 V-4
Parent
Other Relative
)
Alternate
Guardian
Other (specify relationship):____
Page 2 or 4
Section 5—Certifications and Signatures (Failure to sign and date this Application/Promissory Note will result in denial of this application.)
Each of us (Borrower and Cosigner) has completed this Application/Promissory Note to obtain credit, and certifies under penalty of perjury that the
above statements are true and complete, to the best of his or her knowledge and belief. Each of us further certifies that (i) we are permanent residents
of the State of Missouri (with our primary domiciles located in Missouri), (ii) this Application/Promissory Note was signed in the State of Missouri, and
(iii) that proceeds of any loan made will be used only for expenses directly relating to the Cost of Attendance at the school identified in Section 1 of this
Application/Promissory Note, at which the Borrower is enrolled on a full-time basis. Each of us also authorizes Missouri Scholarship and Loan
Foundation (“MSLF”), or its designee, to check our references and to obtain a credit report. Each of us also authorizes MSLF, or its designee, to
provide credit information arising from this transaction to others as permitted by applicable law. We also authorize any educational institution the
Borrower may attend to release to MSLF, or its designee, or any subsequent holder, any information pertinent to this loan (e.g. enrollment status,
current address).
Each of us acknowledges that the information requested from us in this Application/Promissory Note will be used by MSLF, or its designee, to verify
each of our identities, and each of us authorizes MSLF, or its designee, to verify each of our identities.
Each of us authorizes MSLF, or its designee, to release information about the loan to the references on the loan unless we submit written directions
otherwise.
Each of us authorizes MSLF and its agents and contractors to contact us regarding the Application/Promissory Note or the loan, including repayment of
the loan, at the current or any future telephone number that we provide (including for any cell phone, wireless or other communication device) using
automated dialing equipment or artificial or prerecorded voice or text messages.
Any notice or disclosure required to be given to either of us will be effective if sent by first-class mail to the most recent address MSLF has for us, by
electronic means to an address or number we have provided, or by another method of notification permitted or required by applicable statute or
regulation. Each of us will notify MSLF of a change of contact information or status as specified in the Application/Promissory Note Terms.
Each of us acknowledges that we each received the Application and Solicitation Disclosure Statement with this Application/Promissory Note in
accordance with the federal Truth-in-Lending Act, as implemented by the Federal Reserve Board’s Regulation Z, 12 C.F.R. Part 226, and as currently
codified by the Consumer Financial Protection Bureau in 12 C.F.R. Part 1026. Each of us acknowledges that the Application and Solicitation
Disclosure Statement was provided to Borrower, and Borrower provided a copy of such disclosure to Cosigner.
Promise to Pay: For value received, I promise to pay to the order of MSLF all Principal (as defined in Section 2 of the Application/Promissory Note
Terms) sums disbursed under this Application/Promissory Note, and, in addition, pay Interest as described in Section 6 of the Application/Promissory
Note Terms, late charges and returned payment fees, and any other collection costs that are permitted by applicable law, including without limitation,
collection agency charges, reasonable attorneys’ fees, and actual court costs (including fees and costs in bankruptcy court and in appellate courts). I
understand that I will be liable to pay all of these amounts, in full, even if another person also signs this Application/Promissory Note. I agree to make
payments on the Loan (as defined in Section 2 of the Application/Promissory Note Terms) in accordance with the applicable payment schedule even if I
do not receive a bill or repayment notice. I will not sign this Application/Promissory Note before reading the entire Application/Promissory Note, even if I
am told I am not required to read it. I am entitled to an exact copy of this Application/Promissory Note.
Prior to signing this Application/Promissory Note, I have read and understood all the provisions of this Application/Promissory Note. I agree
to the terms of this Application/Promissory Note and acknowledge receiving a completed copy of this Application/Promissory Note, which
includes the Application/Promissory Note Terms and the other documents defined in the Application/Promissory Note Terms to be part of this
Application/Promissory Note. .
CAUTION: IT IS IMPORTANT THAT EACH BORROWER AND COSIGNER THOROUGHLY READS THIS APPLICATION/PROMISSORY NOTE AND
ENSURE THAT THERE ARE NO BLANK SPACES CONTAINED IN THE APPLICATION/PROMISSORY NOTE BEFORE SIGNING BELOW.
Before Borrower and Cosigner (if any) submit these
application materials, make sure Borrower and
Cosigner:
BORROWER SIGNATURE
DATE
COSIGNER SIGNATURE
DATE
• Read Summary of Requirements, Privacy Notice,
Application and Solicitation Disclosure Statement.
• Read Instructions and Checklist,
Application/Promissory Note, and
Application/Promissory Note Terms. Complete all of
these items.
• Sign (Borrower and Cosigner, if any) and date the
Application/Promissory Note, and keep a copy for
Borrower and Cosigner’s records.
• Sign (Borrower and Cosigner, if any) and date the
Private Education Loan Self Certification form.
• Complete and sign as indicated the Auto Debit
Authorization Agreement if Borrower wants to have
payments on the Loan made automatically from a
bank account. Note: Only the borrower can apply for
Auto Debit.
Submit original (not a copy) signed documents to
the Financial Aid Office of Student’s Participating
School.
06-2015 V-4
Page 3 or 4
School Certification of Borrower/Student (to be completed by financial aid office)
The terms “I” and “my,” as used in this School Certification of Borrower/Student, refer to the Authorized Officer signing below on behalf of the Participating School.
1. Participating School:
Name of School
School Code
2. Telephone Number: (__________)______________________________
3. Loan Period:
4. Student Name: ____________________________________________
5. Student Social Security Number: __________/________/__________
6. Student date of birth:
7. Permanent Residence in Missouri (with primary domicile located in Missouri):
________/__________/__________
8. Undergraduate Class Year:
1st Year
2nd Year
3rd
__ __ / __
4th Year
/ __
__ to __
__ / __
/ __ __
Yes
No
5th Year
Year
9. Enrolled Full Time:
Yes
No
10. Have an EFC of $12,000 or less for this academic year:
11. Composite score of at least 21 on the ACT, 1500 on the SAT
12. Satisfactory Academic Progress:
Yes
Yes
No
No
or an overall cumulative GPA of 2.5 or higher on a 4.0 scale
(or the equivalent on another scale) earned at the current
Participating School :
Yes
13. Anticipated or Actual Graduation Date:
No
/
/
14. Prior Bachelor’s Degree:
Yes
No
15. Requested Disbursement Date(s): (Maximum of four dates)
a:
___ /
___ /
c:
___ / ___
b:
___
d: ___
/ ___
___ /
/ ___
___ /
Financial Aid Use Only: Application Rec’d by FAO:
___
/ ___
Date
16. Determination of Certified Academic Financial Need:
Cost of Attendance at Participating School:
____________________________
Less: Estimate of Other Financial Aid Utilized or to be Utilized by Applicant for Applicable Academic Period: Equals: Certified Academic Financial Need:
=
___________________
_________________________
I hereby certify that the student named in this Loan Application/Promissory Note is attending the school identified above during the academic year for which this loan is to
be applied. I further certify that, based upon records of this institution, the information provided in this School Certification of Borrower/Student is true, complete, and
correct to the best of my knowledge and belief. When requested by MSLF or MOHELA, or any subsequent holder of this loan, this institution will provide any information
pertinent to this loan (e.g. Borrower’s enrollment status, current address), or cause such information to be provided. I certify that the MSLF loan program is administered by
this institution in accordance with MSLF program rules and applicable laws and regulations.
__________________________________________________________________
Date:
Month/Day/Year
Signature of Authorized Officer of the above-named Participating School
Print Name:
Title:
Mail with completed Loan Application/Promissory Note & Student Self-Certification to:
(make a copy for the Participating School’s records prior to mailing)
MOHELA
P.O. Box 4602
Chesterfield, MO 63006-4602
Phone: 1.800.809.0964
Fax: 636-787-2768
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Missouri Family Education Loan Program
Application/Promissory Note Terms
1. IDENTIFICATION OF TERMS AND PARTIES
The term “Application/Promissory Note” as used in this document refers to this Loan Application/Promissory Note (including the Application/Promissory Note Terms) and, as applicable, the
School Certification of Borrower/Student, Disclosure Statements, and Cosigner Notices referenced herein, except as otherwise provided in any of the foregoing. Except as provided in
Section 16 of the Application/Promissory Note Terms and as provided in the School Certification of Borrower/Student, the words “I,” “my,” “me” and related pronouns mean, for purposes of
this Application/Promissory Note, each person who signs this Application/Promissory Note as Borrower or as Cosigner, jointly and severally, unless the applicable language specifically
refers to only one or the other or specifies a different meaning. Furthermore, except as provided in Section 16 of the Application/Promissory Note Terms and as provided in the School
Certification of Borrower/Student, the words “you” and “your” mean the Lender, as further defined in Section 2 of the Application/Promissory Note Terms.
2. DEFINITIONS
“Acceptance Period” means the thirty (30) calendar-day period following the date on which Borrower receives the Approval Disclosure Statement for the Loan disclosed therein.
“Application and Solicitation Disclosure Statement” means the statement provided to Borrower, which discloses, among other things, information about applicable Interest rates, fees,
late payment costs, repayment terms, including an example of the total cost of a Loan based upon the maximum Interest rate offered by the Lender, as required by Regulation Z, and which
is included on or with my Application/Promissory Note.
“Application/Promissory Note Terms” means the provisions set forth under this part of the Application/Promissory Note under the heading “Application/Promissory Note Terms.” Except
as otherwise provided in this document, the Application/Promissory Note Terms do not in any way limit the effectiveness of other terms and conditions set forth elsewhere in the
Application/Promissory Note.
“Approval Disclosure Statement” means the statement provided to Borrower, which discloses, among other things, information specific to the applicable Loan approved by the Lender,
as required by Regulation Z, and which is included on or with notice that the Lender has approved my Application/Promissory Note. The term shall also include any subsequent approval
disclosure statement required by Regulation Z to be given upon changes in the Loan.
“Business Day” means all calendar days except Sundays and legal Federal holidays.
“Cancellation Period” means the period during which Borrower or Cosigner has the right to cancel the Loan approved by Lender, without penalty, which period expires at midnight of the
third (3rd) Business Day following Borrower’s receipt of the related Final Disclosure Statement, as specified in the Right to Cancel box at the top of the Final Disclosure Statement.
“Certified Academic Financial Need” means the dollar amount estimate for an academic period determined by the financial aid office of my Participating School that is derived by
subtracting such financial aid office’s estimate of Other Financial Aid utilized or to be utilized by me for the applicable academic period from such financial aid office’s estimate of the Cost
of Attendance at my Participating School.
“Communication” means any Disclosure Statement, notice, tax document, or other form of correspondence related to this Application/Promissory Note or Loan.
“Cosigner Notice” means any applicable notice that describes the obligations of a Cosigner under this Application/Promissory Note with respect to the Loan that I obtain subject to the terms of this
Application/Promissory Note.
“Cost of Attendance” means the cost of attendance, as defined in 20 U.S.C. §1087ll, at the Participating School.
“Current Total Financial Aid” means, at the time of any Loan disbursement, the amount derived by adding all Other Financial Aid of Student for the applicable academic period as of the
date of such disbursement (including any such Other Financial Aid listed in the Application/Promissory Note and any additional Other Financial Aid), as estimated in the sole discretion of
the Participating School, to the total amount of prior Loan disbursements.
“Current Total Financial Need” means, at the time of any Loan disbursement, the amount derived by subtracting Student’s Current Total Financial Aid from the Cost of Attendance at the
Student’s Participating School as estimated in the sole discretion of the Participating School for the applicable academic period. If Current Total Financial Need is calculated to be a negative
number, it shall be deemed to be zero instead.
“Disbursement Date” means the date that the Lender first makes a disbursement of the Loan in accordance with and subject to the terms and conditions of this Application/Promissory
Note.
“Disclosure Statement” means, as applicable, an Application and Solicitation Disclosure Statement, Approval Disclosure Statement and/or Final Disclosure Statement, as required by
Regulation Z, or such other disclosure statement that the Lender may provide when a disclosure statement is not required by Regulation Z.
“Eligible School” means, for purposes of eligibility for deferment from Standard Payments due to enrollment in school, as described in Section 7 of the Application/Promissory Note Terms
(below), an institution of higher education as defined in 34 CFR 600.4.
“Expected Family Contribution” (EFC) means, the number that is designated as the EFC on the Student Aid Report (SAR) issued by the U.S. Department of Education Central Processing
System to the Student of the applicable academic period and certified by the financial aid office of the Participating School on the Loan Application/Promissory Note.
“Final Disclosure Statement” means the statement that discloses information specific to my Loan including, among other things, the right of Borrower or Cosigner to cancel the Loan
during the Cancellation Period, as required by Regulation Z, which will be provided to Borrower if I accept the Loan within the Acceptance Period. The term shall also include any subsequent
final disclosure statement required by Regulation Z to be given upon changes in the Loan.
“Grade Point Average” (GPA) means an indication of a student's academic achievement at a Participating School, calculated by that Participating School as the total number of grade
points received over a given period divided by the total number of credits awarded.
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“Interest” means interest that accrues at the applicable rate set forth in the Final Disclosure Statement on the unpaid Principal balance of the Loan.
“Keep-In-Touch Payment Period” means the period of time during which the Keep-In-Touch Payments will be made. The Keep-In-Touch Payment Period shall begin on the Disbursement
Date and continue until the Maturity Date.
“Keep-In-Touch Payment” means the monthly payment in the amount of $5 that I will make to the Lender during the Keep-In-Touch Payment Period, as provided in the Final Disclosure
Statement and in Section 7 of the Application/Promissory Note Terms, provided that Keep-In-Touch Payments will not be required during any period in which Standard Payments are being
made. Except as expressly authorized under the Application/Promissory Note Terms, Keep-In-Touch Payments cannot be deferred and I will make Keep-In-Touch Payments during any
forbearance or deferment period that may occur under this Application/Promissory Note. Keep-In-Touch Payments shall be applied first to accrued Interest payable under this
Application/Promissory Note and then to the outstanding Principal.
“Lender” means Missouri Scholarship and Loan Foundation, its successors and assigns, or any subsequent holder of this Application/Promissory Note, unless the applicable language
specifies a different meaning.
“Loan” means any extension of credit provided to me under the terms of this Application/Promissory Note in one or more disbursements, including without limitation, all Principal of this
Application/Promissory Note plus Interest and any other fees, charges, or amounts due and owing pursuant to this Application/Promissory Note, as amended from time to time pursuant to
the terms of this Application/Promissory Note.
“Loan Amount Requested” means the loan amount requested on my Application/Promissory Note.
“Loan Start Date” means the date on which my Cancellation Period expires without my cancelling the Loan.
“Maturity Date” means the date the final Standard Payment is due as disclosed in the Final Disclosure Statement provided to Borrower, as the same may be extended pursuant to the
terms of this Application/Promissory Note.
“Other Financial Aid” includes financial aid such as scholarships, grants and loans, other than any estimated family contribution or disbursements received under this Loan.
“Participating School” means, for purposes of eligibility for a Loan, the educational institution identified on page 1 of the Application/Promissory Note, which must be a higher education
institution or technical college, which has been approved by Lender to participate in the Missouri Family Education Loan Program (MOFELP).
“Principal” means any amounts disbursed to me or to the Participating School on my behalf or paid on my behalf under this Application/Promissory Note, which shall include any fees and
charges added to the Principal of the Loan pursuant to this Application/Promissory Note.
“Privacy Policy” means the statement that discloses information regarding how the Lender collects, shares, and protects personal information.
“Regulation Z” means the federal Truth-in-Lending Act, as implemented by the Federal Reserve Board’s Regulation Z, 12 C.F.R. Part 226, and as currently codified by the Consumer
Financial Protection Bureau in 12 C.F.R. Part 1026.
“Self-Certification Form” means the Private Education Loan Applicant Self-Certification or such other form signed by me in a written or electronic format setting forth information pursuant
to Section 155 of the Higher Education Act of 1965, as amended, and Regulation Z.
“Separation Date” means the earlier of: (i) the date that Student ceases to be enrolled in the Participating School on a half-time basis; and (ii) Student’s date of graduation from the
Participating School, each as reflected in the Participating School’s records.
“Servicer” means the Missouri Higher Education Loan Authority (MOHELA) or such other third party that has a contractual agreement to service loans made pursuant to the
Application/Promissory Note, including, but not limited to, invoicing and collecting payments under this Application/Promissory Note.
“Standard Payment” means the monthly payment disclosed in the Final Disclosure Statement that I will make to the Lender during the Standard Repayment Period, as provided in Section
7 of the Application/Promissory Note Terms, as the same may be amended pursuant to the terms of this Application/Promissory Note.
“Standard Repayment Period” means the period of time during which Standard Payments will be made and shall be no longer than 10 years, except as provided in this
Application/Promissory Note. The Standard Repayment Period shall begin on the Standard Repayment Period Start Date and continue until the Maturity Date.
“Standard Repayment Period Start Date” means the date the Standard Repayment Period begins, which shall be the 15 th day of the month first occurring after the 180th day following
the Separation Date, unless otherwise provided in this Application/Promissory Note.
“Student” means the person identified as the Borrower on the Application/Promissory Note.
3. WHEN BOUND; AUTHORITY NOT TO MAKE LOAN OR DISBURSEMENTS; RIGHTS TO ACCEPT OR CANCEL; RECEIPT OF MAILED DISCLOSURE STATEMENTS
A. I understand that when you receive my signed Application/Promissory Note, you are not agreeing to lend me money and I am not bound by the terms and conditions set forth in this
Application/Promissory Note, and there is no such agreement until the Loan Start Date. If you decide to make the Loan to me, I hereby authorize you at your option and on my behalf to
either electronically transfer the Loan proceeds to the Participating School for me or mail a check for the Loan proceeds made payable to the Participating School for me. You have the right
to not make the Loan or not make a disbursement on the Loan, as permitted by applicable law and this Application/Promissory Note, including but not limited to Section 5 below. The
amount of the Loan shall not exceed my Certified Academic Financial Need, regardless of the Loan Amount Requested. Further, you have the right to lend an amount less than the Loan
Amount Requested based upon a certification or other information received from the Participating School or from me indicating that my Cost of Attendance at the Participating School has
decreased or Other Financial Aid has increased, based on my eligibility at the time of my request or based upon availability of funds designated for the loan program for which I applied. I
have the right to accept or reject a Loan counteroffer from you for an amount less than the Loan Amount Requested, provided that this right does not apply to disbursement amounts after
the Loan is effective. If I accept such counteroffer, I agree to repay the loan amount that Lender actually lends to me. I authorize the Participating School to apply each disbursement of
the Loan to Student’s student account at the Participating School and to return to Lender as a partial prepayment on the Loan, the amount that any such disbursement exceeds Current
Total Financial Need. Lender may rely on this authorization and the Participating School’s determination of Current Total Financial Need. Upon receipt of such prepayment, Lender agrees
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06-2015 V-3
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Missouri Family Education Loan Program
to apply the repaid amount as a payment on the Loan. I waive all claims of liability that I may have against Lender if funds that would have otherwise been used to pay any expenses of
mine are repaid to Lender by the Participating School.
B. By signing this Application/Promissory Note, and submitting it to the Lender, either directly or through the Participating School or some other person as directed in the
Application/Promissory Note, I am requesting that you make a Loan to me in the principal amount set forth on this Application/Promissory Note and on the terms and conditions set forth in
this Application/Promissory Note. If you approve this request and agree to make a Loan, you will provide me with an Approval Disclosure Statement, as required by law, in a written or
electronic form, as applicable. After Borrower’s receipt of the Approval Disclosure Statement, I have the right to accept the Loan terms at any time during the Acceptance Period or such
other date provided on the Approval Disclosure Statement, whichever is later, by contacting you as provided on the Approval Disclosure Statement.
C. Upon my acceptance of the Loan terms, as provided in Section 3.B. of the Application/Promissory Note Terms, you will provide Borrower with a Final Disclosure Statement, as required
by law, in a written or electronic form, as applicable. The Final Disclosure Statement will include, among other things, my right to cancel the Loan, without penalty, at any time before the
Cancellation Period expires.
D. In accordance with Regulation Z, whenever you mail to Borrower any Disclosure Statement that is required to be provided under this Application/Promissory Note or by law, Borrower
will be deemed to have received the applicable Disclosure Statement three (3) Business Days after the Lender places the applicable Disclosure Statement in the mail. Borrower will notify
Cosigner of receipt of each Disclosure Statement.
4. CERTIFICATION OF BORROWER; LOAN PURPOSE
I declare under penalty of perjury under the laws of the United States of America that the following is true and correct. I certify that the information contained in my Application/Promissory
Note is true, complete and correct to the best of my knowledge and belief and is made in good faith. I certify, represent and warrant that the proceeds of my Loan will be used for the
payment of the Cost of Attendance at the Participating School. I understand that I am responsible for repaying immediately any funds that I receive which are not to be used or which are
not used for the payment of the Cost of Attendance at the Participating School for the applicable academic period. I hereby authorize the Participating School, and if the Participating School
is closed, any third party such as a custodian, receiver, bankruptcy trustee or trustee for a performance bond or tuition recovery fund, to pay to you any refund which may be due up to the
amount of my Loan.
5. DISBURSEMENTS
Disbursements: Before you make the first disbursement of the Loan made hereunder, you will provide Borrower with the Final Disclosure Statement that applies to the Loan in accordance
with Regulation Z. You will not disburse any Loan funds on my behalf until after my Cancellation Period expires and my completion of the Self-Certification Form. My Loan may be made
in more than one disbursement in the academic period for which I was approved. I acknowledge that Lender will disburse my Loan either by (a) transmitting funds electronically to the
Participating School, to be applied to the Student’s account or (b) by issuing a check made payable to the Participating School. If the Participating School or I return all or part of any
disbursement for whatever reason, Lender will apply any amount it receives to what I owe under this Application/Promissory Note, and if I have paid Lender in full, Lender will then refund
any excess to me.
Full-Time Student Requirement: Student agrees to be a full-time student as determined by the Participating School, at the Participating School throughout the academic period for which
the Loan is issued. If Student is not a full-time student at the Participating School at the time any disbursement is to be issued, such disbursement shall not be issued, and the Loan amount
shall be decreased by the amount of such unissued disbursement. If any such disbursement is issued in error, I am responsible for repaying immediately to Lender the full amount of such
disbursement, and I authorize the Participating School to make such repayment on my behalf. Lender may rely on this authorization. The rights and requirements under this Section 5 are
in addition to any other rights or remedies of Lender.
Effect of Late Payments on Disbursements: In addition to any other remedies available to you upon any default of this Application/Promissory Note, if any payment on my Loan or any
other loan made to me by Lender is more than 60 days past due, no subsequent disbursement, if any, on my Loan will be made.
6. INTEREST
If the fixed annual Interest rate set forth in the applicable Disclosure Statement provided to Borrower is zero, no Interest accrues (Sections 6.A and 6.B of the Application/Promissory Note
Terms below do not apply) and the Loan is interest free, except as stated below in regards to interest after judgment in Section 6.C of the Application/Promissory Note Terms.
A. Interest Begins Accruing on Disbursement Date: Interest accrues on the unpaid Principal balance of the Loan from the Disbursement Date until the date the Loan is repaid in full.
The rate at which Interest accrues on the unpaid Principal is calculated at the fixed annual Interest rate set forth in the Final Disclosure Statement provided to Borrower and shall be
computed on the basis of actual days elapsed and a 365/366-day year.
If I make my payment before it is due, less Interest will accrue. If I make my payment after it is due, more Interest will accrue. The amount of my final payment will depend on the amounts
and dates of my payments.
B. Interest After Default: Interest may accrue after default at the same rate applicable to my Loan before default.
C. Interest After Judgment: If Lender obtains a judgment against me on this Application/Promissory Note, Interest will accrue after judgment at the higher of (i) the same rate applicable
to my Loan after default and before judgment and (ii) the judgment interest rate for judgments and orders for money provided by statute.
7. REPAYMENT
General Repayment: I will repay the Loan as follows:
A. Keep-In-Touch Payments. I will pay the Keep-In-Touch Payment of $5 per month for the Loan under this Application/Promissory Note. This Keep-In-Touch Payment is in
addition to any similar monthly payment I am required to make under each other loan made to me by Lender under any other promissory note. The first Keep-In-Touch Payment
shall be due on the 15th day of the month immediately following the month in which the Disbursement Date occurs for any Disbursement Date occurring on or between the 1st and
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14th days of a month and on the 15th day of the second month immediately following the month in which the Disbursement Date occurs for any Disbursement Date occurring on or
between the 15th and last day of a month. In either case, each subsequent Keep-In-Touch Payment shall be due on the 15th day of each month thereafter, provided that Keep-InTouch Payments will not be required during any period in which Standard Payments are being made.
B. Standard Payments. Commencing on the Standard Repayment Period Start Date and on the 15th calendar day of each month thereafter during the Standard Repayment Period,
I will pay the Standard Payment amount of no less than $25.00 a month, as set forth on the Final Disclosure Statement. The final Standard Payment shall be due on the Maturity
Date.
C. Maturity Date. On the Maturity Date, I understand and agree that the remaining outstanding Principal balance of the Loan and all accrued and unpaid Interest and fees shall be
due and payable in full.
D. Making Payments. I understand and agree that payments must be made in U.S. funds, via Automated Clearing House (ACH) transfers in the manner provided to me by the
Lender or Servicer, or via U.S. mail at the address provided to me by the Lender or Servicer. If I choose not to make payments via ACH transfers, I must mail each payment in time
to reach the Lender or Servicer by the due date.
Prepayment: I may, at my option, prepay all or any part of the Principal, Interest and other charges at any time before payment is due without penalty. Prepayment of less than the entire
outstanding amount of my Loan will not reduce the amount of my required monthly payment, but may reduce the number of payments I must make and/or the amount of my final payment.
Returned Payment Fee: I agree to pay the Lender or Servicer, as applicable, a returned payment fee of $25 for any check or other instrument I give for my payment or electronic payment
that is dishonored for any reason, or if my financial institution returns any of my payments to Lender unpaid, except as prohibited by applicable law. This fee is in addition to any fee that
my financial institution may also charge me.
Payment Due Notwithstanding Withdrawal from School, Death or Disability: I understand that I have to repay this Loan in full, even if I withdraw or I am dismissed from the Participating
School without graduating. If I die, the terms of this Application/Promissory Note will be binding on my estate, which will be liable for my unpaid indebtedness. I also understand that if I
become totally and permanently disabled, my unpaid indebtedness on this Loan will not be canceled. I also understand that I will be liable for my unpaid indebtedness even if I fail to attend
school or am dissatisfied with the education I receive from the Participating School.
Application of Payments: Notwithstanding anything to the contrary herein, you may apply payments on my Loan in any manner that you determine within your sole discretion, as permitted
by applicable law. If I have more than one loan with you, any payments you receive from me that are not designated for a specific loan may be applied to one or more of my loans in any
manner that you determine within your sole discretion, as permitted by applicable law. I will not send you partial payments marked “paid in full,” “without recourse” or with other similar
language unless such payments are submitted in accordance with Section 12 of the Application/Promissory Note Terms under the heading “No Accord and Satisfaction,” and sent to
Missouri Scholarship and Loan Foundation c/o MOHELA, Attention: Accounting Department, P.O. Box 4602, Chesterfield Missouri 63006-4602, or to such other address as I may be given
in the future. I also understand that if I send such payment, Lender or Servicer may accept it without losing any rights under this Application/Promissory Note and that acceptance of such
payment will not be deemed an accord and satisfaction of what I owe on the Loan.
Standard Payment Deferment; Standard Payment Forbearance:
A. Standard Payment Deferment: If at any time during the Standard Repayment Period Student is enrolled at any Eligible School on at least a half-time basis, I may defer my
Standard Payments until Student is no longer a student on at least a half-time basis at an Eligible School by submitting a request for deferment to Servicer, subject to Section C
below. During any such deferment, (i) I will not be required to make Standard Payments, (ii) interest, if any, will continue to accrue and I will remain responsible for all Interest, if any,
that accrues during such deferment and (iii) I will make monthly Keep-In-Touch Payments except as otherwise authorized under the Application/Promissory Note Terms.
B. Standard Payment Forbearance; Reduced Payment. If at any time during the Standard Repayment Period I am unable to make Standard Payments as required by the terms
of this Application/Promissory Note, I may ask for forbearance, subject to Section C below. I understand that granting a request for a period of forbearance, the terms of any
forbearance and/or extending any period of forbearance previously granted, is at Lender’s sole option and in Lender’s sole discretion. If a request for forbearance is granted, during
such forbearance period, (i) I will not be required to make Standard Payments, (ii) interest, if any, will continue to accrue and I will remain responsible for all Interest, if any, that
accrues during such forbearance period, and (iii) I will make monthly Keep-In-Touch Payments or other monthly payments in an amount set at the sole option and in the sole discretion
of Lender that are less than the Standard Payment amount. In connection with any forbearance, Lender may require a term for the forbearance of a number of months determined
solely in the discretion of the Lender.
C. Requests for Deferment/Forbearance; Binding Effect. I must contact the Servicer for deferment and forbearance request forms, eligibility requirements and terms of obtaining
a deferment or forbearance (these forms, requirements and terms may also be obtained from the Servicer’s website, www.mohela.com). Requests must be in writing on forms
obtained from the Servicer. No deferment or forbearance will be effective (i) unless written notice of approval is sent by Lender or Servicer to Borrower and agreed to by Borrower
and Cosigner, and (ii) until the effective date designated in the sole discretion of the Lender.
Reamortization: I agree that in connection with any deferment or forbearance under this Application/Promissory Note, you may require the Standard Repayment Period to be extended
beyond 10 years and/or require reamortization of the Standard Payments; provided that you shall provide me with the applicable Disclosure Statement setting forth the revised terms of the
Loan.
8. DEFAULT
To the extent permitted by applicable law, my Loan will be in default if any of the following occurs: (a) Any payment is not received within fifteen (15) days after its due date; (b) I break any
other promise made in this Application/Promissory Note; (c) Lender discovers any false or misleading statement in any information I have given Lender in connection with this
Application/Promissory Note; (d) The proceeds of this Loan are not used solely for expenses directly related to the Cost of Attendance; (e) Borrower and/or Cosigner make an assignment
for the benefit of creditors or have a voluntary or involuntary bankruptcy proceeding instituted by or against Borrower and/or Cosigner; (f) Borrower and/or Cosigner is adjudicated
incompetent or dies; (g) Borrower and/or Cosigner fail to provide notices to the Lender when required to do so by this Application/Promissory Note; (h) Borrower and/or Cosigner is in default
on any loan(s) Borrower and/or Cosigner may already have with Lender or on any loan(s) Borrower and/or Cosigner may have with Lender in the future; or (i) Borrower and/or Cosigner
fails to provide verification of enrollment status in the Participating School or any Eligible School when asked for it.
I understand that if a default occurs on my Loan, the Participating School may withhold Student’s transcript and/or deny services to me to the extent permitted by applicable law.
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9. LENDER’S REMEDIES AFTER DEFAULT
If a default occurs, then after any applicable notice and right to cure such default that is required by applicable law, which notice shall be deemed to have been received three (3) days after
Lender mails it, Lender shall have the right to declare that the obligations (if any) of Lender to make the Loan or any disbursement on the Loan under this Application/Promissory Note have
terminated, whereupon such obligations of Lender shall be immediately and forthwith terminated, and Lender shall have the further right to declare the entire balance of Principal, Interest
and other charges owed under this Application/Promissory Note immediately due and payable, in full, without further notice to me. Lender may then take action to collect the entire Loan
balance, including: (a) bringing a lawsuit against me and obtaining a judgment against me and/or (b) referring my Loan to a collection agency for further collection efforts. To the extent
permitted by applicable law, I agree to pay any collection agency charges, reasonable attorneys’ fees and actual court costs (including fees and costs in bankruptcy court and in appellate
courts), and other costs of collection incurred by Lender as the result of a default. If a default occurs on my Loan, then after any applicable waiting periods or notices required by applicable
law, and as permitted by applicable law, Lender may also disclose information about the default to one or more national consumer credit reporting agencies, which may adversely affect my
ability to obtain other credit. To maintain a good credit rating, it is to my advantage to meet my obligations under this Application/Promissory Note. I agree that you may report information
about my account to credit reporting agencies and that late payments, missed payments, or other defaults on my account may be reflected in my credit report.
10. NOTICES
I must immediately notify Lender in writing and in no event later than thirty (30) calendar days, after any of the following occurs: (a) a change in my primary address, telephone number, or
email address; (b) a change in my name; (c) Student ceases to be enrolled on a full-time basis at the Participating School; (d) Student ceases to be enrolled on a half-time basis at the
Participating School; (e) Student graduates from the Participating School; or (f) any other event for which this Application/Promissory Note requires that notice be provided to Lender under
the procedures set forth in this Section 10 of the Application/Promissory Note Terms. Any notice I send to Lender will be sent to the address that Lender has most recently provided me for
that purpose. If Lender has not provided any address to me, notices may be sent to the address shown on my monthly statements or coupon book.
I acknowledge that any Disclosure Statement or other notice sent to Borrower or Cosigner by Lender under this Application/Promissory Note is deemed to be received three (3) days after
Lender mails or otherwise sends it.
11. COMMUNICATING WITH ME
I consent to conducting the transactions related to this Application/Promissory Note and to providing and receiving Communication by electronic means, such as via email or the Internet,
and such consent applies until withdrawn as further described in this Section 11. To the extent permitted by applicable law, and without limiting any other rights you may have, I consent to
the Lender and Servicer communicating with me, in connection with my Application/Promissory Note or Loan, using any phone number or email address that I provided in my
Application/Promissory Note, or using any phone number or email address that I provide to the Lender or Servicer in the future. The Lender and/or Servicer may communicate with me
using any current or future means of communication, including, but not limited to, automated telephone dialing equipment, artificial or pre-recorded voice messages, SMS text messages,
email directed to me at a mobile telephone service, or email otherwise directed to me. THE LENDER AND/OR SERVICER MAY USE SUCH MEANS OF COMMUNICATION EVEN IF I
WILL INCUR COSTS TO RECEIVE SUCH PHONE MESSAGES, TEXT MESSAGES, OR EMAILS. Any Communication required to be given to me will be effective if sent by first class
mail to the latest address the Lender or Servicer has for me or, except as otherwise required by law, by electronic means to an address that I have provided.
I acknowledge that I have the right to receive Communication on paper or in nonelectronic form, and that I may withdraw my consent to receive Communication via electronic means at any
time, at no fee or cost to me; provided that a request for specific Communication on paper or in non-electronic form will not be treated as a withdrawal of consent to receive Communication
via electronic means unless I also provide express notice of such withdrawal of consent in the manner set forth in this Section 11. If I wish to receive specific Communication in paper form
at any time, wish to withdraw my consent to send and receive electronic Communication, or need to update my electronic contact information (e.g., my email account address), I must
provide notice to you under the procedures set forth in Section 10 of the Application/Promissory Note Terms. You will confirm in writing the withdrawal of my consent to receive
Communication via electronic means and the effective date of such withdrawal of consent, upon which date you will cease to provide Communication via electronic means. If
I withdraw my consent, all further Communication will be provided to me in non-electronic form via U.S. mail, at no additional cost to me. I acknowledge that to access, view and retain
Communications provided to me electronically, I must have: (1) access to the Internet through means of a computer, tablet, mobile telephone, or other electronic device capable of receiving,
accessing, displaying, printing and storing Communication received in electronic form using an Internet browser or other electronic communication application, (2) sufficient electronic
storage capacity on my computer’s hard drive or other data storage unit, and (3) a PDF reader (or equivalent software) to download and print certain Communications. I acknowledge that
you reserve the right to revise the hardware and software requirements set forth in this section in a manner consistent with the E-Sign Act (15 U.S.C. § 7001 et seq.) and other relevant
federal laws.
I understand that the Lender and Servicer provide an email address (mofelp@mohela.com) to which I can transmit certain questions or comments for the Lender or Servicer about MOFELP;
however, because such email transmissions may not be secure or confidential, I will not transmit any confidential information to this email address, including, for example, any Loan
information or personal information about me. For transmission of any such confidential information, I will use only secure methods, such as U.S. mail, hand delivery by me or electronic
communication methods offered by the Servicer and Lender that are expressly represented to be used for confidential communication transmissions.
12. GOVERNING LAW; INVALID PROVISIONS; WAIVERS; EXTENSION, RENEWAL, OR RELEASE; ASSIGNMENT; CHANGES TO NOTE; CHANGES TO PAYMENT SCHEDULE;
SAVINGS CLAUSE; NO ACCORD OR SATISFACTION; BANKRUPTCY
Governing Law: THIS APPLICATION/PROMISSORY NOTE SHALL BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE OF MISSOURI (EXCLUDING
SUCH LAWS THAT MIGHT DIRECT THE APPLICATION OF LAWS OF ANOTHER JURISDICTION) AND FEDERAL LAW AND THE HIGHER EDUCATION ACT OF 1965, AS AMENDED.
Invalid Provisions: Should any of the provisions of this Application/Promissory Note be held invalid by a court having jurisdiction, the remaining provisions of this Application/Promissory
Note shall not be affected thereby and this Application/Promissory Note shall be construed as if such invalid provisions had not been included in this Application/Promissory Note.
Waivers: I waive my rights to require Lender to demand payment of amounts due (known as “presentment”), to give notice that amounts due have not been paid (known as “notice of
dishonor”), to obtain an official certification of non-payment (known as “protest”), and, to the extent permitted by applicable law, to give any other notices or demands in connection with this
Application/Promissory Note.
You may delay, fail to exercise, or waive any of your rights on any occasion without losing your entitlement to exercise the right on any future occasion.
Extension, Renewal or Release: You may extend, renew or release me without affecting or releasing any other Borrower or Cosigner.
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Assignment: I may not assign this Application/Promissory Note or any of its benefits or obligations. However, you have the right to assign your rights and duties under this
Application/Promissory Note without my consent and without notice to me. If this Application/Promissory Note is sold or otherwise transferred, my rights under the law or under this
Application/Promissory Note are in no way altered or impaired.
Loan Sale Notice: I understand and acknowledge that my Loan may be sold while a balance remains outstanding. Such a sale will not result in any change in terms of my Loan as set
forth herein.
Changes to Application/Promissory Note: Except as otherwise indicated in this Application/Promissory Note, no term or provision of this Application/Promissory Note may be changed,
and no request for forbearance by me may be granted, unless consented to in writing by both you and me.
Savings Clause: If a law which applies to this Application/Promissory Note and which sets maximum Interest or finance charges is finally interpreted so that the Interest or other charges
collected or to be collected in connection with this Application/Promissory Note exceeds the permitted limits, then: (a) any such charge shall be reduced by the amount necessary to reduce
the charge to the permitted limit; and (b) any sums already collected from me which exceeded permitted limits will be refunded to me. You may choose to make this refund by reducing the
Principal I owe under this Application/Promissory Note or by making a direct payment to me. If a refund reduces Principal, the reduction will be treated as a partial prepayment.
No Accord and Satisfaction: A restrictive endorsement on any payment item (such as “paid in full”) will not be considered an accord and satisfaction of what I owe under this
Application/Promissory Note. If I dispute any amount owed you, I must write to Lender at Missouri Scholarship and Loan Foundation c/o MOHELA, Attention Accounting Department, P.O.
Box 4602, Chesterfield Missouri 63006-4602, or such other address provided by you to me for correspondence, and provide a reasonably detailed explanation of my dispute.
Bankruptcy: If I file for bankruptcy I may still be required to pay the amount due under this Application/Promissory Note.
13. PRIVACY MATTERS
Updating Financial Information: I agree to provide to you updated financial information about me any time you reasonably request it.
Participating School: To the extent permitted by applicable law, you may provide a copy of the Application/Promissory Note, or any other document to, and may report my payment history
to, the Participating School. I authorize the release of my student records by the Participating School to you, and I hereby release all claims against the Participating School, its parent
companies, subsidiaries, employees, officers, shareholders and affiliates, pursuant to The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) et seq.
with respect to such release of my student records.
Receipt of and Reporting Credit Information; Authorization of Borrower: I authorize you to investigate my creditworthiness and to receive credit information about me from others,
including other lenders, credit reporting agencies, and educational loan information clearinghouses. You may also furnish information about my Loan to credit reporting agencies and other
persons who may legally receive such information. A negative credit report reflected on my credit record may be submitted to a consumer reporting agency if I fail to fulfill the terms of my
payment obligations under this Application/Promissory Note. If I believe that you have furnished information to a consumer reporting agency that is inaccurate, I will notify you at the address
specified below and identify the specific information that is inaccurate.
Missouri Scholarship and Loan Foundation
C/o MOHELA
P.O. Box 4602
Chesterfield Missouri 63006-4602
This authorization extends to this Loan, any future loans that may be offered to me, any updates, renewals or extensions of this Loan that may be offered to me, any forbearance of this
Loan or any future loans that may be offered to me, and any review or collection of this Loan or any future loans that may be offered to me.
Communications Regarding Loan and Release of Loan Information: To the extent permitted by applicable law, I authorize you and the Participating School to communicate with, and
to release information pertinent to this Loan to, members of my immediate family, including my spouse, unless I submit written directions to you revoking such authorization. I further
authorize any lender or holder of any of my outstanding educational loans to release any information on any of my outstanding educational loans to any other lender or holder of any of my
other educational loans.
Inquiries to Learn Current Address and Telephone Number: I authorize you to release information and make inquiries to the individuals listed as references on the
Application/Promissory Note for the purpose of learning my current address and telephone number.
Social Security Number: You and the Participating School may verify my Social Security number with the Social Security Administration (SSA). If the Social Security Number on my Loan
records is incorrect, then I authorize the SSA to disclose my correct Social Security number to you and the Participating School.
United States Department of Education Information: I authorize the United States Department of Education to send any information about me that is under its control, including
information from the Free Application for Federal Student Aid, to you.
Sharing Information: You may share information about me and my Loan within your affiliates as well as with nonaffiliated third parties including without limitation credit bureaus and
collection agencies, as described in your Privacy Policy. I acknowledge that I have received a copy of your Privacy Policy. To the extent permitted by applicable law and after providing
required notices, Lender or any holder of my outstanding education loans may modify the Privacy Policy.
14. COSIGNER
By signing this Application/Promissory Note as Cosigner, I acknowledge that (a) you may proceed directly against me without first proceeding against the Borrower, and (b) I am fully
responsible for paying all amounts due under this Application/Promissory Note, in full, even if the Borrower is released from liability on this Application/Promissory Note for any reason
whatsoever.
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15. FEDERAL LAW NOTICES
I understand that the following notice is only applicable to loans issued to finance educational expenses at institutions subject to the FTC Holder Rule under 16 C.F.R. Section 433.2.
NOTICE: ANY HOLDER OF THIS CONSUMER CREDIT CONTRACT IS SUBJECT TO ALL CLAIMS AND DEFENSES WHICH THE DEBTOR
COULD ASSERT AGAINST THE SELLER OF GOODS OR SERVICES OBTAINED WITH THE PROCEEDS HEREOF. RECOVERY HEREUNDER
BY THE DEBTOR SHALL NOT EXCEED AMOUNTS PAID BY THE DEBTOR HEREUNDER.
16. STATUTORY NOTICE
For purposes of this Section 16 of the Application/Promissory Note Terms, the terms “Borrower” and “You” each mean the person who signs the Application/Promissory Note as Borrower
and/or the person who signs the Application/Promissory Note as Cosigner; the term “Us” means the Lender as defined under Section 2 of the Application/Promissory Note Terms.
“ORAL AGREEMENTS OR COMMITMENTS TO LOAN MONEY, EXTEND CREDIT OR FORBEAR FROM ENFORCING REPAYMENT OF DEBT,
INCLUDING PROMISES TO EXTEND OR RENEW SUCH DEBT, ARE NOT ENFORCEABLE. TO PROTECT YOU (BORROWER) AND US
(LENDER) FROM MISUNDERSTANDING OR DISAPPOINTMENT, ANY AGREEMENTS YOU AND LENDER REACH COVERING SUCH
MATTERS ARE CONTAINED IN THIS WRITING, WHICH IS THE COMPLETE AND EXCLUSIVE STATEMENT OF THE AGREEMENT BETWEEN
YOU AND LENDER, EXCEPT AS YOU AND LENDER MAY LATER AGREE IN WRITING TO MODIFY IT.”
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NOTICE TO COSIGNER
Cosigner is being asked to guarantee this debt. Cosigner should think carefully before Cosigner does. If Borrower doesn't pay the debt, Cosigner will have to. Cosigner
should be sure Cosigner can afford to pay if Cosigner has to, and that Cosigner wants to accept this responsibility.
Cosigner may have to pay up to the full amount of the debt if Borrower does not pay. Cosigner may also have to pay late fees or collection costs, which increase this
amount.
The creditor can collect this debt from Cosigner without first trying to collect from Borrower. The creditor can use the same collection methods against Cosigner that can be
used against Borrower, such as suing Cosigner, garnishing Cosigner’s wages, etc. If this debt is ever in default, that fact may become a part of Cosigner’s credit record.
This notice is not the contract that makes Cosigner liable for debt.
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Private Education Loan
Applicant Self-Certification
This space for lender use only
OMB No. 1845-0101
Form Approved
Exp. Date 05-31-2016
________________________________________________________________________________________________
Important: Pursuant to Section 155 of the Higher Education Act of 1965, as amended, (HEA) and to satisfy the requirements of Section 128(e)(3) of the Truth in
Lending Act, a lender must obtain a self-certification signed by the applicant before disbursing a private education loan. The school is required on request to provide
this form or the required information only for students admitted or enrolled at the school. Throughout this Applicant Self-Certification, “you” and “your” refer to the
applicant who is applying for the loan. The applicant and the student may be the same person.
Instructions: Before signing, carefully read the entire form, including the definitions and other information on the following page. Submit the signed form
to your lender.
SECTION 1: NOTICES TO APPLICANT
•
•
•
•
Free or lower-cost Title IV federal, state, or school student financial aid may be available in place of, or in addition to, a private
education loan. To apply for Title IV federal grants, loans and work-study, submit a Free Application for Federal Student Aid
(FAFSA) available at www.fafsa.ed.gov, or by calling 1-800-4-FED-AID, or from the school’s financial aid office.
A private education loan may reduce eligibility for free or lower-cost federal, state, or school student financial aid.
You are strongly encouraged to pursue the availability of free or lower-cost financial aid with the school’s financial aid office.
The financial information required to complete this form can be obtained from the school’s financial aid office. If the lender has
provided this information, you should contact your school’s financial aid office to verify this information and to discuss your
financing options.
SECTION 2: COST OF ATTENDANCE AND ESTIMATED FINANCIAL ASSISTANCE
If information is not already entered below, obtain the needed information from the school’s financial aid office and enter it on the appropriate line. Sign
and date where indicated. See Section 5 for definitions of financial aid terms.
A. Student’s cost of attendance for the period of enrollment covered by the loan
$____________________
B. Estimated financial assistance for the period of enrollment covered by the loan
$____________________
C. Difference between amounts A and B
$____________________
WARNING: If you borrow more than the amount on line C, you risk reducing your eligibility for
free or lower-cost federal, state, or school financial aid.
SECTION 3: APPLICANT INFORMATION
Enter or correct the information below.
Full Name and Address of School ________________________________________________________________________________________________________
Applicant Name (last, first, MI) ___________________________________________________
Date of Birth (mm/dd/yyyy) _____/_____/__________
Permanent Street Address __________________________________________________________________
City, State, Zip Code __________________________________________________________________ ____________________
Area Code / Telephone Number Home (
) ____________________________
Other (
) ____________________________
E-mail Address________________________________________________________________________________________
Period of Enrollment Covered by the Loan (mm/dd/yyyy)
From _____ / _____ / _______ to _____ / _____ / _______
If the student is not the applicant, provide the student’s name and date of birth.
Student Name (last, first, MI) ____________________________________________________
Student Date of Birth (mm/dd/yyyy) _____/_____/__________
SECTION 4: APPLICANT SIGNATURE
I certify that I have read and understood the notices in Section 1 and, that to the best of my knowledge, the information provided on this form is true and correct.
Signature of Applicant ____________________________________________________________________ Date (mm/dd/yyyy) _______________________
SECTION 5: DEFINITIONS
Cost of attendance is an estimate of tuition and fees, room and board, transportation, and other costs for the period of enrollment covered by the loan, as
determined by the school. A student’s cost of attendance may be obtained from the school’s financial aid office.
Estimated financial assistance is all federal, state, institutional (school), private, and other sources of assistance used in determining eligibility for most Title IV
student financial aid, including amounts of financial assistance used to replace the expected family contribution. The student’s estimated financial assistance is
determined by the school and may be obtained from the school’s financial aid office.
A lender is a private education lender as defined in Section 140 of the Truth in Lending Act and any other person engaged in the business of securing, making, or
extending private education loans on behalf of the lender.
A period of enrollment is the academic year, academic term (such as semester, trimester, or quarter), or the number of weeks of instructional time for which the
applicant is requesting the loan.
A private education loan is a loan provided by a private education lender that is not a Title IV loan and that is issued expressly for postsecondary education
expenses, regardless of whether the loan is provided through the school that the student attends or directly to the borrower from the private education lender. A
private education loan does not include (1) An extension of credit under an open-end consumer credit plan, a reverse mortgage transaction, a residential mortgage
transaction, or any other loan that is secured by real property or a dwelling; or (2) An extension of credit in which the school is the lender if the term of the extension
of credit is 90 days or less or an interest rate will not be applied to the credit balance and the term of the extension of credit is one year or less, even if the credit is
payable in more than four installments.
Title IV student financial aid includes the Federal Pell Grant Program, the Federal Supplemental Educational Opportunity Grant (FSEOG) Program, the Federal
Work-Study (FWS) Program, the William D. Ford Federal Direct Loan (Direct Loan) Program, the Federal Perkins Loan Program, and the Teacher Education
Assistance for College and Higher Education (TEACH) Grant Program. To apply for Title IV federal grants, loans, and work-study, submit a Free Application for
Federal Student Aid (FAFSA), which is available at www.fafsa.gov, by calling 1-800-4-FED-AID, or from the school’s financial aid office.
SECTION 6: PAPERWORK REDUCTION NOTICE
Paperwork Reduction Notice: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it
displays a currently valid OMB control number. The valid OMB control number for this information collection is 1845-0101. The time required to complete this
information collection is estimated to average 0.25 hours (15 minutes) per response, including the time to review instructions, search existing data resources, gather
and maintain the data needed and complete and review the information collection.
If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of
Education, Washington, DC 20202-4651
If you have any comments or concerns regarding the status of your individual submission of this form, contact your lender.
Debit Authorization Agreement – Disclosure Statement for Recurring Auto Debit Payments
1) Applicability of Promissory Note Terms/Authority for Auto Debit/Acceptance of Agreement
You represent that you have the right and are authorized by yourself, and without any further authorization from anyone else, to agree to
the terms of this Agreement and to authorize Servicer to make Auto Debits from, and to authorize the Bank to allow Auto Debits to, the
Bank Account under this Agreement. Servicer will not start Auto Debit authorized by this Agreement until acceptance. Notification of
acceptance of this Agreement may be expressed to you by written or verbal notice or by initiating any transaction authorized by this
Agreement, which initiation shall constitute notice of acceptance of the Agreement.
2) The Type and Nature of Auto Debit
Each Auto Debit will be effective on the due date of the applicable student loan payment. The payment amount will be equal to your
monthly student loan payment based on the applicable repayment schedule and obligations plus any additional amount authorized under
this Agreement and applicable law.
3) In Case of Errors and Questions About Your Auto Debit
All questions about Auto Debits made under this Agreement with the Servicer must be directed to Servicer, and not the bank or other
financial institution where you have your deposit account. Servicer is responsible for the Auto Debit service and for resolving any errors
in transactions made with your Auto Debit.
Servicer will not send you a periodic statement listing Auto Debit transactions. The transactions will appear only on the statement issued
by your Bank or other financial institution. If you have any questions about the transactions, contact Servicer. If Servicer is MOHELA,
call 800.809.0964, write MOHELA, PO Box 4602, Chesterfield MO 63006-4602, or log in and send a secure email through
www.mohela.com.
You understand that you have certain rights under the Electronic Funds Transfer Act and its implementing regulation (Regulation E) with
respect to unauthorized Auto Debits and the resolution of errors related to Auto Debits, and that, if you suspect an error in any Auto Debit
transaction, you may contact the Bank to preserve those rights. This will not negate your responsibility to make payments on your student
loan(s) as required by the applicable promissory note(s) during the investigation by Servicer.
4) How to Suspend an Auto Debit
After you have authorized Servicer to make Auto Debits pursuant to this Agreement, you may suspend any specific Auto Debit by providing
timely notice to Servicer using the telephone number, address or e-mail provided in this Agreement. Servicer must receive your call, email or written request 3 business days or more before the Auto Debit is scheduled to be made in order for the Auto Debit to be suspended.
A phone, written or electronic request may be made to suspend Auto Debits. Auto Debits will resume the month following the last
suspended Auto Debit. If you wish to terminate all Auto Debits, you should do so in the manner set forth in Section 5. You are responsible
for all monthly payments on your student loan(s) for which you have suspended or terminated Auto Debit. You must select another
payment option made available by Servicer in place of the suspended or terminated Auto Debit.
5) Termination, Changes, Assignment, Insufficient Funds
This Agreement may be suspended or terminated upon written or verbal agreement by you and Servicer. This Agreement is not assignable
by you. Servicer may assign its rights and obligations under this Agreement to a third party at any time, and you consent to any such
assignment and to any assignment of such rights and obligations to any new Servicer. This Agreement shall continue in effect until your
student loan(s) are paid in full, this Agreement is superseded by another Auto Debit Authorization Agreement, or until this Agreement is
terminated by you or Servicer in accordance with the terms of this Agreement.
Servicer or you may terminate this Agreement at any time, with or without cause, by giving 10 business days advance written notice to
the non-terminating party. For example, Servicer will normally terminate this Agreement if Servicer receives three consecutive insufficient
funds returns. After any termination of this Agreement, you may reapply for Auto Debit the next month. It is your responsibility to ensure
that you have sufficient funds to cover each Auto Debit. Servicer is authorized to collect by Auto Debit under this Agreement any additional
fees, as permitted by law and/or your promissory note(s), resulting from insufficient funds. You may also be charged a return fee by the
Bank if funds are not available in the Bank Account at the time of an Auto Debit.
If Servicer initiates a monthly student loan payment amount change, the new payment amount and any additional amount you previously
requested to be Auto Debited will continue to be Auto Debited. You have the right to receive notice at least 10 days in advance if any
Auto Debit amount will vary from the previous Auto Debit amount under this Agreement for the same student loan(s).
You are required to promptly submit a new Auto Debit Authorization Agreement to Servicer to make changes including, but not limited to,
your ABA/Routing number and deposit account number. Please notify MOHELA in writing to change the monthly additional amount
withdrawn. You are also required to submit a new Auto Debit Authorization Agreement in order to preauthorize Auto Debits for any
additional student loans or any student loans previously excluded from this Agreement.
6) Servicer (MOHELA)’s Liability for Failure to Stop Auto Debit
If you request Servicer to stop a payment 3 business days or more before the transfer is scheduled, and Servicer does not do so, the
Servicer may be liable for your losses or damages.
phone 800.809.0964 fax 636.787.2768
PO Box 4602, Chesterfield, MO 63006-4602
Secure Form Submission on www.mohela.com. Click Contact Us, then Submit a Form.
RETAIN FOR YOUR RECORDS
7) Servicer (MOHELA)’s Liability
If Servicer does not complete a transfer from your account according to our Agreement with you, Servicer will be liable for your loss or
damages. However, there are some exceptions. Servicer will not be liable for instance:
1) If through, no fault of Servicer, you do not have enough money in your account to make the transfer.
2) If circumstances beyond our control (such as fire or flood) prevent the transfer, despite reasonable precautions that we have
taken.
3) There may be other exceptions stated in our agreement with you.
8) Confidentiality/Privacy
Servicer may disclose information to third parties regarding your Bank Account, your student loan account(s) and/or Auto Debits in
accordance with the rules and law applicable to the Missouri Scholarship and Loan Foundation (“MLSF”), including but not limited to, the
following circumstances:
a) When necessary to complete an Auto Debit;
b) To verify the existence and condition of your account for a credit bureau or merchant;
c) In order to comply with government agency requests, subpoenas, or orders, lawful discovery under federal or state rules of civil
and criminal procedure, court orders, or as otherwise required by applicable law; or
d) If you give Servicer written permission to do so.
9) Other Agreements and Regulations
Auto Debits are subject to all changes, rules and regulations governing debits to accounts and all other applicable agreements and
disclosures for deposit and overdraft line of credit accounts, and are subject to any future charges.
10) Business Days
For purposes of this Agreement, business days are Monday through Friday, excluding bank holidays.
11) Auto Debit Statements
You will not receive a monthly account statement.
12) Paid Ahead Status
Servicer will Auto Debit your scheduled payment amount and any additional amount you have requested each month, even if the
applicable student loan(s) is in a paid ahead or partially paid ahead status. Visit www.mohela.com/payingahead to learn more. If you
would like to suspend an Auto Debit, please refer to the instructions provided in section 4 “How to Suspend an Auto Debit.”
13) Disclosure
You should keep a copy of this disclosure for your records. You have also been provided two copies of the Auto Debit Agreement, please
complete and sign, return one copy to MOHELA at the previously provided address and keep the other copy for your records.
14) Definitions
a) Student loan means each loan issued by MSLF to Borrower under the Account Number listed on this Agreement under Borrower
Information.
b) Bank Account means the deposit account of Borrower identified on this Agreement under Financial Institution Information.
c) Borrower means the individual identified on this Agreement under Borrower Information, who is also referred to in this Agreement
as “you” and with terms “your” and “yours.”
d) MOHELA means the Higher Education Loan Authority of the State of Missouri.
e) Servicer means MOHELA or any other agent designated from time to time by MSLF to conduct Auto Debits under this
Agreement.
phone 800.809.0964 fax 636.787.2768
PO Box 4602, Chesterfield, MO 63006-4602
Secure Form Submission on www.mohela.com. Click Contact Us, then Submit a Form.
RETAIN FOR YOUR RECORDS
AUTO DEBIT AUTHORIZATION AGREEMENT
Auto Debit: “Auto Debit” is an electronic fund transfer (EFT) preauthorized to recur at substantially regular monthly intervals from Borrower’s
designated bank deposit account. Other capitalized terms used in this Auto Debit Authorization Agreement (this Agreement) are defined when
introduced in the text of this Agreement or in the Definitions section of this Agreement. This Agreement authorizes Servicer to affect Auto
Debits and conduct related activities.
Instructions: Using Auto Debit is optional for Borrower. If Borrower decides to use Auto Debit for payments on the student loan(s),
Borrower must agree to the terms of this Agreement. To do so, Borrower should sign, date and return one copy of the Agreement to
MOHELA at the address shown at the bottom of this page. In most cases, Borrower may be able to complete this Agreement online.
During any period for which MOHELA is Servicer, only one bank account can be designated at a time for Auto Debit transactions for any
or all MOHELA-serviced loans per Borrower, with or without a cosigner or co-borrower. Also, note that this Agreement can only be used
for Auto Debits from a bank deposit account of the Borrower on one or more MOHELA-serviced student loans. Borrower understands
that Borrower should carefully read all of this Agreement before agreeing to its terms.
Borrower should continue to make payments using the current method until Agreement is accepted by Servicer and you are notified of
first withdrawal is scheduled by Servicer.
SECTION 1: BORROWER IDENTIFICATION
Please enter the following information.
SSN (required) __ __ __ - __ __ - __ __ __ __
PLEASE PRINT LEGIBLY IN BLUE OR BLACK INK
Name __________________________________________
Address ________________________________________
City, State, Zip Code ______________________________
Telephone – Primary (_______) _____________________
Telephone – Alternate (_______) ____________________
E-mail _________________________________________
 Check this box if any of your information has changed.
SECTION 2: BANK INSTITUTION INFORMATION
Borrower is a direct account holder of the Bank Account identified below, and in such capacity, Borrower hereby authorizes Servicer to
initiate Debits to transfer funds from the Bank Account for any payments due on each student loan and authorizes the Bank to allow such
Auto Debits to the Bank Account. Only the required monthly payment amount and other amounts due will be transferred based on the
applicable repayment schedule and obligations for each such student loan.
If Borrower would like an additional amount withdrawn from the Bank Account by Auto Debit monthly, you will ENTER ONLY THE
ADDITIONAL AMOUNT HERE: $__________*
*If Borrower has multiple Loans, such additional amount will be prorated across all student loans.
Bank Name: ______________________________________________________
Bank Address: ____________________________________________________
This is a (check one):
 Checking Account
 Savings Account
Bank Account Holder’s Name: _______________________________________ (Borrower must be the Bank Account Holder)
Routing Number: _________________________ Account Number _________________________
SECTION 3: TERMS AND CONDITIONS
1) By signing below Borrower agrees that he or she has read, understands and agrees to be bound by all of the terms and conditions
of this Agreement. The terms and conditions of this Agreement include all of the provisions of this Agreement, including without
limitation the provisions of the attached Auto Debit Authorization Agreement Disclosure Statement for Recurring Auto Debit Payments.
2) Borrower also hereby authorizes the Missouri Scholarship and Loan Foundation (“MLSF”) and Servicer and their respective agents
and contractors to contact Borrower regarding Borrower’s loan(s) (with any cosigner or co-borrower, as applicable), including
repayment of such loan(s), in any manner, including at the current or any future number provided for cellular telephone or other
wireless device using automated telephone dialing equipment or artificial or prerecorded voice or text messages, email directed to
Borrower at a mobile telephone service, or email otherwise directed to Borrower. MSLF, Servicer and their respective agents and
contractors may use such means of communication even if Borrower will incur costs to receive such communication.
BORROWER PRINTED NAME (REQUIRED) _________________________________________ DATE _______________________
BORROWER SIGNATURE (REQUIRED) ____________________________________________
phone 800.809.0864 fax 636.787.2768
PO Box 4602, Chesterfield, MO 63006-4602
Secure Form Submission on www.mohela.com. Click Contact Us, then Submit a Form.
RETURN ONE COPY TO MOHELA
RETAIN ONE COPY FOR YOUR RECORDS
AUTO DEBIT AUTHORIZATION AGREEMENT
Auto Debit: “Auto Debit” is an electronic fund transfer (EFT) preauthorized to recur at substantially regular monthly intervals from Borrower’s
designated bank deposit account. Other capitalized terms used in this Auto Debit Authorization Agreement (this Agreement) are defined when
introduced in the text of this Agreement or in the Definitions section of this Agreement. This Agreement authorizes Servicer to affect Auto
Debits and conduct related activities.
Instructions: Using Auto Debit is optional for Borrower. If Borrower decides to use Auto Debit for payments on the student loan(s),
Borrower must agree to the terms of this Agreement. To do so, Borrower should sign, date and return one copy of the Agreement to
MOHELA at the address shown at the bottom of this page. In most cases, Borrower may be able to complete this Agreement online.
During any period for which MOHELA is Servicer, only one bank account can be designated at a time for Auto Debit transactions for any
or all MOHELA-serviced loans per Borrower, with or without a cosigner or co-borrower. Also, note that this Agreement can only be used
for Auto Debits from a bank deposit account of the Borrower on one or more MOHELA-serviced student loans. Borrower understands
that Borrower should carefully read all of this Agreement before agreeing to its terms.
Borrower should continue to make payments using the current method until Agreement is accepted by Servicer and you are notified of
first withdrawal is scheduled by Servicer.
SECTION 1: BORROWER IDENTIFICATION
Please enter the following information.
SSN (required) __ __ __ - __ __ - __ __ __ __
PLEASE PRINT LEGIBLY IN BLUE OR BLACK INK
Name __________________________________________
Address ________________________________________
City, State, Zip Code ______________________________
Telephone – Primary (_______) _____________________
Telephone – Alternate (_______) ____________________
E-mail _________________________________________
 Check this box if any of your information has changed.
SECTION 2: BANK INSTITUTION INFORMATION
Borrower is a direct account holder of the Bank Account identified below, and in such capacity, Borrower hereby authorizes Servicer to
initiate Debits to transfer funds from the Bank Account for any payments due on each student loan and authorizes the Bank to allow such
Auto Debits to the Bank Account. Only the required monthly payment amount and other amounts due will be transferred based on the
applicable repayment schedule and obligations for each such student loan.
If Borrower would like an additional amount withdrawn from the Bank Account by Auto Debit monthly, you will ENTER ONLY THE
ADDITIONAL AMOUNT HERE: $__________*
*If Borrower has multiple Loans, such additional amount will be prorated across all student loans.
Bank Name: ______________________________________________________
Bank Address: ____________________________________________________
This is a (check one):
 Checking Account
 Savings Account
Bank Account Holder’s Name: _______________________________________ (Borrower must be the Bank Account Holder)
Routing Number: _________________________ Account Number _________________________
SECTION 3: TERMS AND CONDITIONS
1) By signing below Borrower agrees that he or she has read, understands and agrees to be bound by all of the terms and conditions
of this Agreement. The terms and conditions of this Agreement include all of the provisions of this Agreement, including without
limitation the provisions of the attached Auto Debit Authorization Agreement Disclosure Statement for Recurring Auto Debit Payments.
2) Borrower also hereby authorizes the Missouri Scholarship and Loan Foundation (“MLSF”) and Servicer and their respective agents
and contractors to contact Borrower regarding Borrower’s loan(s) (with any cosigner or co-borrower, as applicable), including
repayment of such loan(s), in any manner, including at the current or any future number provided for cellular telephone or other
wireless device using automated telephone dialing equipment or artificial or prerecorded voice or text messages, email directed to
Borrower at a mobile telephone service, or email otherwise directed to Borrower. MSLF, Servicer and their respective agents and
contractors may use such means of communication even if Borrower will incur costs to receive such communication.
BORROWER PRINTED NAME (REQUIRED) _________________________________________ DATE _______________________
BORROWER SIGNATURE (REQUIRED) ____________________________________________
phone 800.809.0864 fax 636.787.2768
PO Box 4602, Chesterfield, MO 63006-4602
Secure Form Submission on www.mohela.com. Click Contact Us, then Submit a Form.
RETURN ONE COPY TO MOHELA
RETAIN ONE COPY FOR YOUR RECORDS