Ritchie County Educational Trust
P.O. Box 239 Harrisville, WV 26362 Phone: (304)643-2460 Fax: 304-643-2994
E-mail:
APPLICATION Circle: Male / Female
I (first)______(mi)___(last)______(maiden)______S.S.#______
of (home address)______(phone)______
hereby make application for a loan of (max. $1,500/semester)______dollars
to enable me to pursue my studies at ______(college)
for the academic year beginning: Month______Year______If the loan is granted, I agree to comply with all the requirements and regulations governing the same. I also authorize release of any information the Director may request concerning my status as a student but not limited to:
transcript information and ACT scores.
Date______Applicant Signature______
*Personal Statement*
(This is a frank and friendly means of learning your circumstances. All statements will be held confidential.)
Born at City______County______State______Mo____/Day____/Year______
Hours
Higher Education Institute where last a student?______Completed:______GPA_____
High School Graduated from?______Year?______GED?______Are you married?______Do you have any children, #?______What type of job do you want or what are you majoring in?______Have you any indebtedness?______Amount______When due______
Do you own real estate in your own right?______Acreage______Value$ ______
Do your parents own real estate? ______Acreage______Value$ ______
Name of Father______Address ______
Name of Mother______Address ______
Name of Guardian______Address ______
*Family Resources*
Total Family Income for past Year $______(as on tax return). Number of persons dependent upon above income (i.e. parents, children, aged relatives or others as reported on income tax return).______Are you included?______Number of the above dependents, excluding yourself, that will be attending college this year?______Where Attending?______
*Resources to be used for the coming Academic Year*
From Parents ...... $______
From Friends ...... $______
From Student's earnings including anticipated summer money ...... $______
If married, earnings of spouse for education ...... $______
From Federal Sources (G.I. Bill, Social Security, etc.) ...... $______
From other sources (savings, insurance, investments, etc.) ...... $______
From Financial Aid or scholarships ...... $______
T O T A L $______Do you plan to work part-time while in college?______Do you expect to drive a car while in college?______Do you own this car or make payments on this car?______
*References*
Educational Reference: Give name and full mailing address of High School Counselor, or College Advisor.
Street______
Name______City______State_____Zip______
Two Personal References: Not connected with school and not related to you. Please put full mailing address.
(Preferably working Ritchie County citizens).
Street______
Name______City______State_____Zip______
Street______
Name______City______State_____Zip______
Credit Reference: Give name of lending institution you have previously borrowed from, if any.
Name______
Address______
Date______Applicant Signature______
*Parents’ / Guardians’ / Co-Makers’ Statement*(2 required)
(Co-Makers are normally parents, but are not required to be. Two co-makers are always required.)
Are you familiar with the terms, purposes and conditions of this loan?______
Do you approve this request for a loan?______
Do you verify the necessity for this loan and the personal statement as made?______Will you guarantee the payment of the loan applied for by executing note as a co-maker with the applicant?______
Date______Signatures______
Father / Guardian / Co-Maker #1 Mother / Guardian / Co-Maker #2
Social Security Numbers: (1)______(2)______Address of Co-Maker: (1)______(2)______
______
Employment of Co-Maker:(1)______(2)______