Student Emergency Loan Application

Student Emergency Loan Application

Students must be currently enrolled during the semester in which they apply for a loan. Incoming students are not eligible for emergency loan until the add/drop period has ended. Students can apply for an emergency loan once per semester, and may only have one outstanding loan at a time. Process time for applications is five business days. If completing electronically, make sure you save the form before e-mailing it to .

*Please fill out the form in its entirety and attach documentation of your emergency when submitting this form. Incomplete forms will not be considered.

(If you are unable to enter information through Microsoft Word, please click on Tools > Macro > Security, set to “Low”, and reopen the file. You may revert back to a higher level of security after saving and completing the form.)

Contact Information:

Name: Student ID number:

Address:

Phone Number: E-mail:

Program: Expected Graduation Date:

Amount Requested: ($750.00 maximum; only one loan at a time)

Please explain your emergency situation (for example: loss or reduction in employment; medical emergency; unexpected

or unplanned expenses due to unforeseen event.) and how do you plan to repay the loan by September 30, 2014?

Please check the box to verify that you have read and understood the conditions of the loan, and sign below. Return this form to the Student Affairs Office, Mission Building, Room 401; or save the completed form and email it to .

I would like my loan check to be held at the business office for pickup
I would like my loan check to be mailed to the address listed above

I understand that the emergency loan must be repaid by September 30, 2014 by submitting a check to the Business Office payable to CIIS. A hold will be assigned if the loan becomes past due.

Signature: Date:

(If filling out electronically, enter your whole name)

For inquiries about the status of your loan request, please contact . We will use the email address you provided above to contact you with updates regarding your loan status.