2024-2025 Loan Request Form

2024-2025 Loan Request Form
For what academic school year are you requesting funds for?
Student Information
Name

First NameLast Name
Student ID
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Requirements
I certify that I meet or I will meet the student eligibility requirements below:*

Complete my FAFSA for this academic school year at www.fafsa.govComplete the Entrance Counseling at www.studentloans.govComplete the Master Promissory Note (MPN) also at www.studentloans.gov
Amount Requesting

Note: Either specify a dollar amount below or mark "maximum" if you wish your loan(s) maximized. The loan processor will always increase subsidized loans first and unsubsidized last.

I would like to request a loan for the following semester:

(Note: If you are an undergraduate student requesting summer loans, you must complete a SUMMER Financial Aid Application first. This application is available in March.)
Student Signature

Submitting this application via Jotform constitutes your electronic signature. This application shall be deemed for all purposes to have been "signed" and will constitute an "original" when printed from electronic records established and maintained by the Office of Financial Aid & Scholarships, if an electronic signature is contained.
Student Signature*

Clear
Date

MonthDayYear
Date
Have Questions About Your Financial Aid?

Financial Aid Office Contact Information

Address: Attn: Financial Aid Office 3240 Fort Rd., Toppenish, WA 98948 | Phone: (509) 865-8502 | Fax: (509) 677-4748 | Email: financial_aid@heritage.edu
Should be Empty:

Student Information