PART A Individual Applicant, Not a Legal Entity and Married, Applying as – Individual Items 1 15 are completed by all individual applicants. – Fld Name / Instruction Item No. 1A Enter the legal name as shown on a state driver's applicant’s exact full Exact Full license or State ID card. Legal Name 2 Enter the email address. applicant’s Email Address 3 complete mailing address. Indicate if the mailing Enter applicant’s Mailing address is different from applicant's physical address. Address 4A Enter applicant's complete physical address if different from mailing Physical address. Address 4B Enter the county where the residence is located. County of Residence 5 Enter the home, cell, and business telephone number, as applicant’s Contact applicable. Telephone Numbers Indicate applicant's best contact telephone number by selecting "Primary" in the applicable box. 6 Enter the county where the operation headquarters is located. County of Operation Headquarters 7 Enter date of birth. applicant’s Date of Birth 8 Enter social security number (9-digit number) applicant’s Social Security Number 9 Enter the name, address and telephone number of the applicant’s Name and employer, if applicable. Address of Employer 10 Check applicable citizenship status. If non-citizen national, qualified Citizenship alien, or refugee, as defined by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), 8 U.S.C. 1641, applicant must provide copies of appropriate documentation of
PART A – Individual Applicant, Not a Legal Entity and Married, Applying as Individual Items 1 – 15 are completed by all individual applicants. Fld Name / Item No. Instruction 1A Exact Full Legal Name Enter the applicant’s exact full legal name as shown on a state driver's license or State ID card. 2 Email Address Enter the applicant’s email address. 3 Mailing Address Enter applicant’s complete mailing address. Indicate if the mailing address is different from applicant's physical address. 4A Physical Address Enter applicant's complete physical address if different from mailing address. 4B County of Residence Enter the county where the residence is located. 5 Contact Telephone Numbers Enter the applicant’s home, cell, and business telephone number, as applicable. Indicate applicant's best contact telephone number by selecting "Primary" in the applicable box. 6 County of Operation Headquarters Enter the county where the operation headquarters is located. 7 Date of Birth Enter applicant’s date of birth. 8 Social Security Number Enter applicant’s social security number (9-digit number) 9 Name and Address of Employer Enter the name, address and telephone number of the applicant’s employer, if applicable. 10 Citizenship Check applicable citizenship status. If non-citizen national, qualified alien, or refugee, as defined by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), 8 U.S.C. 1641, applicant must provide copies of appropriate documentation of
FSA_2001_Instructions_Loan_Application_Form.docx