Washington Student Achievement Council Aerospace Loan Program 2013-14 LOAN APPLICATION Revised 3/24/14 – MAIL THIS APPLICATION ALONG WITH YOUR COMPLETED, SIGNED PROMISSORY NOTE Failure to respond or submit required documentation will delay the processing of your loan application. Last Name: First Name: MI SSN: Address: City: State: Zip: State: Phone: Driver’s License #: Ethnicity African-American Asian-Pacific Islander Vietnamese Korean Alaskan Native White Caucasian Filipino Chinese Other (optional) Male Female Birth date: Email (required): How long have you lived in Washington state? years If less than five, previous state of residence: If no - VISA Type: I-151 I-551 I-551C VISA Number: Are you a U.S. Citizen Yes No See Guidelines & Terms of Agreement for (NOT your Visa credit card number) eligible non U.S. citizen requirements. Contacts: Provide two contacts with addresses different from your own and different from each other that will always know your current address. The first contact should be a relative but not a spouse. Contact One: Contact Two: Name Permanent Address City, State, Zip Code Area Code/Telephone Relationship to Recipient Are you delinquent on any Federal/State debts? No Yes (example: Federal Income Tax, Student Loans) Are you delinquent on child support payments? No Yes Have you filed a Bankruptcy in the last seven years? No Yes Do you have dependents? Yes No # of dependents: If yes Are you receiving unemployment benefits? Yes No (dependents are those you claim on your IRS Federal Income Tax Return) Current work status: Working : full time part time Not Working: but looking for work not looking work Current Monthly Gross Income $ Monthly Gross Income $ Spouse’s 2012 or 2013 Adjusted Gross Income $ Total monthly gross income $ From your most current Federal Income Tax Form (yours + spouses) If you did not file in 2012, write 0 in the blank above. If you have Do not count unemployment benefits as income filed your 2013 IRS Federal Income Tax, use 2013. Page 1 of 2 Criminal History Background Information: No Yes I have been convicted of Felony. Date: _____________________
Washington Student Achievement Council Aerospace Loan Program 2013-14 LOAN APPLICATION – Revised 3/24/14 MAIL THIS APPLICATION ALONG WITH YOUR COMPLETED, SIGNED PROMISSORY NOTE Failure to respond or submit required documentation will delay the processing of your loan application. Last Name: First Name: MI SSN: Address: City: State: Zip: Driver’s License #: State: Phone: Ethnicity (optional) African-American Asian-Pacific Islander Vietnamese Korean Alaskan Native White Caucasian Filipino Chinese Other Male Female Birth date: Email (required): How long have you lived in Washington state? years If less than five, previous state of residence: Are you a U.S. Citizen Yes No If no - VISA Type: I-151 I-551 I-551C See Guidelines & Terms of Agreement for eligible non U.S. citizen requirements. VISA Number: (NOT your Visa credit card number) Contacts: Provide two contacts with addresses different from your own and different from each other that will always know your current address. The first contact should be a relative but not a spouse. Contact One: Contact Two: Name Permanent Address City, State, Zip Code Area Code/Telephone Relationship to Recipient Are you delinquent on any Federal/State debts? No Yes (example: Federal Income Tax, Student Loans) Are you delinquent on child support payments? No Yes Have you filed a Bankruptcy in the last seven years? No Yes Are you receiving unemployment benefits? Yes No Do you have dependents? Yes No If yes # of dependents: (dependents are those you claim on your IRS Federal Income Tax Return) Current work status: Working : full time part time Not Working: but looking for work not looking work 2012 or 2013 Adjusted Gross Income $ From your most current Federal Income Tax Form If you did not file in 2012, write 0 in the blank above. If you have filed your 2013 IRS Federal Income Tax, use 2013. Current Monthly Gross Income $ Spouse’s Monthly Gross Income $ Total monthly gross income (yours + spouses) $ Do not count unemployment benefits as income Page 1 of 2 Criminal History Background Information: No Yes I have been convicted of Felony. Date: _____________________
2013_-14_app_fillable_format_wsac_rev_3-24-14.docx