PERSONAL DATA SHEET - South Dakota State University



Department of Finance and Budget

Loan Office

Admin. 140, Box 2201

South Dakota State University

Brookings, SD 57007-1829

Phone: 605-688-6183

Fax: 605-688-6944

PERSONAL DATA SHEET

It is a Federal requirement that I complete exit counseling and provide all the required information my school requests if I cease half-time enrollment, withdraw or graduate.

Date of graduation or withdrawal from SDSU: __________________________________________

Curriculum/Major: ________________________________________________________________

Will you be continuing your education? _______________________________________________

If so, WHAT UNIVERSITY/SCHOOL? ________________________________________________

Future Career Plans:______________________________________________________________

| BORROWER’S INFORMATION |

NAME:_______________________________ TYPE OF STUDENT LOAN:

PERMANENT MAILING Perkins______Stafford_______Nursing_______HPL______

ADDRESS____________________________ Nursing Faculty Loan_____

City__________________________________ SOCIAL SECURITY NUMBER:________________________

State________________________Zip______ BIRTHDATE:______________________________________

Telephone No:(___)_____________________ DRIVER’S LICENSE

Cell Phone No:(___)____________________ STATE AND NUMBER:______________________________

E-Mail:_________________________________ SPOUSE:_________________________________________

Spouse’s Employer: _______________________________

| PARENT/GUARDIAN INFORMATION |

Name:____________________________ Address_____________________________________

Telephone_(___)____________________ ____________________________________________

Name:____________________________ Address_____________________________________

Telephone_(___)_____________________ ____________________________________________

| MAILING REFERENCES (other than parents who will know your address) |

1.Name____________________________ Address_____________________________________

Telephone_(___)___________________ ____________________________________________

2.Name____________________________ Address_____________________________________

Telephone_(___)___________________ ____________________________________________

3.Name____________________________ Address_____________________________________

Telephone_(___)___________________ ____________________________________________

I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE IS TRUE AND CORRECT

Name________________________________ Date________________________________________

I understand that:

____ 1. I must inform South Dakota State University immediately of any change in my name, address, or telephone number.

____ 2. I know the full amount of my loan and I must repay my loan on a timely basis even if I did not complete my

education and/or am not satisfied with my education, or cannot find a job in my field.

____ 3. I understand I must make payments on my loan even if I do not receive a bill or repayment notice. Billing

statements are sent to you as a convenience.

____ 4. I understand the minimum monthly payment will be $40.00. However, it may be more if the amount

borrowed is sufficient to require larger payments. This loan must be repaid in a 10-year repayment

period. The interest rate is specified on my promissory note.

____ 5. I must contact South Dakota State University prior to the due date, if payment cannot be made for any

reason.

____ 6. I may accelerate or make payments prior to the due date without penalty. This can reduce the total

amount of interest I will be required to pay over the life of the loan.

____ 7. I must submit timely certification when requesting deferment, postponement and/or cancellation

benefits and notify SDSU of anything that might alter my eligibility for an existing deferment. The

appropriate form to request any of these privileges can be obtained from SDSU or our website.

____ 8. I authorize South Dakota State University to contact any school which I may attend or have attended

to obtain information concerning my student status, my year of study, my dates of attendance,

graduation or withdrawal, my transfer to another school, or my current address. This authorization is in

effect until my loan is paid in full.

____ 9. I understand my account is reported to a national credit bureau every month.

____10. If I fail to repay my student loan, I will be considered in default and the following may result: Subject

to late charges; additional interest; denied copy of transcripts; ineligible to receive any additional

federal or state financial aid funds; negative credit report; collection costs; entire unpaid amount will

become due and payable immediately; and wages garnished.

____11. Loan rehabilitation is available on a defaulted Perkins loan one time only, by requesting rehabilitation and making

consecutive, monthly, on-time payments, as determined by your school.

____12. A Consolidation Loan Program may be an option for me if my loans are from more than one lender.

This program allows me to consolidate student loan debt from various programs into one loan, usually

extending the payment period and lowering monthly payments. Interest rates and total interest paid

may be greater with consolidation. You will not receive cancellation benefits on a Perkins Loan if the Perkins Loan has

been consolidated.

____13. Department of Defense has a program which may repay a portion of student loans on the basis of specific military

service. Military deferment for more than 30 days but less than 3 years active duty during a war or terrorist

attack on loans given after July 1, 2001.

____14. You may request a copy of your promissory note at any time.

THIS IS A LOAN WHICH MUST BE REPAID

I understand that I will be contacted during the next few months by South Dakota State University, Loan Collections, Box 2201, Brookings, SD 57007, 605-688-6183, with further information and instructions. I understand that my school and anyone servicing my student loan may communicate with me at any of the numbers listed above or any number I provide to my school or to anyone servicing my student loan in the future. I also agree that communication may be made to my telephone or mobile device using an auto-dialer, text message or pre-recorded message. If I dispute the terms of this loan in writing, Student Loan Collections does not resolve the dispute. I may contact Student Ombudsman at (877) 557-2575 or ombudsman..

BORROWER’S

SIGNATURE ____________________________________________ DATE _________________________

INSTITUTION REPRESENTATIVE SIGNATURE: ______________________________________________

If I do not make payments when due, my loan may be declared in default. If I default, the Federal Government will take over my loan and I will owe the Government. The Federal Government will actively pursue me for repayment of the debt, including the use of collection agents and reporting my default to consumer credit reporting agencies or to the Internal Revenue Service for purpose of locating me or for income tax refund offset, and referred to the Department of Justice for litigation.

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