SS#: _____-___-_____

Telephone: (____) _____-_______

Year in School: ________________

School you attend: _________________

Application for Loan

Full Legal Name:

_________________________________________________________________

Present Address:

_________________________________________________________________

_________________________________________________________________

Permanent Address:

_________________________________________________________________

_________________________________________________________________

Number of years you have resided in Alabama: ____________________

Place of Birth: _________________________________________________

Date of Birth: __________________________________________________

Martial Status: _______________ No. of Children: ________________

Name of Father: _________________________________________________

Address of Father: ______________________________________________

_________________________________________________________________

Father’s Telephone Number Including Area Code:

_________________________________________________________________

Name of Mother: _________________________________________________

Address of Mother: ______________________________________________

_________________________________________________________________

Mother’s Telephone Number Including Area Code:

_________________________________________________________________

Two references who will know your address and phone number at all times:

1. 1. Name: ________________________________________________________

   Relationship: ___________________________________________________

   Address: ________________________________________________________

   Phone Number Including Area Code: _______________________________

2. 2. Name: ________________________________________________________

   Relationship: ___________________________________________________

   Address: ________________________________________________________

   Phone Number Including Area Code: _______________________________

   To complete this application you are asked to write an essay of what you feel this loan program and your career goals have in common.

   All applicants will have a personal interview with representatives from the board.

Author: Wayne P. Turner

Statutory Authority: Code of Ala. 1975, §§16-47-121 et seq.; 41-22-1 et seq.

History: New Appendix: Filed May 16, 2006; effective June 20, 2006. Amended: Published September 29, 2023; effective November 13, 2023. Amended: Published September 29, 2023; effective November 13, 2023.