Direct Loan Borrower Information

I have attended exit counseling for Direct Subsidized Loan and Direct Unsubsidized Loan borrowers. I understand
that I must repay my loan according to the terms of my promissory note.
Student Information (Please print clearly.)

Name (last, first, middle initial) Social Security Number Date of Birth

Home Address (street, city, state, zip code)

( )
Home Area Code/Telephone Number Driver’s License (state and number)

Expected Permanent Address (street, city, state, zip code)

Write N/A if you do not know the information requested for your expected employer.

( )
Expected Employer (after leaving school) Expected Employer’s Area Code/Telephone Number

Expected Employer’s Address (street, city, state, zip code)

References: You must list two persons, with different U.S. addresses, who will know your whereabouts for at least
three years.

1. 2.
Name Name

Street Address Street Address

City, State, Zip Code City, State, Zip Code

( ) ( )
Area Code/Telephone Number Area Code/Telephone Number

You must list your next of kin, with a U.S. address different from yours, who will know your whereabouts for at least
three years.

1.
Name

Street Address

City, State, Zip Code

( )
Area Code/Telephone Number

Student’s Signature Date