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INITIAL INTERVIEW QUESTIONNAIRE (PERSONAL AND CONFIDENTIAL INFORMATION)
-Student Loan Entrance Counseling Sheet Page 2-

TYPE OF LOAN:
Perkins HPL Stafford
NSL Alternative PCL
 
College of
 
Please complete the following data:
 
Enter data in each field-Use N/A or SAME if applicable.
 
 SSN/PVID/CollegeNet ID
 Driver's License Number State
 Birth Date
 Expected Graduation Date
 Name
 E-Mail Address
 Permanent Address- Street
 City
 State
 Zip
 Telephone
 Local Address- Street
 City
 State
 Zip
 Telephone
 If employed give name and address of employer:
 Name
 Address- Street
 City
 State
 Zip
 Telephone
 Give name and address of Spouse's employer:
 Name
 Address- Street
 City
 State
 Zip
 Telephone
 Parents:
 Mother
 Address- Street
 City
 State
 Zip
 Telephone
 Father
 Address- Street
 City
 State
 Zip
 Telephone
 Brothers or Sisters over 18 not living at home: (List  current  name of sister, IE., Mrs. James R. Doe)
 Name
 Address- Street
 City
 State
 Zip
 Name
 Address- Street
 City
 State
 Zip
 Personal References #1
 Name
 Address- Street
 City
 State
 Zip
 Personal References #2
 Name
 Address- Street
 City
 State
 Zip
 Insurance Company or Agent
 Name (automobile)
 Address- Street
 City
 State
 Zip
 I certify that the above information is correct and complete, and I  hereby  authorize verification as required by the university.
Signature _________________________________
  
 Date  


Don't forget to complete pages 1 and 2