EmailMe Form - Federal Direct Loan Application

Student Name *

First Last

Student BHC Number 900 *

Student Address: *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Permanent/Home Address (if different from above):

Street Address City State / Province / Region Postal / Zip Code Country / Region

Student phone *

### - ### - ####

Personal email *

Do you/your family receive SNAP? *

Yes

No

Do you/your family receive rent subsidy or housing assistance? *

Yes

No

LOAN REQUEST

Loan period *

If you are requesting Fall Only, please give the reason you ONLY need this semester (ie. graduation, transfer, etc.)?

Loan amount requested *

Do you want to receive a Direct Loan if you are only eligible for an unsubsidized loan? *

Yes

No

If you are eligible for Work Study, do you want to cancel all or a portion of the Work Study Award to receive a loan? *

Yes

No

REPAYMENT INFORMATION

View your National Student Loan Data System (NSLDS) history. (Click #1 by the first loan to see servicer information.) Enter the amount (First time borrower enter $0). *

Your Federal Servicer is:
(ie. FedLoan, Great Lakes, Navient, Nelnet, etc.)
If no prior debt write “none.” *

Complete your Loan Repayment Calculation. (Prior borrowers add the NSLDS total PLUS(+) your current requested amount to get the "Principle Amount" in the calculator.)

Principal Amount of Loan *

Your Monthly Payment Will Be *

Your Total Interest Cost will be *

ENROLLMENT INFORMATION

Are you enrolled at another College/University while attending BHC? *

Yes

No

Are you enrolled in ALL online courses? *

Yes

No

Are you enrolled in second 8-week courses only? *

Yes

No

First Time Borrowers at Black Hawk College with prior student loan debt, please list ALL colleges you attended and received federal loans. You must request official transcripts to be sent to Black Hawk College Enrollment Services:

WE RECOMMEND YOU PRINT THIS PAGE FOR YOUR RECORDS BEFORE YOU SIGN AND SUBMIT (right click and select “Print”)

SIGNATURE
I certify that I am the student requesting loan funds, and all information provided on this form is true and complete to the best of my knowledge. This is a loan that must be repaid.
*We must have your MyBlackHawk Email as a loan signature. (This is your BHC User Name followed by: @mymail.bhc.edu).

Black Hawk student email: *

Deadlines:

November 1 (Full Year or Fall Only Semester)
April 1 (Spring Only Semester)
June 15 (Summer Semester)