Emergency Loan Application

This is a non-monetary loan that is given to students, who qualify, in the amount of their first installment, only. The maximum amount that can be given is $1500. Undergraduates must have at least 2.0 overall GPA, while graduate students must have at least a 3.0 overall GPA.

Last Name

First Name

Middle Inital

Campus Wide ID (CWID)

Address

City

State

Zip Code

Phone Number

Email Address

I promise to pay Texas A&M University-Texarkana all sums disbursed under the terms of this Master Promissory Note, plus interest and other charges and fees that may become due as provided in this Note.

I am requesting an emergency tuition loan in the amount of:

Enter amount of loan request for total tuition under $1500.00

(May not be less than 25% of the total charge owed if payment plan selected)

Information Release

I agree

I authorize the Financial Aid Office to release any information concerning my records at A&M-Texarkana to any Federal/State Institution or local organization necessary for the administration of my emergency loan.

Term agreement

I agree

I understand that any remaining balance after the application of the emergency loan must be made by the tuition due date each semester in order to remain enrolled and not be dropped for non-payment.

I will repay this emergency loan with funds I receive from the following sources:

Other payment methods

I CERTIFY THAT THE ABOVE INFORMATION IS CORRECT

I agree

BY CHECKING THIS BOX, I CERTIFY THAT THE ABOVE INFORMATION IS CORRECT AND THAT SUBMISSION OF FALSE OR MISLEADING INFORMATION ON THIS APPLICATION MAY DISQUALIFY ME FROM RECEIPT OF AN EMERGENCY LOAN.

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