Emergency Loan Application (Students)

Name

E-Mail Address

Penn State 9-digit ID Number

Permanent Address

Permanent Phone Number

Local Address

Local Phone Number

Major

Semester Standing

Expected Graduation Date

MM/YYYY

Advisor

Reason for Requesting Loan

Have you reached out to the Sokolov-Miller Family Financial and Life Skills Center for financial planning assistance?

Yes

No

Amount being requested (max of $5,500)

Will this loan be going toward a bursar account balance?

Yes

No

If yes, will a balance remain if approved for the loan?

Yes

No

If yes, is there a plan in place to pay off the remaining balance?

Yes

No

Explain the plan to pay off the remaining balance

How did you learn of the emergency loan?

Additional documentation

Please verify that you are not a robot