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<tbody>
<tr class="odd">
<td colspan="11"><p><strong>Federal Family Education Loan Program
(FFELP)</strong></p>
<p><strong>Federal PLUS Loan Information and School
Certification</strong></p>
<p>WARNING: Any person who knowingly makes a false statement or
misrepresentation on this form is subject to penalties that may include
fines, imprisonment, or both, under the U.S. Criminal Code and 20 U.S.C.
1097.</p></td>
<td colspan="11">Guarantor, Program, or Lender Identification</td>
</tr>
<tr class="even">
<td colspan="11"><em>(Reserved for school, lender, or guarantor mailing
address as appropriate)</em></td>
<td colspan="11"><p><strong>1.</strong> School Code</p>
<p><strong>2.</strong> School Information (Name, Address, and Phone
Number)</p></td>
</tr>
<tr class="odd">
<td colspan="22"><strong>Borrower and Student Information</strong></td>
</tr>
<tr class="even">
<td colspan="6"><strong>3.</strong> Borrower Last Name</td>
<td colspan="8">First Name</td>
<td colspan="3">MI</td>
<td colspan="5"><strong>4.</strong> Borrower Social Security Number</td>
</tr>
<tr class="odd">
<td colspan="13"><strong>5.</strong> Permanent Address (See
instructions.)</td>
<td colspan="4"><strong>6.</strong> Area Code/Telephone Number</td>
<td colspan="5"><strong>7.</strong> Borrower Date of Birth
(mm-dd-yyyy)</td>
</tr>
<tr class="even">
<td colspan="3"><blockquote>
<p>City</p>
</blockquote></td>
<td colspan="5">State</td>
<td colspan="5">Zip Code</td>
<td colspan="9"><strong>8.</strong> Borrower E-mail Address</td>
</tr>
<tr class="odd">
<td colspan="10"><strong>9.</strong> Lender Name/Lender Code, if
known</td>
<td colspan="7">City</td>
<td colspan="5">State</td>
</tr>
<tr class="even">
<td colspan="11"><p><strong>10.</strong> Borrower Requested Loan
Amount</p>
<blockquote>
<p>$ .00</p>
</blockquote></td>
<td colspan="11"><p><strong>11.</strong> Loan Period (mm-dd-yyyy)</p>
<blockquote>
<p>From: To:</p>
</blockquote></td>
</tr>
<tr class="odd">
<td colspan="4"><strong>12.</strong> Student Last Name</td>
<td colspan="5">First Name</td>
<td colspan="2">MI</td>
<td colspan="6"><strong>13.</strong> Student Social Security Number</td>
<td colspan="5"><strong>14.</strong> Student Date of Birth
(mm-dd-yyyy)</td>
</tr>
<tr class="even">
<td colspan="12"><h3 id="school-certification-information">School
Certification Information</h3></td>
<td colspan="10"><strong>(To be completed only by the
school.)</strong></td>
</tr>
<tr class="odd">
<td colspan="11"><p><strong>15.</strong> Enrollment Status (Check
one)</p>
<blockquote>
<p>Full Time At Least Half Time</p>
</blockquote></td>
<td colspan="11"><strong>16.</strong> Anticipated Graduation
(Completion) Date (mm-dd-yyyy)</td>
</tr>
<tr class="even">
<td colspan="11"><p><strong>17.</strong> Loan Period (mm-dd-yyyy)</p>
<blockquote>
<p>From: To:</p>
</blockquote></td>
<td colspan="6"><strong>18.</strong> Grade Level</td>
<td colspan="5"><p><strong>19.</strong> Certified Loan Amount</p>
<blockquote>
<p>$ .00</p>
</blockquote></td>
</tr>
<tr class="odd">
<td colspan="22"><strong>20.</strong> Recommended Disbursement Date(s)
(mm-dd-yyyy)</td>
</tr>
<tr class="even">
<td colspan="2">1st</td>
<td colspan="5">2nd</td>
<td colspan="5">3rd</td>
<td colspan="4">4th</td>
<td colspan="4">5th</td>
<td colspan="2">6th</td>
</tr>
<tr class="odd">
<td colspan="22">This space reserved for additional disbursement dates,
if needed.</td>
</tr>
<tr class="even">
<td colspan="12"><h3 id="school-certification">School
Certification</h3></td>
<td colspan="10"><strong>(To be completed only by the
school.)</strong></td>
</tr>
<tr class="odd">
<td colspan="22"><p>I certify:</p>
<ul>
<li><p>That the graduate or professional student borrower or the
dependent undergraduate student named on this Certification is accepted
for enrollment as a regular student in an eligible program on at least a
half-time basis, is a U.S. citizen, permanent resident, or other
eligible non-citizen, and is making satisfactory academic
progress;</p></li>
<li><p>That the borrower is an eligible borrower in accordance with the
Higher Education Act of 1965, as amended, and applicable U.S. Department
of Education regulations (collectively referred to as the Act) and has
been determined eligible for a loan in the amount certified;</p></li>
<li><p>That the borrower, if a graduate or professional student, has
completed a Free Application for Federal Student Aid (FAFSA) and that
the borrower’s eligibility for the maximum annual amount of a Stafford
Loan (subsidized and unsubsidized) has been determined;</p></li>
<li><p>That the disbursement schedule complies with the requirements of
the Act;</p></li>
<li><p>Based on available records and appropriate inquiry,
that:</p></li>
</ul>
<blockquote>
<p>(i) the graduate or professional student borrower or the dependent
undergraduate has met the requirements of the Selective Service Act, and
is not incarcerated;</p>
<p>(ii) neither the borrower nor, if applicable, the dependent
undergraduate student is liable for an overpayment of any federal grant
or loan made under the Act;</p>
<p>(iii) neither the borrower nor, if applicable, the dependent
undergraduate student is in default on any Title IV education loan(s);
or if the borrower or student is in default, satisfactory repayment
arrangements have been made with the holder(s) of any defaulted
loan(s);</p>
<p>(iv) neither the borrower nor, if applicable, the dependent
undergraduate student has been convicted of or pled <em>nolo
contendere</em> (no contest) or guilty to a crime involving fraud in
obtaining funds under Title IV of the Higher Education Act of 1965
(HEA), as amended; or if the borrower or student has pled <em>nolo
contendere</em> or guilty to such a crime, the borrower or student has
repaid the funds to the Secretary of Education or to the loan holder in
the case of a Title IV federal student loan;</p>
<p>(v) neither the borrower nor, if applicable, the dependent
undergraduate student has property subject to a judgment lien for a debt
owed to the U.S; and</p>
<p>(vi) the information provided in this Certification is true,
complete, and accurate to the best of my knowledge and belief.</p>
</blockquote>
<p>I agree to provide the borrower with <strong>(i)</strong>
confirmation of any transfer of funds through electronic funds transfer
(EFT) or master check to the graduate or professional student borrower’s
or dependent student’s account, and <strong>(ii)</strong> an opportunity
to cancel or reduce any disbursement of a loan.</p></td>
</tr>
<tr class="even">
<td><strong>21.</strong></td>
<td colspan="4"><h5
id="signature-of-authorized-school-official">Signature of Authorized
School Official</h5></td>
<td colspan="9"></td>
<td><strong>22.</strong></td>
<td colspan="4"><strong>Today’s Date (mm-dd-yyyy)</strong></td>
<td colspan="2"></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2"><strong>Name/Title (Printed or Typed)</strong></td>
<td colspan="11"></td>
<td colspan="4"></td>
<td colspan="3"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="22"><h4
id="please-refer-to-the-instructions-for-completing-this-form.">Please
refer to the instructions for completing this form.</h4></td>
</tr>
</tbody>
</table>

+----------------------+----------------------+-----------------------+
| # Instructions for   |                      |                       |
| Completing Federal P |                      |                       |
| LUS Loan Information |                      |                       |
|                      |                      |                       |
| **and School         |                      |                       |
| Certification**      |                      |                       |
+----------------------+----------------------+-----------------------+
| *Items 1 and 2 may   | *the school you or   | **Item 18:** Enter    |
| be prefilled or      | the student will     | the grade level of    |
| completed by the     | attend minus any     | the graduate or       |
| school.*             | estimated financial  | professional student  |
|                      | assistance that has  | borrower or the       |
| **Item 1:** Enter    | been or will be      | dependent             |
| the code for your    | awarded during the   | undergraduate         |
| school. This code is | period of            | student. Select the   |
| provided by the U.S. | enrollment.*         | proper grade level    |
| Department of        |                      | indicator using the   |
| Education for the    | **Item 11:** Enter   | standard grade level  |
| Federal Family       | the beginning and    | codes provided:       |
| Education Loan       | ending dates of the  |                       |
| Program.             | academic period for  | +---+--------------+  |
|                      | which this loan is   | | # | ###          |  |
| **Item 2:** Enter    | to be used.          | | # |  Grade Level |  |
| your school name and |                      | | # |              |  |
| address, and the     | **Item 12:** If the  | |   |              |  |
| telephone number,    | borrower is the      | | C |              |  |
| including area code, | parent of a          | | o |              |  |
| of a school official | dependent            | | d |              |  |
| who can answer       | undergraduate        | | e |              |  |
| questions about this | student, enter the   | +---+--------------+  |
| certification.       | student's last name, | | 1 | Fr           |  |
|                      | first name, and      | |   | eshman/First |  |
| *Items 3-14 may be   | middle initial.      | |   | Year         |  |
| completed by the     |                      | |   | (including   |  |
| borrower, school, or | **Item 13:** If the  | |   | proprietary  |  |
| lender. If the       | borrower is the      | |   | school       |  |
| borrower is          | parent of a          | |   | programs     |  |
| completing this      | dependent            | |   | that are     |  |
| section and any      | undergraduate        | |   | less than    |  |
| information has been | student, enter the   | |   | one year in  |  |
| prefilled by the     | student's nine-digit | |   | duration)    |  |
| school or lender,    | Social Security      | +---+--------------+  |
| the borrower should  | Number. This loan    | | 2 | Soph         |  |
| review it for        | cannot be processed  | |   | omore/Second |  |
| correctness. If any  | without the          | |   | Year         |  |
| part of the          | student's Social     | +---+--------------+  |
| prefilled            | Security Number.     | | 3 | Junior/Third |  |
| information is       |                      | |   | Year         |  |
| incorrect, cross out | **Item 14:** If the  | +---+--------------+  |
| the incorrect        | borrower is the      | | 4 | S            |  |
| information and      | parent of a          | |   | enior/Fourth |  |
| print the correct    | dependent            | |   | Year         |  |
| information.         | undergraduate        | +---+--------------+  |
| Incorrect,           | student, enter the   | | 5 | Fifth        |  |
| incomplete, or       | date of the          | |   | Year/Other   |  |
| illegible            | student's birth. Be  | |   | U            |  |
| information may      | careful not to enter | |   | ndergraduate |  |
| delay the loan.*     | the current year.    | |   | (including   |  |
|                      |                      | |   | sixth year   |  |
| *If the borrower is  | *Items 15-22 are to  | |   | u            |  |
| the parent of a      | be completed only by | |   | ndergraduate |  |
| dependent            | the school. This     | |   | and          |  |
| undergraduate        | information is to be | |   | continuing   |  |
| student borrowing    | certified by a       | |   | education    |  |
| for the student's    | financial aid        | |   | students)    |  |
| education, all       | administrator or     | +---+--------------+  |
| references to        | other school         | | A | First Year   |  |
| "student" mean the   | official authorized  | |   | Graduate or  |  |
| dependent            | to certify financial | |   | Professional |  |
| undergraduate        | aid forms. If        | +---+--------------+  |
| student named in     | certification        | | B | Second Year  |  |
| Item 12.*            | information is       | |   | Graduate or  |  |
|                      | transmitted          | |   | Professional |  |
| *Enter dates as      | electronically, the  | +---+--------------+  |
| month-day-year       | School Certification | | C | Third Year   |  |
| (mm-dd-yyyy). Use    | form does not have   | |   | Graduate or  |  |
| only numbers.        | to be submitted.*    | |   | Professional |  |
| Example: June 24,    |                      | +---+--------------+  |
| 1982 = 06-24-1982.*  | **Item 15:**         | | D | Beyond Third |  |
|                      | Indicate whether the | |   | Year         |  |
| **Item 3:** Enter or | graduate or          | |   | Graduate or  |  |
| correct the          | professional student | |   | Professional |  |
| borrower's last      | borrower or the      | +---+--------------+  |
| name, first name,    | dependent            |                       |
| and middle initial.  | undergraduate        | **Item 19:** Enter    |
|                      | student is (or plans | the maximum amount of |
| **Item 4:** Enter or | to be) enrolled at   | PLUS Loan the         |
| correct the          | least half time or   | borrower is eligible  |
| borrower's Social    | full time. A         | to receive for the    |
| Security Number.     | graduate or          | academic period       |
| This loan cannot be  | professional student | covered in Item 17.   |
| processed without    | borrower who is      | This amount cannot    |
| the borrower's       | enrolled (or         | exceed the cost of    |
| Social Security      | planning to enroll)  | attendance minus      |
| Number.              | less than half time, | other financial aid.  |
|                      | or the parent of a   |                       |
| **Item 5:** Enter    | dependent            | **Item 20:** Enter    |
| the borrower's       | undergraduate        | the disbursement      |
| permanent address    | student who is       | dates for this loan   |
| (number, street,     | enrolled (or         | as determined in      |
| apartment number) or | planning to enroll)  | accordance with the   |
| rural route number   | less than half time, | Act.                  |
| and box number, then | is not eligible for  |                       |
| city, state, and zip | a Federal PLUS Loan. | **Item 21:** Your     |
| code. If the         |                      | signature             |
| borrower's mailing   | **Item 16:** Enter   | acknowledges that you |
| address is a post    | the date the student | have read and agree   |
| office box or        | is expected to       | to the provisions in  |
| general delivery,    | complete the program | the School            |
| list both the        | at your school. If   | Certification. You    |
| mailing address and  | you are unsure of    | must sign the         |
| the street address   | the actual           | certification and     |
| or rural route       | completion date in   | print your name and   |
| number and box       | the future, enter    | title.                |
| number.              | the last day of the  |                       |
|                      | month.               | **Item 22:** Enter    |
| **Item 6:** Enter    |                      | the date of           |
| the borrower's area  | **Item 17:** Enter   | certification.        |
| code and telephone   | the dates covered by |                       |
| number. If the       | the cost of          | ##### Paper           |
| borrower does not    | attendance. These    | work Reduction Notice |
| have a telephone,    | dates must coincide  |                       |
| enter N/A.           | with actual term     | According to the      |
|                      | starting and ending  | Paperwork Reduction   |
| **Item 7:** Enter    | dates. At a school   | Act of 1995, no       |
| the date of the      | without academic     | persons are required  |
| borrower's birth. Be | terms, these dates   | to respond to a       |
| careful not to enter | must coincide with   | collection of         |
| the current year.    | the student's        | information unless it |
|                      | program of study if  | displays a currently  |
| **Item 8:** Enter    | that is less than an | valid OMB control     |
| the borrower's       | academic year in     | number. The valid OMB |
| e-mail address.      | length, or the       | control number for    |
|                      | academic year.       | this information      |
| **Item 9:** Enter    |                      | collection is         |
| the borrower's       |                      | 1845-0069. The time   |
| lender selection     |                      | required to complete  |
| (name,               |                      | this information is   |
| identification       |                      | estimated to average  |
| number, city, and    |                      | 0.15 hours (9         |
| state), if known.    |                      | minutes) per          |
|                      |                      | response, including   |
| ***Note to           |                      | the time to review    |
| Borrower:** If you   |                      | instructions, search  |
| do not have a lender |                      | existing data         |
| for this loan,       |                      | resources, gather and |
| contact the school's |                      | maintain the data     |
| financial aid        |                      | needed, and complete  |
| office, a bank or    |                      | and review the        |
| other financial      |                      | information           |
| institution, or the  |                      | collection. **If you  |
| guarantor or program |                      | have any comments     |
| listed on this form  |                      | concerning the        |
| for information on   |                      | accuracy of the time  |
| lenders willing to   |                      | estimate(s) or        |
| make Federal PLUS    |                      | suggestions for       |
| Loans.*              |                      | improving this form,  |
|                      |                      | please write to:**    |
| **Item 10:** Enter   |                      |                       |
| the maximum Federal  |                      | U.S. Department of    |
| PLUS Loan amount the |                      | Education             |
| borrower wishes to   |                      |                       |
| borrow for           |                      | Washington, DC        |
| himself/herself or   |                      | 20202-4700            |
| for the dependent    |                      |                       |
| undergraduate        |                      |                       |
| student listed in    |                      |                       |
| Item 12 for the loan |                      |                       |
| period listed in     |                      |                       |
| Item 11.             |                      |                       |
|                      |                      |                       |
| ***Note:** Apply     |                      |                       |
| only for the amount  |                      |                       |
| you will need to pay |                      |                       |
| educational costs    |                      |                       |
| this year, keeping   |                      |                       |
| in mind your ability |                      |                       |
| to repay your        |                      |                       |
| loan(s). You may     |                      |                       |
| borrow up to the     |                      |                       |
| estimated cost of    |                      |                       |
| education at*        |                      |                       |
+----------------------+----------------------+-----------------------+