STUDENT VISA APPLICATION 

With a credit line of just $500, our Student Visa allows you to build credit without building a pile of debt… 

   Standard Student Visa           

Example of Customized image 

You will receive our standard design free of charge.  Once that arrives you may choose to customize your card for just $10. 

APPLICANT INFORMATION (please print clearly and all information is required) 

Are you a citizen or permanent resident of the United States?  

 Yes 

  No 

_____________________________________________ 
(as you wish it to appear on the card) 
Name 

____________________ 
Date of Birth 

____________________ 
Social Security # 

____________________ 
Mother’s Maiden Name 

_____________________________________________      ____________________ 
Street Address 

Phone Number 

____________________ 
Email Address 

____________________ 
UICCU Member Number 

_____________________________________________   ____________________________________________ 
City, State   

Name of college or university at which you are enrolled        

Zip 

_____________________________________________ 
Employer  

____________________ 
How Long at Employer 

$__________ 
_____________  
Hourly Wage           Hours per Week 

Name:____________________________Address:_____________________________________________Telephone Number___________________________________ 

REQUIRED:  Please list the required information of the nearest relative not living with you. 

Name:____________________________Address:_____________________________________________Telephone Number___________________________________ 

REQUIRED:  Please list the required information of a second relative not living with you. 

OTHER APPLICANT INFORMATION (if applicable) 

_____________________________________________ 
Name 

(no plastic will be issued unless requested) 

____________________ 
Date of Birth 

____________________ 
Social Security # 

____________________ 
Mother’s Maiden Name 

_____________________________________________      ____________________        ____________________        ____________________ 
Street Address 

How Long at Address 

Email Address 

Home Phone 

____________________________________________________________________ 
City 

State 

ZIP 

____________________ 
Cell Phone 

Do You  
 Rent  
Payment $___________ 

 Own  

_____________________________________________      ____________________ 
Employer  

How Long at Employer 

____________________ 
Work Phone 

$___________________  
Gross Annual Income 

 
         
 
 
 
 
 
 
 
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
APR for Purchases, 
Balance Transfers and 
Cash Advances 

15.99% Annual Percentage Rate   
Non-Variable Rate 

Interest Rate and Interest Charges 

How to Avoid Paying 
Interest on Purchases 

If the New Balance shown on this statement is paid in full by the Payment Due Date shown on this statement, no interest charge will be imposed on Current 
Cycle Purchases (which are the purchases itemized on this statement). Each cash advance under your account will be subject to an interest charge 
beginning on the date the advance is posted to your account. Interest charges will continue to accrue on your account until the entire outstanding balance is 
paid in full. 

Fees 

Minimum Finance Charge 

None 

Annual Fee 
Transaction Fees 

None 

Balance Transfer 
Cash Advance 
Foreign Transaction 

None (for non-UICCU balances only) 
3% or $5 whichever is greater. 
1% of each transaction in U.S. dollars 

Penalty Fees 

Late Payment 
Over-the-Credit Limit 
Returned Check Fee 

Up to $15 
None 
Up to $25 

Other Fees & Charges 

Card Replacement Fee (for any reason): $10.00 

For Credit Card Tips from 
the Federal Reserve Board 

To learn more about factors to consider when applying for or using a credit card, visit the website of the Federal Reserve Board at 
http://www.federalreserve.gov/creditcard.  

How We Will Calculate Your Interest:  We figure the interest charge on your account by applying the periodic rate, as stated in your Account Opening Disclosures to the 
“average daily balance” of your account. To get the “average daily balance” we take the beginning balance of your account each day, add any new purchases/advances/fees, 
and subtract any unpaid interest or other finance charges and any payments or credits. This gives us the daily balance. Then, we add up all the daily balances for the billing 
cycle and divide the total by the number of days in the billing cycle. This gives us the “average daily balance.”  
Minimum Payment: The minimum monthly payment is 2% of the new balance, but at least $25.00 or the new balance if less than $25.00.  If the unpaid interest and fees on the 
account are greater than the minimum monthly payment, the minimum monthly payment will become that amount. Any amount that is past due or prior minimum payments that 
were not made will also be added to the minimum monthly payment amount. 
This information is accurate as of 6/1/2011 

SIGNATURE(S) 

1.  You  promise  that  everything  you  have  stated  in  this  application  is  correct  to  the 
best of your knowledge and that the above information is a complete listing of what 
you  owe.  If  there  are  any  important  changes  you  will  notify  us  in  writing 
immediately.  You  authorize  the  UICCU  to  obtain  credit  reports  in  connection  with 
this  application  for  credit  and  for  any  update,  increase,  renewal,  extension  or 
collection  of  the  credit  received.  You  understand  that  the  UICCU  will  rely  on  the 
information  in  this  application  and  your  credit  report  to  make  its  decision.  If  you 
request, the UICCU will tell you the name and address of any credit bureau from 
which  it  received  a  credit  report  on  you.  It  is  a  federal  crime  to  willfully  and 
deliberately provide incomplete or incorrect information on loan applications made to 
federal credit unions or state chartered credit unions insured by the NCUA.  
2.  You pledge as security all share and dividends and, if any, all deposits and interest 
in  all  joint  and  individual  accounts  you  have  with  us  now  and  in  the  future.    Your 
pledged shares may be withdrawn by you unless you are in default.  The credit  

union  may  have  what  is  known  as  a  statutory  lien  on  all  individual  and  joint 
accounts that you have with us.  A statutory lien means we have the right under 
federal law and many state laws to claim an interest in your accounts.  We can 
enforce  a  statutory  lien  against  your  shares  and  dividends,  and  if  any,  interest 
and deposits, in all individual and joint accounts you have with us to satisfy any 
outstanding financial obligation that is due and payable to us.  We may exercise 
our right to enforce this lien without further notice to you, to the extent permitted 
by law.  The statutory lien will allow us to apply the funds in your account(s) to 
what you owe when you are in default.  The statutory lien does not apply to any 
Individual Retirement Account or any other account that would lose special tax 
treatment under state or federal law if given as security. 
3.You understand that the use of your card will constitute acknowledgement of 
receipt and agreement to the terms of the credit card agreement and disclosures. 
Visa and/or MasterCard may not be used for any illegal transactions. 

___________________  ____________________ 
     Applicant Signature                             Date              Other Applicant Signature                     Date 

FOR UICCU USE ONLY 
Approval Checklist 

The member is currently enrolled at a 2 or 4 year college or university(vocational or technical schools do not qualify) 
2 references above and all information is complete 
Member has a checking account with the UICCU 
One of the following is complete if Student only on application (please indicate which item) 

       The member has no credit score  or   The member credit score exceeds 640 

Member has one of the following if Student and a co-applicant are on application (please indicate which item) 

       Co-Applicant credit score exceeds 640  or   Properly approved exception to score requirement obtained and noted in SAIL 

Member has employment income and  D/I Ratio is <45% not including housing expenses or student loans (either as income or obligations) 

     or  Co-applicant present  and combined D/I Ratio is <45% 
Loan is complete, properly approved, and funded in SAIL 

Date_____________ 

 Approved 

Employee Number___________________________________ 

 Denied 

Employee Signature__________________________________