Education Loan

Employment Information
Are you currently employed?*

YesNo
Applicant's Occupation
Name of Employer
Yearly Gross Salary
Employed since
Year
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Postal / Zip
Business Phone Number
Please enter a valid phone number.

Spouse and Dependent Information
Name

First NameLast Name
Spouse's Maiden Name (if applicable)
Spouse's Social Security Number
Spouse's California Driver's License Number
Spouse's Date of Birth

MonthDayYear
Spouse's Occupation
Spouse's Yearly Gross Salary
Name of Spouse's Employer
Spouse employed since
Year
Spouse's Work Phone
Please enter a valid phone number.
Spouse's Cell Phone
Please enter a valid phone number.
Spouse's Email
example@example.com
Number of Dependents
Please enter the ages of your 6 youngest dependents
Age Dependent 1*
Age Dependent 2*
Age Dependent 3*
Age Dependent 4*
Age Dependent 5*
Age Dependent 6*

Parent Information

Must be completed if applicant is under 21 years-of-age
Parent 1 or Legal Guardian

First NameLast Name
Work Phone
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Email
example@example.com
Occupation
Name of Employer
Parent 2 or Legal Guardian Name

First NameLast Name
Work Phone
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Email
example@example.com
Occupation
Name of Employer
Parents' Combined Monthly Salary (gross)
Will the student loan applicant be a dependent on your tax return or anyone else's?

YesNo

School Information
Name of School:*
City*
State*
Field of Study*
Degree Sought*
Program Length*
What year are you currently in*
Yearly Cost of Tuition*
Expected Graduation Date*
Does the above tuition include books/supplies?*

YesNo

Financial Assistance
Loans applied for and/or received

ScholarshipsGrantsFellowshipsAssistantshipsStipendsOther
Amount Received from above:
Amount Requested from HFLSD*
Please complete information for your bank(s).*
Income and Expenses — Detail

You will be asked to provide additional supporting documentation, as well as a detailed budget worksheet. This is to get a general understanding of your financial situation.
Please provide details of your income sources (report net income)*
Please provide details of your expenses (ie. utilities, food, gas, books, etc.)*
Current Assets and Liabilities
Please list your assets*
Please list your liabilities*
Please list your liabilities*

Certification of Completeness and Accuracy, and Approval to Obtain Additional Information
I authorize the Hebrew Free Loan of San Diego to investigate my credit and personal history.

I authorize agencies and persons contacted by the Hebrew Free Loan of San Diego in connection with this application (including credit reporting agencies, banks, and social service organizations) to provide information about my credit and personal history to Hebrew Free Loan of San Diego.

I certify that the information contained in this loan application is complete and accurate
Applicant's Signature *

Clear
Date*

MonthDayYear
Date
Spouse's Signature

Clear
Date

MonthDayYear
Date
[If applicant is under age 18, signature of parent or legal guardian is also required.]
Parent 1 or Guardian Signature

Clear
Parent 2 or Guardian Signature

Clear
Date

MonthDayYear
Date

Hebrew Free Loan of San Diego Privacy Policy
The Hebrew Free Loan of San Diego (HFLSD) is a nonprofit organization that makes interest-free loans to deserving individuals in San Diego County. All providers of loan services are required by law to inform their clients of their policies regarding privacy of client information. HFLSD observes all state and federal requirements regarding the confidentiality and safeguarding of the personal information of its borrowers and guarantors.

Federal law requires HFLSD to tell you how we collect, share, and protect your non-public personal information. Please read this notice carefully to understand what we do.

We collect your personal information when you apply for a loan or provide a guaranty for a loan. We may also collect your non-public personal information from credit bureaus and other sources with your authorization. The types of personal information we collect on our borrowers and guarantors can include: Social Security number, driver license number, address, telephone number, income, credit history, and credit scores.

HFLSD keeps confidential the personal information regarding its borrowers or guarantors, except to the extent required or permitted by law (e.g. in response to court orders or legal investigations) or for our everyday business purposes, such as to report to credit bureaus, to process borrower transactions, enforce borrower or guarantor obligations, or maintain loan accounts. In all such situations, we stress the confidential nature of the information being shared.

We restrict access to your personal information to those who need to know that information to process the loan application and collect loan payments. We retain records relating to loan services that we provide so that we are better able to assist borrowers with their needs. To protect personal information from unauthorized access and use, we maintain physical, electronic, and procedural safeguards that comply with federal and our internal standards. These measures include computer safeguards and secured files.

We will continue to adhere to the privacy policies and practices as described in this notice even after the time you satisfy your loan obligation to us.

Our staff is trained to not disclose personal information unless in compliance with this policy. Your privacy and the ability to provide you with quality loan services are very important to us. If you have questions about our privacy policy, please call (858) 345-8018 or email info@HFLSD.org
Signature*

Clear
Date*

MonthDayYear
Date

Borrower's Acknowledgement of Terms and Conditions
I understand and agree that the following terms and conditions will apply to my loan:
- There will be no interest charged.
- The cost of obtaining a credit report will be deducted from the proceeds of the loan.
- I will repay my loan according to the amounts and schedule stated in the promissory note that I sign.
- If I fail to make payments as agreed, the Hebrew Free Loan of San Diego will start collection proceedings against me and my guarantors (each of whom is individually responsible for the full amount of the outstanding balance).
- I will immediately notify the Hebrew Free Loan of San Diego about any changes in my address or in my ability to make my payments as agreed.
Applicant's Signature *

Clear
Date*

MonthDayYear
Date
Please upload an image of your Photo ID*

Cancelof
Spouse's Signature

Clear
Date

MonthDayYear
Date
Please upload an image of your Photo ID

Cancelof
Parent 1 or Guardian Signature

Clear
Date

MonthDayYear
Date
Please upload an image of your Photo ID

Cancelof
Parent 2 or Guardian Signature

Clear
Date

MonthDayYear
Date
Please upload an image of your Photo ID

Cancelof
Should be Empty:

Student Loan Application Form

Applicant Information

Employment Information

Spouse and Dependent Information

Parent Information

School Information

Financial Assistance

Income and Expenses — Detail

Current Assets and Liabilities

Certification of Completeness and Accuracy, and Approval to Obtain Additional Information

Hebrew Free Loan of San Diego Privacy Policy

Borrower's Acknowledgement of Terms and Conditions