Lifepoint College
STUDENT LOAN APPLICATION FORM
Contact Information
Name of Loan Applicant
*
Title
First Name
Last Name
Birth Date
*
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Month
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Day
Please select a year
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Year
Marital Status:
*
Single
Married
E-mail
*
example@example.com
Phone
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Student (If different than above)
Title
First Name
Last Name
Employment Information
Present Employer
*
First Name
Last Name
Occupation
*
Gross monthly income
*
Comments
Loan Options
Choose the loan option that you would like to apply for.
*
Please Select
Loan Amount: $2,000 // Term: 36 months // Rate: 4% APR // Payment: $59.05/mo
Loan Amount: $13,600 // Term: 36 months // Rate: 2.5% APR // Payment: $392.51/mo
Loan Amount: $13,600 // Term 60 months // Rate: 5% APR // Payment: $256.65/mo
Loan Amount: $17,000 // Term 36 months // Rate: 2% APR // Payment: $486.92/mo
Loan Amount: $17,000 // Term 60 months // Rate: 4% APR // Payment: $313.08/mo
Other Loan Amount (please specify below) // Term 36 months
Other Loan Amount (please specify below) // Term 60 months
Custom Loan Amount
Enter amount if you chose a custom loan amount option above
Consent
If approved for this application, I understand that my loan will be underwritten and financed by Lifepoint Holdings, LLC, a third-party company, and that Lifepoint College is not responsible for or a party to any decisions pertaining to this loan. Furthermore, I agree to repay this loan in its entirety as scheduled per the loan agreement. I understand that failure on my part to make my scheduled payments on time may result in additional late fees and/or this debt being turned over to a third-party collection agency.
*
YES
I confirm that I am applying for this loan for the purpose of myself, or the student listed in this application, attending Lifepoint College. I acknowledge that if my loan is approved, the status of this loan is contingent upon the student remaining in good academic status with Lifepoint College and that failure to do so may result in this loan becoming due in its entirety upon dismissal from the school.
*
YES
I hereby agree that the information given is true, accurate and complete as of the date of this application submission.
*
YES
Send Application Now
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