This form is to be completed by graduate students who wish to borrow under the Federal Direct Graduate PLUS Program (PLUS). Student's Name (last, first, MI)* Student ID # Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code Driver's License Number State of Issue Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Date of Birth (mm/dd/yy) Home Phone Daytime Phone Email Address Loan Period Requested Full Academic Year Fall Semester Only Spring Semester Only Summer Session I Summer Session II Summer Session III Academic Year of Loan Loan Amount Requested (for maximum, enter "MAX") Please note: By completing this form, I acknowledge that a credit check will be done to determine my eligibility for this loan. I authorize this check of my credit. Before submitting this form to the Financial Aid Office for processing, be sure that you have completed your Free Application for Federal Student Aid (FAFSA) and that you have been awarded your maximum Federal Subsidized and Unsubsidized Student Loans for this loan period. You will need to complete the GradPLUS Master Promissory Note and GradPLUS Entrance Counseling if you have not already done so. If credit is denied, you may appeal the credit denial and/or obtain a credit-eligible endorser for the Grad PLUS Loan. Information on this process will be mailed to you from the Direct Loan Servicing Center. Submit * Required