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Troubled Teen Program Loan Application

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General Information
Which School Are You Applying For?
Who Is Your Admissions Counselor?
If you will be paying the initial fees to enroll your child out-of-pocket and would like to be reimbursed when your loan is disbursed, check this box. Yes
Amount Requested $ Repayment Terms (years, 15 max)
Student Information
First Name Last Name
Estimated Enrollment Date Date of Birth
Primary Borrower Information
First Name Last Name
SS# Date of Birth
Perm. Address
City State Zip
How Long at this Address? Years Months
Home Phone    
Cell Phone Email
Housing: Rent Own Live with others
Are you a U.S. Citizen? Yes No
Mortgage Company Mortgage Company Phone
Approximate Mortgage Balance $ Approximate Home Value $
Monthly Mortgage/Rent $    
Primary Borrower Employment
Current Employer Occupation/Title
How long at Current Employer? Years Months
Current Employer Address
City State Zip
Work Phone    
Primary Income Source
Gross Annual Income from Primary Source $
Secondary Income Source
Gross Annual Income from Secondary Source (Do not list cosigner income here) $
Cosigner Information (Optional)
First Name Last Name
SS# Date of Birth
Perm. Address
City State Zip
How Long at this Address? Years Months
Home Phone    
Cell Phone Email
Housing: Rent Own Live with others
Are you a U.S. Citizen? Yes No
Approximate Mortgage Balance $ Approximate Home Value $
Current Employer Occupation/Title
How long at Current Employer? Years Months
Current Employer Address
City State Zip
Work Phone    
Primary Income Source
Gross Annual Income from Primary Source $
Secondary Income Source
Gross Annual Income from Secondary Source (Only include income directly attributable to cosigner) $
Reference
First Name Last Name
Address
City State Zip
Relationship to Borrower Phone
 
Are you the borrower and do you authorize Sallie Mae Financial to check your credit? Yes No