Hargens Loan Assistance Program (HLAP) - 2008 Application

I. APPLICANT INFORMATION Name: ________________________________ Social Security Number:___________________ Date of Birth: _____________________ Citizenship: __________________________________ Date of Fletcher Graduation: ____________________ Degree: ___________________________ Marital Status: _______________ Name of Spouse: ___________________________________ Number/Age of Dependants: ______________________________________________________ Mailing Address: _______________________________________________________________ _____________________________________________________________________________ _ Months/Years at this Address: _____________________________________________________ Home Phone: _____________________________ Work Phone: _________________________ Email Address: ________________________________________________________________ II. EMPLOYMENT INFORMATION To complete this portion of the application, please provide the information below for your current employer. Attach an additional sheet with this information if you have more than one employer. In addition, please attach: 1 • A copy of your resume.

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2 • A letter from your current employer verifying employment and salary information. 3 • A copy of a current pay stub. 4 • One copy of your 2007 Federal Tax Return. Current Employer Name/Address: __________________________________________________ _____________________________________________________________________________ _ Supervisor Name/Title/Phone Number: ______________________________________________ Job Title: _____________________________________________________________________ Annual Salary: _______________________ Months/Years at Job: ________________________

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III. EDUCATIONAL LOAN INFORMATION Please provide educational loan information as of February 28, 2008 for all academic programs (Undergraduate, Fletcher, Other) attended. Attach an additional sheet if needed. University or Institution 1 Program Dates Attended Original Amount Borrowed Principle Balance(s) Remaining Monthly Payments Consolida ted loan? (Y/N)

(Undergrad, MA, etc)

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Loan Details Please provide details on loans listed above. Line 1 in the chart above should correspond to Line 1 in the chart below. Provide documentation (account statements from lenders or original loan paperwork) for all educational loans listed, labeling the paperwork with the numbers corresponding to the lines below. Please provide details on consolidated loans if applicable. Loan Type
(Stafford, private, etc)

Lender Name

Repayme nt Start Date

Years of repaymen t remaining

Interest Rate

Consolidation Details
Please estimate % of loan applicable to your Fletcher education

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IV. FINANCIAL INFORMATION If married, please indicate your spouse’s place of employment and salary: ____________ ________________________________________________________________________ Asset Information as of February 28, 2008. If married, please itemize joint and individual information. Cash, savings and checking accounts Trusts Home (current value) Rental Property Value and Income Stocks, bonds, etc. IRA, Keogh, etc. Other taxable income
(capital gains, interest/ dividend income, alimony, etc.)

Untaxed income
(i.e. child support, VA benefits, worker compensation)

Other loan assistance income Liability Information as of February 28, 2008. If married, please include joint and individual information. Outstanding mortgage and monthly payment Monthly Rent Other non-educational indebtedness
(credit card, personal loans, etc.)

Other

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V. ADDITIONAL INFORMATION Please attach an additional statement if you have any other information that might be pertinent to your application for the Hargens Loan Assistance Program. VI. CERTIFICATION I certify that the information given by me in this application is complete and accurate, and I understand that any misrepresentation may because for refusing educational loan assistance from The Fletcher School. Applicant’s Signature: _______________________________ Date: _______________ Spouse’s Signature: _________________________________ Date: _______________

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