Form MO 350-1464 Large Animal Veterinary Student Loan Contract and Promissory Note - Missouri

Form mo350-1464 is a Missouri Departament of Agriculture form also known as the "Large Animal Veterinary Student Loan Contract And Promissory Note". The latest edition of the form was released in March 1, 2009 and is available for digital filing.

Download an up-to-date fillable Form mo350-1464 in PDF-format down below or look it up on the Missouri Departament of Agriculture Forms website.

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MISSOURI DEPARTMENT OF AGRICULTURE
FORM 2 ­ PAGE 1
1616 MISSOURI BOULEVARD, JEFFERSON CITY, MO 65109
ALL INFORMATION IS CONFIDENTIAL AND
LARGE ANIMAL VETERINARY STUDENT LOAN PROG
RAM
FOR PROGRAMMATIC PURPOSES ONLY
LOAN CONTRACT AND PROMISSORY NOTE
MUST BE TYPED OR PRINTED
B
ORROWER S NAME
(LAST
, FIRST, MIDDLE INITIAL)
ADDRESS
STREET
TELEPHONE
NUMBER
FAX NUMBER
CITY
STATE
ZIP CODE
BIRTHDATE
SOCIAL SECURITY NO.
E­MAIL
APPLYING FOR ACADEMIC YEAR
LENDING INSTITUTION
The Missouri Department of Agriculture
TERMS
I agree to pay the State of Missouri, or its authorized agent, the principal sum of twenty thousand dollars ($20,000), plus interest in United
States currency, upon maturity of this note.
INTEREST
I hereby agree to pay simple interest on the unpaid loan principal at a rate of __________________________________ from the issue
date of the state check until the principal and accumulated interest are paid.
MATURITY
This note will mature when the borrower ceases to be an eligible student in the University of Missouri ­ College of Veterinary Medicine
Program.
FORGIVENESS
Payment of $20,000 principal and accrued interest will be forgiven for each full calendar year that borrower engages in qualified employment,
(defined in Section 340.777) in an area of defined need, (defined in 2 CSR 30­11.010) in this state. Qualified employment or financial
repayment must begin within six (6) months after completion of the doctor of veterinary medicine degree.
ADDITIONAL AGREEMENTS
The borrower fully understands and agrees to the following:
1. The borrower will use the proceeds of this loan for educational and/or living expenses.
2. The borrower will send written notice to the Missouri Department of Agriculture within thirty (30) days after any change in enrollment status,
practice location, type of practice, name or address.
3. That the borrower is making a commitment to provide services, upon completion of veterinary training, in an area of defined need as
determined by the Missouri Department of Agriculture.
4. If the borrower’s eligibility status changes (no longer a veterinary student or a veterinary student in good standing) or the borrower is not
providing professional veterinary services in an area of defined need, repayment of the loan principal and interest shall begin with ninety
(90) days of the date the recipient ceases to be an eligible student. Payment shall be completed no more than twelve (12) months from
that date.
5. The borrower will provide verification to the Missouri Department of Agriculture as to their enrollment, program eligibility, and academic
standing within thirty (30) days of the completion of each semester and summer session and their expected program completion date.
6. Upon completion of the DVM program and becoming licensed should the borrower at any time choose not to provide veterinary services
in an area of defined need, repayment of the loan principal and interest becomes due and owing immediately and under a jointly agreed
to repayment program must be completely repaid within one (1) year of the breach.
7. If the borrower violates any of the provisions of this loan contract or promissory note, including notifying the Missouri Department of
Agriculture of change of address, the Missouri Department of Agriculture may call the note due immediately.
8. When necessary to protect the interest of the State in any loan transaction under Section 340.335, RSMo, the Missouri Department of
Agriculture may institute any action to recover any amount owed.
MO 350­1464 (3­09)
AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER
PAGE 1 OF 2
services provided on a nondiscriminatory basis
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Print
Reset
MISSOURI DEPARTMENT OF AGRICULTURE
FORM 2 ­ PAGE 1
1616 MISSOURI BOULEVARD, JEFFERSON CITY, MO 65109
ALL INFORMATION IS CONFIDENTIAL AND
LARGE ANIMAL VETERINARY STUDENT LOAN PROG
RAM
FOR PROGRAMMATIC PURPOSES ONLY
LOAN CONTRACT AND PROMISSORY NOTE
MUST BE TYPED OR PRINTED
B
ORROWER S NAME
(LAST
, FIRST, MIDDLE INITIAL)
ADDRESS
STREET
TELEPHONE
NUMBER
FAX NUMBER
CITY
STATE
ZIP CODE
BIRTHDATE
SOCIAL SECURITY NO.
E­MAIL
APPLYING FOR ACADEMIC YEAR
LENDING INSTITUTION
The Missouri Department of Agriculture
TERMS
I agree to pay the State of Missouri, or its authorized agent, the principal sum of twenty thousand dollars ($20,000), plus interest in United
States currency, upon maturity of this note.
INTEREST
I hereby agree to pay simple interest on the unpaid loan principal at a rate of __________________________________ from the issue
date of the state check until the principal and accumulated interest are paid.
MATURITY
This note will mature when the borrower ceases to be an eligible student in the University of Missouri ­ College of Veterinary Medicine
Program.
FORGIVENESS
Payment of $20,000 principal and accrued interest will be forgiven for each full calendar year that borrower engages in qualified employment,
(defined in Section 340.777) in an area of defined need, (defined in 2 CSR 30­11.010) in this state. Qualified employment or financial
repayment must begin within six (6) months after completion of the doctor of veterinary medicine degree.
ADDITIONAL AGREEMENTS
The borrower fully understands and agrees to the following:
1. The borrower will use the proceeds of this loan for educational and/or living expenses.
2. The borrower will send written notice to the Missouri Department of Agriculture within thirty (30) days after any change in enrollment status,
practice location, type of practice, name or address.
3. That the borrower is making a commitment to provide services, upon completion of veterinary training, in an area of defined need as
determined by the Missouri Department of Agriculture.
4. If the borrower’s eligibility status changes (no longer a veterinary student or a veterinary student in good standing) or the borrower is not
providing professional veterinary services in an area of defined need, repayment of the loan principal and interest shall begin with ninety
(90) days of the date the recipient ceases to be an eligible student. Payment shall be completed no more than twelve (12) months from
that date.
5. The borrower will provide verification to the Missouri Department of Agriculture as to their enrollment, program eligibility, and academic
standing within thirty (30) days of the completion of each semester and summer session and their expected program completion date.
6. Upon completion of the DVM program and becoming licensed should the borrower at any time choose not to provide veterinary services
in an area of defined need, repayment of the loan principal and interest becomes due and owing immediately and under a jointly agreed
to repayment program must be completely repaid within one (1) year of the breach.
7. If the borrower violates any of the provisions of this loan contract or promissory note, including notifying the Missouri Department of
Agriculture of change of address, the Missouri Department of Agriculture may call the note due immediately.
8. When necessary to protect the interest of the State in any loan transaction under Section 340.335, RSMo, the Missouri Department of
Agriculture may institute any action to recover any amount owed.
MO 350­1464 (3­09)
AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER
PAGE 1 OF 2
services provided on a nondiscriminatory basis
FORM 1 ­ PAGE 2
LARGE ANIMAL VETERINARY STUDENT LOAN PROGRAM APPLICATION
MUST BE TYPED OR PRINTED
REMEDIES
The Department retains all administrative, civil and criminal remedies for breach of this contract by the Participant.
MODIFICATION EXTENSION
This contract may not be amended or modified without prior written agreement of the parties.
EXECUTION
The parties signed this contract on the dates and in places indicated below.
FOR THE PARTICIPANT
FOR THE DEPARTMENT OF AGRICULTURE
SIGNATURE
AUTHORIZED SIGNATURE
TITLE
TITLE
DATE
DATE
PLACE
PLACE
NOTARY
WITNESS
DATE
DATE
FOR OFFICE USE ONLY
O.R.:
MO 350­1464 (3­09)
AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER
PAGE 2 OF 2
services provided on a nondiscriminatory basis

Download Form MO 350-1464 Large Animal Veterinary Student Loan Contract and Promissory Note - Missouri

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