Sample "Rensselaer Exit Interview Information Form"

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Download Sample "Rensselaer Exit Interview Information Form"

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EXIT INTERVIEW INFORMATION FORM
EXIT INTERVIEW INFORMATION FORM. ALL QUESTIONS MUST BE ANSWERED.
Name:
Major:
Student ID Number:
Local Address Apt. No.
Permanent Address Apt. No.:
Street:
Street:
County:
County:
City, State:
City, State:
Zip Code: Phone:
Zip Code: Phone:
Social Security No. Drivers License No. State of Issue of D/L Date of Birth Expected Grad. Date:
Plans for two years after graduation:
Employer's Name: Address: City/State: Phone:
Amount of loan award to Date: Type of loan:
Credit Card Companies:
1. Card. No.
2. Card. No.
Banks (Show Name & City)
1. Type: A/C No.
2. Type: A/C No.
Father, Stepfather, or Guardian Address City/State Phone Employer
Mother, Stepmother, or Guardian Address City/State Phone Employer
Two references From Home Locality Other Than Relatives or Students
1. Name Phone Employer
Address City/State
2. Name Phone Employer
Address City/State
One Relative Other Than Parents Who Will Always Know Your Address
1. Name Phone Employer
Address City/State
His/Her Spouse's Name Phone Employer
Address City/State
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EXIT INTERVIEW INFORMATION FORM
EXIT INTERVIEW INFORMATION FORM. ALL QUESTIONS MUST BE ANSWERED.
Name:
Major:
Student ID Number:
Local Address Apt. No.
Permanent Address Apt. No.:
Street:
Street:
County:
County:
City, State:
City, State:
Zip Code: Phone:
Zip Code: Phone:
Social Security No. Drivers License No. State of Issue of D/L Date of Birth Expected Grad. Date:
Plans for two years after graduation:
Employer's Name: Address: City/State: Phone:
Amount of loan award to Date: Type of loan:
Credit Card Companies:
1. Card. No.
2. Card. No.
Banks (Show Name & City)
1. Type: A/C No.
2. Type: A/C No.
Father, Stepfather, or Guardian Address City/State Phone Employer
Mother, Stepmother, or Guardian Address City/State Phone Employer
Two references From Home Locality Other Than Relatives or Students
1. Name Phone Employer
Address City/State
2. Name Phone Employer
Address City/State
One Relative Other Than Parents Who Will Always Know Your Address
1. Name Phone Employer
Address City/State
His/Her Spouse's Name Phone Employer
Address City/State
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EXIT INTERVIEW INFORMATION FORM
DID YOU RECEIVE A COPY OF THE LOAN
PROMISSORY
NOTE? ________
I understand that:
____ 1. I received a student loan and must repay my loan on a timely basis as called for in the repayment agreement which was mutually agreed upon by me and my lending institution
____ 2. I must contact the lending institution prior to the due date, if any payment cannot be made for any reason.
____ 3. I must inform my lending institution or billing agent immediately of any change in my name or address.
____ 4. I must submit timely certification when requesting deferment, postponement, and/or cancellation benefits.
____ 5. I may accelerate or make prior to the due date without penalty.
____ 6. I may make payment in excess of the amount due. This can reduce the total amount of interest I will be required to pay over the life of the loan, but may not automatically apply to my
next scheduled payment.
____ 7. I may be eligible to defer, postpone, and/or cancel repayment of my loan. The appropriate form to request any one of these privileges can be obtained from the lending institution or my
billing agent.
____ 8. Provisions of my promissory note may require payment of my loan in minimum monthly (or quarterly) installments.
____ 9. My loan may be subject to late charges if payments are past due depending on the provisions of my promissory note.
____ 10. I may be required to pay the total cost of collection and/or litigation if my loans(s) becomes past due and remains past due without appropriate arrangements to bring it current.
I understand that I will be contacted during the next few months, with further informaion and instructions.
_____________________________________________________ ________________________ ________________________________________________
Borrower Signature Date Institution Representative Signature
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