The University of Kansas Medical Center

Office Use Only/Date Stamp Return to: University of Kansas Medical Center Student Financial Aid G035 Dykes Library Mail Stop 4005 Kansas City, KS 66160-7192 Alternative Loan Request (913) 588-5170 Phone (913) 588-8841 Fax Form for Non-FAFSA Applicants Only 2016-17

Every student that completes the Free Application for Federal Student Aid (FAFSA) and meets minimum eligibility criteria (citizenship, Selective Service registration, no defaulted loans, etc.) could be eligible for a Federal Direct Subsidized and/or Unsubsidized Loan.

The Federal Direct Subsidized and Unsubsidized Loans have fixed interest rates. There is a six month grace period after you graduate or drop below half- time before repayment is required. The subsidized loan does NOT accrue interest while you are in school; the unsubsidized loan DOES accrue interest while you are in school.

If you have filed a FAFSA, or plan to file one for the 2016-17 academic year, Student Financial Aid Office (SFAO) will review the processed FAFSA for eligibility in all financial aid programs. SFAO will award financial aid and notify you via your KUMC email to accept, reduce or decline the award(s). Eligibility for an alternative loan will be based on your cost of attendance minus any other aid you have been awarded, including scholarships, grants, and student loans.

Please read the following and check only the statement that is true for 2016-17. If you have questions about which statement to check, please contact the SFAO.  I have completed the 2016-17 FAFSA and selected KUMC as my institution of choice for financial aid. I understand my alternative loan application will be processed after the FAFSA is processed.  I have not completed the 2016-17 FAFSA, but will complete the FAFSA to be considered for financial aid at KUMC. I understand my alternative loan application will be processed after the KUMC financial aid awarding process is complete.  I will NOT file the 2016-17 FAFSA. I do not want to be considered for financial aid other than the alternative loan. Student Name______SSN or KUMC ID______

Address ______

City/State/Zip ______

Phone # (____)______Date of Birth ______/_____/______

Expected Graduation Date or date you will complete your degree/certificate: ______/______/______

Student Citizenship Status:  U.S. Citizen  Permanent Resident/eligible Alien A # ______ Other ______

Please list how many hours you plan to be enrolled in for the 2016-2017 academic year. Summer 2016______Fall 2016______Spring 2017______Undergraduate Full-time >6 Undergraduate Full-time >12 Undergraduate Full-time >12 Undergraduate Half-time 3-5 Undergraduate Half-time 6-8 Undergraduate Half-time 6-8 Undergraduate Less than Half- time <3 Undergraduate Less than Half-time <6 Undergraduate Less than Half-time <6 Graduate Full-time >6 Graduate Full-time >9 Graduate Full-time >9 Graduate Half-time 3-5 Graduate Half-time 5-8 Graduate Half-time 5-8 Graduate Less than Half-time <3 Graduate Less than Half-time <5 Graduate Less than Half-time <5

I have read and understand the statements on this form. I understand my financial aid options as a KUMC student.

______Student Signature Date