LOAN DEFAULT STATEMENT:

STATE OF ILLINOIS

STATEMENT REQUIRED BY PUBLIC ACT 85-827,

AN ACT IN RELATION TO

EDUCATION LOANS

AMENDING AN ACT NAMED THEREIN

The applicant is or is not (check one) in default on the repayment of an educational loan for a period of six months or more and in an amount of $600 or more. An educational loan means any loan guaranteed by the State Scholarship Commission under the Higher Education Student Assistance Law, any education loan made by an institution of higher education from the proceeds of a loan to the institution by the Illinois Independent Higher Education Loan Authority under the Illinois Independent Higher Education Loan Authority Act, or any other loan from public funds made for the purpose of financing an individual's attendance at an institution of higher education.

NOTICE TO APPLICANT:

If you are hired and become an employee of Southern Illinois University Edwardsville, and if you are in default on the repayment of an educational loan as defined above, you must make a satisfactory loan repayment arrangement with the maker or guarantor of that loan prior to the completion of the sixth month of employment or July 1, 1988, whichever is later. If you fail to establish a satisfactory repayment arrangement prior to completion of the sixth month of employment, the University must terminate your employment. For further information, please contact the Office of Human Resources.

Print/Type Name:
Social Security Number:

- -
Date:

Signature:

5/04

LOAN DEFAULT STATEMENT:

OIT

2009-09-30

SIUE