Summary: POLYTECHNIC INSTITUTE OF NYU PREAPPLICATION FOR FEDERAL DIRECT PLUS LOAN
Complete and fax to 718-260-3052.
Or mail to: Student Financial Service, Room JB256, Six MetroTech Center, Brooklyn, NY 11201
Student's Name: _____________________________ Poly ID Number: _______________________
Parent or Graduate Student Borrower:
Last Name: ____________________________ First : ________________________ M.I. ____________
City: _______________________________ State: ___________ Zip Code: _____________________
Social Security Number: ________________________ Date of Birth: ____________________________
Home Telephone: ________________________ E-Mail Address: ______________________________
U.S. Citizen: ___ Yes ___No If no, Alien Reg. No. _____________________________
Are you in default on an education loan? ____Yes ____No
Total Amount of Loan Requested for full Academic Year 2010-2011: $_____________ (split fall/spring).
Please note: A 2.5% fee is deducted by the lender from the amount requested.
I authorize NYU-Poly to apply PLUS loan funds toward the payment of tuition, fees, room and board, insurance and any other
charges billed by the University. I understand that this authorization may be rescinded by my so notifying the Student Financial
Services Office in writing.
Consent to Obtain Credit Report
I consent to the U.S. Department of Education and its agents to obtain a report of my credit record and use the information from
that report in determining whether to make a Direct PLUS loan to me.