Barton Online Forms

Plus Loan Authorization

* required fields
Parent Information

SSN:

**Social Security Number is required in order to obtain a Plus Loan. However, SSN is not required for this form in order to protect your privacy. If you choose to not enter your SSN on this form and prefer to give your SSN number to a Financial Aid Officer, please contact BCCC Financial Aid Office (620) 792-9270 or 1-800-748-7594.

Name:*	Date of Birth (M/D/YYYY):*
Address:*	City:*
State:*	Zip:*
Phone:*	Loan Amount Requested:*

Email Address:

(Barton may only certify the student's COA less any estimated financial assistance.)

Student Information:

Name:*

Social Security Number:

**Your student's Social Security Number is required in order to obtain a Plus Loan. However, SSN is not required for this form in order to protect your child's privacy. If you choose not to enter your student's SSN on this form and prefer to give your student's SSN number to a Financial Aid Officer, please contact BCCC Financial Aid Office (620) 792-9270 or 1-800-748-7594.

Disbursement Authorization (Choose one): *

a	I give Barton County Community College authorization to apply the PLUS loan funds to the student's account and release any refunds directly to the student. I realize that at a later date I have the right to rescind this authorization and to have the funds paid directly to me.
b	I give Barton County Community College authorization to apply the PLUS loan funds to the student's account and want any refunds released directly to the parent applying for the loan. I realize that at a later date I have the right to rescind this authorization and to have all the funds paid directly to me.
c	I want all PLUS loan funds sent directly to me, the borrower.

I give permission to Barton County Community College to do a credit check to determine my credit worthiness.

I certify that to the best of my knowledge the information on this form is true and complete without evasion or misrepresentation. I understand that if found to be otherwise, it is sufficient cause for rejection.*

By checking this box you have created an electronic signature as legally binding as your handwritten signature.

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