Southeastern Community College

Custom Loan Request Form

If you wish to borrow under the Stafford Loan Programs, please complete this form and click Submit at the bottom of this page.


First Name:

Last Name:

Current Phone Number: Please include area code.

Social Security Number (Last Four):

Loan Amount Requested:    Subsidized    Unsubsidized

Subsidized loan = Interest is paid by government while attending school.
Unsubsidized loan = You are responsible for interest payments.
(Please check both if you would accept either type of loan)

For what term(s) are you applying for a loan? Choose only one. Normally, students will choose to "set-up" their loans to cover two terms (such as the fall and spring; see your award letter). SCC highly recommends this. For example, if you choose to borrow $3500 for a particular year you will receive $1750 in the fall and $1750 in the spring.

Applying for term(s):

"Fall Only" loans are available upon request. You must be graduating at the end of the Fall term in order to request such a loan. Other exceptions to this policy can be made at the discretion of the Financial Aid Office if you provide written verification that you will not need a student loan in the spring term. You may request a fall only loan in person in the Financial Aid Office at the campus you are attending.

Is this a new Loan Authorization, or an update/change to a current Loan Authorization?

Enrollment Status

Anticipated Graduation Date: (mm/yy)

What is your current degree or certificate objective at SCC(what program will you graduate from)?

Rights and Responsibilities


Your Rights and Responsibilities
Regarding Your Federal Subsidized or Unsubsidized Stafford Loan
  1. I understand that if I apply as a part-time student, I will enroll in a minimum of six(6) credit hours for each semester included in my loan period.
  2. I understand that federal regulations require multiple disbursements of all loan funds.
  3. I understand that all loan funds will first be credited to my student account.
  4. I understand that if this is the first loan I am borrowing at SCC, I am required to complete entrance counseling. If I fail to do so, my loan will be cancelled and the funds will be returned to the Department of Education.

By placing your initials here, you acknowledge that you understand your rights and responsibilities.

Which campus do you attend? West Burlington Keokuk

It is recommended that you print a copy of this form for your records before submitting.