Loan Application Form
Section I: Applicant Information
Date: _________________________
Name: __________________________________________________________________
Permanent Address: _______________________________________________________
________________________________________________________________________
________________________________________________________________________
Telephone (home): ________________________ (work): ___________________________
E-mail: __________________________________________________________________
Schools Attended: _________________________________________________________
Is your MLA membership current? yes____ no____
Section II: Employer Information
Current Employer: _________________________________________________________
Address: ________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Telephone (voice): _________________________ (fax): ___________________________
E-mail: __________________________________________________________________
Section III: Program Information
Course or Degree Program Title: ______________________________________________
Location: ________________________________________________________________
Starting date and duration of program, course or seminar: ___________________________
Expected completion date: ___________________________________________________
Amount of loan requested: $__________________________________________________
Other financial aid awards (sources and amounts):_________________________________
________________________________________________________________________
________________________________________________________________________
Copyright 1996-2005 Maine Library Association. Updated 03/01/2006 by Lyn Smith
