(PLEASE fill in the following information and return to the Aurora United Methodist Church, Student Loan / Scholarship Committee, along with the Contract and Agreement Form)

    What is your area of study?  ___________________________________

2. What do you anticipate your expenses will be?

                 Tuition                                                              $ _________

                Room and Board                                            $ _________

                Books and supplies                                        $ _________

                Other: _________________

                ______________________                         $ _________

TOTAL = $ _________

3. What other financial resources do you have?

                Other loans and scholarships $ _________

                Personal earnings and resources $ _________

                Financial assistance from family $ _________

                Other: _________________

                ______________________                         $ _________

TOTAL = $ _________

4. Other information you feel the Committee should have?

____________________________             _________________    

Signature                                                                     Date

P.O. Box 293, 1104 A Street

Aurora, Nebraska 68818-0293

STUDENT LOAN FUND CONTRACT AND AGREEMENT

NAME OF APPLICANT __________________________

AMOUNT REQUESTED $ _______

ADDRESS__________________________________________________

If the loan is made to me, I hereby promise and agree to pay to the Aurora United Methodist Church, Aurora, Nebraska, the total amount of the loan in accordance with the terms hereof, on or before maturity. The purpose is so that other students may be helped through the fund. I promise to answer promptly all letters relating to my loan, and to keep the Chairperson of the Student Loan / Scholarship Committee informed of my address as long as any party of my indebtedness remains unpaid.

I understand that all loans are to be repaid within three (3) years in equal monthly installments, beginning not later than six (6) months after graduation or upon withdrawal from full-time school attendance. Delinquent accounts will be subject to 1 1/2% per month interest until paid (18% per year).

________________________                             ______________

Applicant's Signature                                                          Date

________________________________

Parent or Guardian Signature

APPROVED BY:

________________________                             ____________

Chairperson of Loan Committee                                     Date