Tufts Loan Repayment Assistance Program (LRAP) - 2015 Application

  1. Applicant Information

Last Name, First Name:

Name while attending Tufts (if different):

Social Security #: Student ID: Date of Birth:

Mailing Address:

City: State:Zip Code: Country:

Home / Cell Phone: Work Phone:

Email Address:

Marital Status (Check one): ☐ Single☐ Married☐ Registered Domestic Partner

Name of Spouse or Domestic Partner: ______

Check one: ☐U.S. Citizen or U.S. Resident Alien / ☐ Non U.S. Citizen or Foreign National

Last Tufts School Attended: Year of Graduation:

☐Undergraduate Art and Sciences______

☐Graduate Art and Sciences______

☐Cummings School of Veterinary Medicine______

☐School of Dental Medicine______

☐Undergraduate School of Engineering______

☐Graduate School of Engineering______

☐Fletcher School of Law and Diplomacy______

☐Friedman School of Nutrition Science and Policy______

☐School of Medicine______

  1. Employment

☐Use my 2015 Employment Certification form to confirm my continued employment for 2014 LRAP award recipients

Employer Name & Address:

Job Title:

Start date:End Date:Salary:

III. Tufts Educational Loan Information

  • Provide your current Tufts educational loan information for all academic programs at Tufts.
  • Submit a copy of your current monthly loan statement for each loan and or consolidated loan.
  • All submitted loan statements must display: loan status, balance and monthly payment amount and due date.
  • Electronic statements must be printed down from your Lender’s web site and submitted.
  • Applicants in grace, please submit proof of grace if available.
  • Applicants with a loan status of deferment, economic hardship deferment, forbearance, default or delinquent do not qualify for LRAP.

Loan * Type / Lender Name / Amount Borrowed / Balance Outstanding / Monthly Payment / Consolidated
Yes / No
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* Federal Stafford, Perkins, HPSL, Grad Plus, Tufts Loans, Alternative Loans. If needed, list additional loans on a separate sheet.

Application Deadline is September 1, 2015. Completed application must be received by deadline.

Mail completed application to: LRAP, Tufts University, Dowling Hall – 770, 419 Boston Ave. Medford, MA 02155