Loan Request/Change Form

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Fall 2009 - Spring 2010

Please complete the following information indicating the type of loan(s) you would like to request or change. Changes will be reflected on MAX after your request has been processed

Please be aware that if you cancel the first disbursement of your loan, the entire loan will be cancelled. If you have any questions, please contact your financial aid counselor.

* - denotes a required field

Contact Information

First Name:*

Last Name:*

MU ID Number:*

E-Mail Address:

Note: If your MU ID begins with an M, enter an upper case M plus the remaining eight digits: e.g. M00012345

Loan 1

Loan Type:*

Term:*

Action:*

Amount:*

Reason:*

Note: For the amount, enter specific amount or 'MAX' for maximum eligibility

Loan 2 (click to expand)

Loan Type:

Term:

Action:

Amount:

Reason:

Note: For the amount, enter specific amount or 'MAX' for maximum eligibility

Loan 3 (click to expand)

Loan Type:

Term:

Action:

Amount:

Reason:

Note: For the amount, enter specific amount or 'MAX' for maximum eligibility

Loan 4 (click to expand)

Loan Type:

Term:

Action:

Amount:

Reason:

Note: For the amount, enter specific amount or 'MAX' for maximum eligibility

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a member of the Pennsylvania State System of Higher Education

Millersville University
PO Box 1002
1 South George St.
Millersville, PA 17551

Phone Number (717) 872-3011

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