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Texas Higher Education Coordinating Board
P.O. Box 12788, Austin, TX 78711
1200 E. Anderson Lane, Room 2.100, 78752
(800) 242-3062 FAX (512) 427-6423
www.collegefortexans.com
www.hhloans.com
TEXAS B-ON-TIME
APPLICATION & PROMISSORY NOTE
1. Educational Institution Name
2. Application Number (CLUID)
Personal Information:
3. Social Security Number
4. Last Name
5. Mailing Address
City
6. Phone Number
First Name
State
7. Driver’s License Number
Zip Code
8. State of Issuance
M.I.
Email Address
9. Date of Birth
10. Requested Amount
References:
Name
A.
B.
Mailing Address
City, State, Zip Code
Relationship to Borrower
Phone Number
(
)
(
)
(
)
(
)
Employer
Employer’s Phone Number
_______________________________________
Borrower Certification and Promissory Note for a B-On-Time Loan:
A. Certification: (1) I am applying for a Texas B-On-Time Loan. I certify that the information contained in this application is true, complete, and correct to the best of my
knowledge and belief. (2) Further, I certify that the proceeds of any loan(s) made as a result of this application will be used for educational expenses at the school herein named.
(3) I understand that I must immediately repay any funds that I receive which cannot reasonably be attributed to meeting my educational expenses at the school named in this
application. I authorize the school to pay THECB any refund which may be due up to the amount of the loan(s). (4) I further authorize any school that I may attend to release to
THECB any information pertinent to this loan (e.g., employment, enrollment status, current address). (5) I request a total amount of loans under this Promissory Note not to exceed
the annual and aggregate loan limits authorized under the B-On-Time Loan Program. My school will notify me of the amount(s) of loan(s) that I am eligible to borrow. I may cancel
my loan or request a lower amount by contacting THECB or my school. (6) I understand that I will receive a Disclosure Statement that identifies my actual loan amount(s) (as
determined by THECB with input from my school). The Disclosure Statement will contain origination fee rates and amounts, which I agree to have deducted from the proceeds of
my loan. (7) I certify I am not more than 30 days delinquent in paying any child support owed. (Texas Family Code Section 231.006.)
B. Promissory Note: (1) I promise to pay to the Texas Higher Education Coordinating Board (THECB) the sum(s) advanced to me under this promissory note. (2) I will not sign
this promissory note before reading the entire promissory note and the "Terms and Notices", which are incorporated into this note by reference. (3) I authorize my school to
transfer loan proceeds received by electronic funds transfer (EFT) to my student account. (4) I agree to pay an Origination Fee, which will be deducted from each disbursement of
my loan(s). After a loan has been approved, THECB will provide me with a Disclosure Statement, which also will be incorporated into this promissory note, and which will include
the loan amount, origination fees, disbursement date(s), and other applicable fees. Information about my rights to cancel or reduce my loan(s) is included in the Terms and
Notices. If I accept the funds, I am consenting to the terms in the Disclosure Statement. (5) My B-On-Time Loan(s) will be forgiven only if I am awarded an undergraduate degree
or certificate from an eligible institution, and either:
(A) graduate with a B average, or the equivalent of a cumulative grade point average of at least 3.0 on a 4.0 scale, and receive:
(i) a baccalaureate degree within 48 months from the date I initially enrolled in an eligible institution;
(ii) a baccalaureate degree within 60 months from the date I initially enrolled in an eligible institution, if the degree is in architecture (Texas CIP code, category
04.0201), engineering (Texas CIP code, category 14), or any other program determined by the Board to require more than four years to complete;
(iii) a degree or certificate from a two-year program within 24 months from the date I initially enrolled in an eligible institution
(iv) a certificate from a one-year program within 12 months from the date I initially enrolled in an eligible institution; or
(B) graduate with a B average, or the equivalent of a cumulative grade point average of at least 3.0 on a 4.0 scale, with a total number of course credit hours, including transfer
credit hours, that is not more than:
(i) six hours more than the number of credit hours required to complete a degree or certificate; or
(ii) three hours more than the number of credit hours required to complete a one-year certificate.
(6) If my loan is not forgiven under the conditions outlined in item (5), above, my payments will be at least $75.00 per month and must be of an amount that will pay my entire debt
in 15 years. I will begin payments 6 months after the date on which I cease to be enrolled at least half-time at an eligible school. A repayment schedule stating the actual amount of
my payments will be mailed to me before the first payment becomes due. More information about payments is in the Terms and Notices. (7) If I fail to repay any amounts when
due, I agree to pay late charges and other collection charges as described in Terms and Notices. If my account becomes 180 days past due in payments, or if THECB becomes
aware of any material misrepresentations in this promissory note or in my application, the entire balance due under the promissory note will be accelerated and demand made for
payment in full. If a judgment is taken against me, interest will begin to accrue at the legal rate described in Terms and Notices from the date of judgment until the entire debt is
paid in full. (8) The terms of this promissory note cannot be discharged, compromised, modified, or amended except in writing, signed by THECB. THECB's endorsement or
acceptance of a payment does not constitute written consent to a modification of the terms of the promissory note.
By signing below, I, the Borrower, acknowledge that I have read, understand and agree to all of the terms and conditions of this Promissory Note, and to the terms and conditions
in the Terms and Notices.
Borrower’s Signature
Date
/
/
Warning: A person submitting misleading or fraudulent information to the Texas Higher Education Coordinating Board in an attempt to obtain financial aid is subject to criminal
prosecution. Please contact the Fraud Hotline to report suspected fraud.
If you signed this document electronically, retain a copy for your records. If you did not sign electronically, please use a ballpoint pen to sign your legal name and date your
signature and submit to:
Client Services, Loan Program Operations
Texas Higher Education Coordinating Board
P.O. Box 12788, Austin, Texas 78711
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TERMS AND NOTICES
A. Loan Amount and Disbursements: Loan amount(s) will not
exceed the maximum annual or aggregate limits for this
program. The entire approved amount may not be disbursed to
me at once, and if not, disbursements will discontinue if I cease
to meet any of the eligibility requirements. The proceeds of the
loan(s) must be used only for education expenses at the school
which certified my eligibility.
B. Origination Fee: The origination fee rate for loans under this
Promissory Note is 3%. The origination fee will be applied to and
be deducted from each disbursement. The origination fee is
refundable only if a disbursement is cancelled by an institution
within 120 days of issuance.
C. Tax Liability: I understand that if the debt I owe is forgiven, I
may be required to report the forgiven debt as taxable income on
my federal tax return. THECB will mail IRS Form 1099-C,
Cancellation of Debt, to my latest physical address on record at
THECB if the forgiven debt is $600.00 or more (IRS Publications
17 and 525).
D. Repayment: I will repay the total amount due under this
Promissory Note in monthly installments, in accordance with the
repayment schedule as described in B6 of this Promissory Note,
which may include all loans I receive from THECB under the
Texas B-On-Time loan program. The repayment schedule will be
incorporated into this Promissory Note. Payments will be
credited first to late charges, costs of cancellation, and then to
principal, unless a judgment is entered against me. If a judgment
is entered on this Promissory Note, payments will be credited
first to court costs, then attorney fees, then to interest on the
judgment, and finally to principal.
E. Forbearance: Under certain circumstances, I may be eligible
for periods of forbearance in the form of a temporary
postponement or reduction of monthly payments. I must provide
the appropriate documentation supporting any request for
forbearance.
F. Collection Charges: I agree to pay THECB late charges,
skip-tracing fees, court costs, attorney's fees, return check fees,
and other charges which THECB incurs in collecting any amount
I owe under the terms of this Promissory Note which is not paid
when due. If any payment has not reached THECB within 20
days after its due date, THECB will assess a late charge at the
rate stated in 19 Texas Administrative Code section 21.131.
G. Delinquency, Acceleration, and Default: If my account
reaches a past due status, THECB will notify my institution and
request a hold on official or certified records and on reenrollment until I have corrected the delinquency to the
satisfaction of THECB. If my loan account becomes delinquent in
payments as scheduled, the State of Texas may withhold certain
state privileges, including (without limitation) further state student
financial aid, occupational or professional licenses, official
transcripts, or payment of debts owed to me by the State of
Texas until the delinquency is resolved. If I fail to make six
monthly payments in accordance with the terms of this
Promissory Note, my loan shall be declared in default. In the
event of default, the entire unpaid loan(s) including accrued late
charges, skip-tracing fees, and any other charges shall be come
due and payable immediately. If a judgment is obtained against
me, in addition to the charges detailed in this paragraph, I will be
responsible for paying interest that accrues on the judgment at
the legal judgment interest rate in the Texas Finance Code, Sec.
304.003, from the date the judgment is entered until it is paid in
full, plus court costs and attorney fees.
consider carefully academic or other information provided by the
school. (2) It is my responsibility to keep THECB apprised of my
current name, address, school enrollment status, or any other
event affecting the discharge of my responsibilities under the
conditions of this Promissory Note, including these Terms and
Notices. If I choose to provide THECB with my electronic
address for receipt of documents and communications regarding
my loan(s), such communications will be effective when sent to
the address I have provided. Otherwise, communications will be
effective when sent by first class mail to the latest address
THECB has on file for me. (3) THECB's failure to enforce or
insist that I comply with any terms of this Promissory Note is not
a waiver of THECB's rights. (4) If not forgiven as described in B5
of this Promissory Note, I must repay this loan(s) even though I
may have been under 18 years of age when I signed this
Promissory Note. (5) My loan(s) will be canceled if I die or
become totally and permanently disabled as defined in the rules
and regulations of the THECB, Chapter 21, Subchapter C.
I. Credit Bureau Notification: THECB will report the status of
this loan(s) to credit bureaus during the life of the loan. If my loan
account becomes delinquent in payments as scheduled, this
may significantly and adversely affect my credit.
J. Privacy Notices:
(1) Privacy Act of 1974 (5 USC 552a): Certain information
required on the application is made confidential by the Privacy
Act of 1974 (5 USC 552a); nevertheless, the requested
information is necessary for participation in the HinsonHazlewood College Student Loan Program, to verify your identity
and to determine your eligibility for the program and for any
benefits from it. The Privacy Act provides that an agency may
continue to require disclosure of an applicant's Social Security
Number (SSN) as a condition for the granting of a right, benefit,
or privilege if the agency required this disclosure prior to
January, 1975. The Texas Higher Education Coordinating Board
has, for years prior to 1975, required the disclosure of the SSN
of all applicants for the programs that it administers. The SSN
will be used to verify your identity and as an account number
(identifier) throughout the life of the loan, in order to make certain
that THECB records necessary data accurately. As an identifier,
the SSN is used in such program activities as determining
program eligibility, certifying attendance and student status,
determining eligibility for deferment of repayment, determining
disability and death, and for locating borrowers and their assets
in cases of delinquent or defaulted loans.
(2) Texas Government Code, Section 559.003(a): With few
exceptions, you are entitled upon request to be informed about
the information the THECB collects about you. Under Sections
552.021 and 552.023 of the Government Code, you are entitled
to receive and review the information. The information that the
Texas Higher Education Coordinating Board collects will be
retained and maintained as required by Texas record retention
laws (Texas Government Code, Section 441.180 et seq.) and
rules. Different types of information are kept for different periods
of time. Under Section 559.004 of the Government Code, you
are entitled to have THECB correct information about you that is
incorrect. You may do so by writing to Student Services Division,
Loan Program Operations, P.O. Box 12788, Austin, Texas
78711.
H. Rights and Considerations: (1) The THECB makes no
representations regarding the quality of the institution I have
selected, or the appropriateness of any program of study for my
educational or career plans. In choosing a school, I must
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Private Education Loan
Applicant Self-Certification
OMB No. 1845-0101
Form Approved
Exp. Date 05-31-2016
Common-Line Unique ID:
Loan Type:
Important: Pursuant to Section 155 of the Higher Education Act of 1965, as amended, (HEA) and to satisfy the requirements of Section 128(e)(3) of the Truth in Lending Act, a lender
must obtain a self-certification signed by the applicant before disbursing a private education loan. The school is required on request to provide this form or the required information only for
students admitted or enrolled at the school. Throughout this Applicant Self-Certification, “you” and “your” refer to the applicant who is applying for the loan. The applicant and the student
may be the same person.
Instructions: Before signing, carefully read the entire form, including the definitions and other information on the following page. Submit the signed
form to your lender.
SECTION 1: NOTICES TO APPLICANT
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Free or lower-cost Title IV federal, state, or school student financial aid may be available in place of, or in addition to, a private education loan.
To apply for Title IV federal grants, loans and work-study, submit a Free Application for Federal Student Aid (FAFSA) available at
www.fafsa.ed.gov, or by calling 1-800-4- FED-AID, or from the school’s financial aid office.
A private education loan may reduce eligibility for free or low-cost federal, state, or school student financial aid.
You are strongly encouraged to pursue the availability of free or lower-cost financial aid with your school’s financial aid office.
The financial information required to complete this form can be obtained from the school’s financial aid office. If the lender has provided this
information, you should contact your school’s financial aid office to verify this information and to discuss your financial options.
SECTION 2: COST OF ATTENDANCE AND ESTIMATED FINANCIAL ASSISTANCE
If information is not already entered below, obtain the needed information from the school’s financial aid office and enter it on the appropriate line.
Sign and date where indicated. See Section 5 for definitions of financial aid terms.
A.
B.
C.
Student’s cost of attendance for the period of enrollment covered by the loan
Estimated financial assistance for the period of enrollment covered by the loan
Difference between amounts A and B
WARNING: If you borrow more than the amount on line C, you risk reducing your eligibility for
free or lower-cost federal, state, or school financial aid.
$_
$_
$_
SECTION 3: APPLICANT INFORMATION
Enter or correct the information below.
Full Name and Address of School
Applicant Name (last, first, MI)
Date of Birth (mm/dd/yyyy)
Permanent Street Address
City, State, Zip Code
Area Code/Telephone Number Home
Other
E-mail Address
Period of Enrollment Covered by the Loan (mm/dd/yyyy) From
To
If the student is not the applicant, provide the student’s name and date of birth.
Student Name (last, first, MI)
Student Date of Birth (mm/dd/yyyy)
SECTION 4: APPLICANT SIGNATURE
I certify that I have read and understood the notices in Section 1 and, to the best of my knowledge, the information provided on this form is true and correct.
Signature of Applicant
Date (mm/dd/yyyy)
SECTION 5: DEFINITIONS
Cost of attendance is an estimate of tuition and fees, room and board, transportation, and other costs for the period of enrollment covered by the loan, as determined
by the school. A student’s cost of attendance may be obtained from the school’s financial aid office.
Estimated financial assistance is all federal, state, institutional (school), private and other sources of assistance used in determining eligibility for most Title IV
student financial aid, including amounts of financial assistance used to replace the expected family contribution. The student’s estimated financial assistance is
determined by the school and may be obtained from the school’s financial aid office.
A lender is a private education lender as defined in Section 140 of the Truth in Lending Act and any other person engaged in the business of securing, making, or
extending private education loans on behalf of the lender.
A period of enrollment is the academic year, academic term (such as semester, trimester, or quarter) or the number of weeks of instructional time for which the
applicant is requesting the loan.
A private education loan is a loan provided by a private education lender that is not a Title IV loan and that is issued expressly for postsecondary education
expenses, regardless of whether the loan is provided through the school that the student attends or directly to the borrower from the private education lender. A
private education loan does not include (1) An extension of credit under an open-end consumer credit plan, a reverse mortgage transaction, a residential mortgage
transaction, or any other loan that is secured by real property or a dwelling; or (2) An extension of credit in which the school is the lender if the term of the extension
of credit is 90 days or less or an interest rate will not be applied to the credit balance and the term of the extension of credit is one year or less, even if the credit is
payable in more than four installments.
Title IV student financial aid includes the Federal Pell Grant Program, the Federal Supplemental Educational Opportunity Grant (FSEOG) Program, the Federal
Work-Study (FWS) Program, the William D. Ford Federal Direct Loan (Direct Loan) Program, the Federal Perkins Loan Program, and the Teacher Education
Assistance for College and Higher Education (TEACH) Grant Program. To apply for Title IV federal grants, loans, and work-study, submit a Free Application for
Federal Student Aid (FAFSA), which is available at www.fafsa.gov, by calling 1-800-FED-AID, or from the school’s financial aid office.
SECTION 6: PAPERWORK REDUCTION NOTICE
Paperwork Reduction Notice: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information
unless it displays a currently valid OMB control number. The valid OMB control number for this information collection is 1845-0101. The time required to
complete this information collection is estimated to average 0.25 hours (15 minutes) per response, including the time to review instructions, search
existing data resources, gather and maintain the data needed and complete and review the information collection.
If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S.
Department of Education, Washington, DC 20202-4651
If you have any comments or concerns regarding the status of your individual submission of this form, contact your lender.