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Sample
Short Term Loan Statement of Policy
(please come to the Short Term Loans Office to get this form)

111-11-1111
Student Name
Address
City, State, Zip Code

Short Term Loan Statement of Policy

I understand that I may be denied future loans for one term if:

1. I have twice failed to repay previous Short Term Loans by the last day of classes in their respective terms.
   
2. I have made late payments on three previous Short Term Loans.
   
3. I have repaid a previous Short Term Loan three (3) or more months late.
   

I understand that I may be denied future loans permanently if:

1. I have three times failed to repay previous Short Term Loans by the last day of classes in their respective terms.
   
2. I have made late payments on four previous Short Term Loans.
   
3. I have repaid a previous Short Term Loan which was referred to a collection agency.
   
4. I knowingly give false information on a loan application or Promissory Note.
   
5. I have become three or more months delinquent on other SUWG debts, such as NDSL/Perkins student loans, fees, etc.

I have read and understand this Statement of Policy for Short Term Loans and agree to abide by its terms.