RSL APPLICATION

About You:

First Name *

Middle Name *

Last Name *

Street Address *

City *

State/Province *

ZIP / Postal Code *

Email Address *

Mobile Phone *

Home Phone

Birthdate *

Month

Day

Year

Last 4 Digits - Social Security Number *

High School You are Graduating/Graduated From *Lincoln CharterEast Lincoln High SchoolLincolnton High SchoolNorth Lincoln High SchoolWest Lincoln High School

Graduating Year *

College you attend / plan to attend

Estimated Graduating Year *

Upload Latest High School or College Transcript

No file chosen

Acceptance Letter if first year attending college

No file chosen

If approved, will this be your first Rotary Student Loan? *YESNOcheck yes or no

Parent / Guardian Info:

Father's Full Name *

Street Address *

City *

State/Province *

ZIP / Postal Code *

Email Address *

Mobile Phone *

Home Phone

Father's Last 4 Digits - Social Security Number *

Father's Occupation

Father's Employer

Years Employed

Mother's Full Name *

Street Address *

City *

State/Province *

ZIP / Postal Code *

Email Address *

Mobile Phone *

Home Phone

Mother's Last 4 Digits - Social Security Number

Mother's Occupation

Mother's Employer

Years Employed

Personal References

List 3 Personal References with email address and phone number

Financial Arrangements

Estimated Tuition

Estimated Room/Board

Estimated Books/Fees/Other

Total Annual Costs

Total Amount You Are Applying For(up to $4000 - annual amount varies)

Co-Borrowers Information

Three BORROWERs are required per loan - Student, and 2 additional borrowers

Co-Borrower 1

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Email Address

Preferred Phone Number

Birthdate *

Month

Day

Year

Last 4 Digits - Social Security Number

Employers Name

Occupation

Years Employed

Gross Income/Month

Do You Own or Rent Your Home?

Monthly Mortgage/Rental Payment

Name of Bank

Types of Account(s)

Co-Borrower 1 Credit References

Please list 3 credit institutions complete with Name, Address, Phone, Account Number(s) and Balance

Credit Reference 1

Credit Reference 2

Credit Reference 3

Co-Borrower 2

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Email Address

Preferred Phone Number

Birthdate *

Month

Day

Year

Last 4 Digits - Social Security Number

Employers Name

Occupation

Years Employed

Gross Income/Month

Do You Own or Rent Your Home?

Monthly Mortgage/Rental Payment

Name of Bank

Types of Account(s)

Co-Borrower 2 Credit References

Please list 3 credit institutions complete with Name, Address, Phone, Account Number(s) and Balance

Credit Reference 1

Credit Reference 2

Credit Reference 3

About You:

Parent / Guardian Info:

Personal References

Financial Arrangements

Co-Borrowers Information

Three BORROWERs are required per loan - Student, and 2 additional borrowers

Co-Borrower 1 Credit References

Please list 3 credit institutions complete with Name, Address, Phone, Account Number(s) and Balance

Co-Borrower 2 Credit References

Please list 3 credit institutions complete with Name, Address, Phone, Account Number(s) and Balance

Contact Us
annabmullen@rotarylinc.org

Support Education
in Lincoln County TODAY!

About You:

Parent / Guardian Info:

Personal References

Financial Arrangements

Co-Borrowers Information

Three BORROWERs are required per loan - Student, and 2 additional borrowers

Co-Borrower 1 Credit References

Please list 3 credit institutions complete with Name, Address, Phone, Account Number(s) and Balance

Co-Borrower 2 Credit References

Please list 3 credit institutions complete with Name, Address, Phone, Account Number(s) and Balance

Contact Usannabmullen@rotarylinc.org

Support Education in Lincoln County TODAY!

Contact Us
annabmullen@rotarylinc.org

Support Education
in Lincoln County TODAY!