School CertificationTo be completed by the Financial Aid Office.Financial Aid Office:

Please complete the below certification for the Student's Name. Please fax this certification to801-320-5952. If you have any questions please call our Student Loan Department at801-325-6574 or 1-800-748-4302 ext 6574.

Thank you.

Kim KnaptonStudent Loan RepresentativeMountain America Credit Union

Academic Year for Use of Funds (mm/dd/year)

Student's Current Year in School

Undergraduate

Graduate

Medical

Law

Student's Enrollment Status

Anticipated Graduation Date (mm/dd/year)

Student's Name

School Name

School Code

From To

1

1

1

1 2

2

2

2

3

3

3

3

4

4

4

4

5

5

6

6

Certification

Continuing Education

Full Time Half Time Less than Half Time

Cost of Education

Tuition

Fees

Books*

Room & Board(If living off campus, only normal fees are eligible.)

Other

Total Cost of Education

Financial Aid Received

Federal Stafford Loans

Grants

Scholarships

Other

Total Financial Aid Received

Loan Amount**

*Books cannot exceed $800 per academic year.**Loan amount equals the total cost of education less the total financial aid received.

Recommended Disbursement Dates (Disbursements will be divided equally) (mm/dd/year) *At Least One Required.

3rd1st*

4th2nd

We certify that the student named in this application is attending this educational institution during the academicperiod for which this loan is being requested. We further certify that, based upon records available at this educationalinstitution, the applicant is not in default on any student loan and that the information provided above is accurate tothe best of our knowledge. We certify that the total amount of all loans and financial aid, including this loan, does notexceed the cost of education at this institution.

Signature of School Official ______________________________Date _________________Print Name ____________________________________________________________Title _________________________________________________________________Phone Number _________________________________________________________