Gabriel J. Brown Trust

Part 1: Personal Information

Date:

College you plan to attend:

Which school year will this loan be used?

Amount Desired

Full Name (First, Middle and Last)

Current Mailing Address (street, apt., city, state, zip)

Current email address:

Marital Status:

Number of Children:

Ages of children:

Number and explination of other dependents:

Are you a resident of North Dakota?

If you have changed your residence to another state than ND by getting a drivers license, and submitting taxes to another state than ND you are unfortunately NOT elegible for this loan. If you are still a resident of ND please continue to fill out this form.

How long have you been a resident of North Dakota?

What is the name of the high school from which you graduated?

Street address and city high school:

Your high school grade poiont average:

Names, addresses and phone numbers of two persons in your home community we can contact as a character reference:

Have you served in the military service for the USA?

Date of discharge or present status in the US military:

Highest rank attained:

If you have not been in the military service, your present status:

Name of parent or guardian:

Address of parent or guardian:

If your mother and father are both living, are they residing together?

If not, separate address of mother:

Are your parents divorced?

Number of brothers and sisters:

Number of siblings living at home:

Have you attended any other colleges or universities?

If so, give the name of the other college(s) and reason for transferring:

Number of collge semester hours/credits you have earned:

If other than semester hours/credits please designate:

Your grade pooint average based on system: A=4.0, B=3.0, C=2.0, D=1.0, F=0:

My major field(s) in college:

The year I plan to graduate from college:

List any honors, prizes or special recognition received in high school:

List any honors, prizes or special recignition received in college:

Have you received a loan from the Gabriel J. Brown Trust before? If so, list amount:

Do you plan to do graduate work?

Have you received any scholarships or loans?

If so, list name and amount:

Thank you for filling out this prelimiary application. If you potentially qualify we will send you a full application.

Would you like the full loan application sent via email or mail?