THE MAGBIT FOUNDATION OF GREATER LOS ANGELES

The Iranian Sponsored Student Loan Program

Phone: 310-273-2233     Fax: 310-273 -6426

STUDENT LOAN APPLICATION FOR THE ACADEMIC YEAR ....................................

Name Of The University .............................................................

Please complete this application answering all questions and return along with:

•A- Two passport photographs of yourself:

•B- A letter (preferably in English) stating brief history of your family, academic background and any special honors or academic achievements.

NOTICE: Applications that are not completed will automatically be rejected.

Date .........................................Teudat Z'hut Number............................

Use Name under which you are registered at the University:

First Name .....................................Last Name .......................

Phone # .....................................................Email ..............................................

Home Address............................................................................................

Date of Birth ....................Date Of Aliya....................Country of Birth ..................................

Single......Married.......Divorced......Widow(er).....Number of Children........ Number of siblings.......

Military or National Services: Yes______ No_______ Academic reserve: Yes ______No_____

Father's Name ...........................Occupation...................Country of Birth ...................

Mother's Name .........................Occupation....................Country of Birth ...................

Field of Study.................................Title of Drgree..............Expected Year of Graduation.........

Number of years studied towards this degree(not including high school and the current year)........

Number of years to complete studies towards this degree (including the current year)...........

Have you received Magbit loans before, ..........if yes, how many years.........total to date............

Amount of loan requested this year in U.S. Dollars......................

•1. I hereby declare that all the information provided above is full and accurate.

•2. I am aware and agree that the University has every right to check the details whenever needed.

•3. If granted, I promise to repay the loan back to the University/College under the conditions specified so that funds may be used in the future by other students attending the University.

SIGNATURE OF THE STUDENTS .....................................

For use by Magbit only:

Not Approved...........................Approved...............................Amount$.............................

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