Employee Loan Application Form - Rhode Island

An active employee, who is eligible for full time benefits, has completed their probationary period, and who does not have an outstanding employee loan,
can apply for an employee loan in an amount that does not exceed twenty percent (20%) of their annual base salary. The loan is repaid through
payroll deductions over a period not to exceed twelve months. The interest rate is fixed at the prime rate at the time the application is approved. The
approval process includes a review of the applicant
s standing with the University and their creditworthiness. A credit report will be obtained and reviewed
each time an employee submits an application. Applications will not be approved if the employee has outstanding debt due the University or has liens
or garnishments attaching their wages. Employees who do not receive a salary (for leave of absence or other reason) must make regularly scheduled
payments by the due date. Failure to remit payments as scheduled will result in the assessment of a late fee equal to ten percent (10%) of the
payment amount. Employees, who terminate before the loan is paid, must pay the remaining balance by the last day of employment. Loans placed with
commercial collection agencies will be reported to national credit bureau services by the agency, and the borrower will be responsible for any
collection costs and legal fees.
Please complete Applicant Section and obtain Department Head's certification. Return Application to:
Brown University Loan Office, Box 1950, Providence, RI 02912
Applicant Section (to be completed by employee)
Requested Loan Amount:
Street Address:
State: Zip Code:
Email Address:
Home Phone:
Cell Phone:
Work Phone:
For the purpose of obtaining the herein requested credit from Brown University, the undersigned warrants the truth and accuracy of the foregoing
information. I agree that the application shall remain the property of the University whether or not the loan is granted. I agree that information
regarding the account may be given to a credit bureau. I affirm that I know of no reason or condition that would prevent me from repaying this loan
and that I do not presently have an outstanding employee loan with Brown University. I further understand that regularly scheduled payments are
required even if I do not receive my salary, and if I terminate my employment before this loan is paid, I promise that the amount remaining shall
be paid in full as of the last day of my employment.
I authorize Brown University to obtain such information as it may reasonably require relative to this application, including a credit history.
Signature of Applicant ___________________________________________Date______________________________
Department Head's Certification
The applicant is current working, has completed applicable probationary period, an employee in good standing, and to my knowledge, there are
currently no plans to discontinue the employment of this person in the next year.
_______________________________________________ ______________________________________________
Type or Print Department Head's Name & Title Signature of Department Head Date
Human Resource Certification
Weekly _____ 12 Mos. _____ ______________________________________________
Semi-Monthly _____ 10 Mos.
Signature of Human Resources Official
Other _____
If applicable, contract expiration date ________________ ______________________________________________
Name and Title of Human Resource Official
Yrs. _____ Months ______ ____________
Loan Office Approval
pproved __________ Denied _________
Loan Balance _________
MAR Balance
_________ Signature of Loan Office Official Date
Payroll Garnish _________ _______________________________________________
Signature of Senior Officer Date
Contact hours at work:
Brown ID:
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