Instructions: Upon completion of each full year of doctoral study, (a) Complete Part I and (b) Ask the appropriate school official to complete Part II and return to the address below
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| Mellon-Mays Undergraduate Fellowship Program
Request for Loan Repayment INSTRUCTIONS: Upon completion of each full year of doctoral study, (a) Complete Part I and (b) Ask the appropriate school official to complete Part II and return to the address below. PART I Name of Student (Type or Print) Social Security Number: Address (Number, Street, City, State, Zip Code) I claim partial repayment of my undergraduate loan(s) for a full year of doctoral studies completed during the period indicated: Signature of Student Date PART II
To be completed by the Registrar of the Institution of doctoral studies: FOR THE PERIOD FROM: TO: Anticipated Graduation Date: Name of Institution Area Code: Phone Number: Signature of Registrar/OFFICIAL SEAL or STAMP Date ============================================================================ Please Return Form to: Sharleen Sanchez Barriera c/o Mellon Mays Undergraduate Fellowship Program Yale College Dean’s Office P.O. Box 208241/SSS 110 New Haven, CT 06520-8241 |