Short Term Loan Application

The WVSOM Foundation, Inc. makes available on a first come first serve basis short term low-interest loans to qualified students in need. The maximum loan is $1,000 for a maximum term of 90 days. To facilitate processing, loan applications are handled through the WVSOM Financial Aid Office. The monies for these loans have been made available through fund raising efforts of the Foundation and are disbributed via one of three funds. They are:

  • The Dr. Byron E. Laycock Short Term Loan
  • The Dr. Frank Wallington Memorial Fund
  • The Frank J. Hennessey Short Term Loan

Please complete the following form and submit to the WVSOM Financial Aid Office. Loan applications will be processed as rapidly as possible, usually within 24 to 48 hours.

 

Date of Application:

Class of:

Personal Information
First Name:
Last Name:
Address:
City:
State:
Zip Code:
Email Address:
Phone:
Date of Birth:
Amount Requested:
Estimated Repayment Date:

Purpose of Loan

Source of Repayment