APPLICATION/TEACHING AGREEMENT/MASTER PROMISSORY NOTETuition Waiver Agreement • December 13th, 2018 • Illinois
Contract Type FiledDecember 13th, 2018 JurisdictionSECTION A ⎯ Applicant Information IMPORTANT: PLEASE NOTE that your Social Security number is needed for the purpose of collecting funds awarded to you in the event that those funds convert to a loan under the terms of this Promissory Note.Complete all applicable items on this application according to the instructions on Page 3. This application is only valid for the 2019-20 academic year. - - Social Security Number Name (Last, First, Middle Initial, include prior name, if applicable) ( ) Permanent Home Address Area Code Telephone Number - City State Zip Code Driver’s License or State ID Number or indicate NONE / / Birthdate: Month Day Year Name of the Illinois public 4 year college you will attend College Code (optional)❑U.S. Citizen ❑Eligible NoncitizenE-mail address (optional) Citizenship (check one) State of Legal Residence CHECK ONE: ❑ I will or have graduated from high school in the 2018-19 academic year.Name of High Schoo