University
of Maryland

Emergency Loan Fund

Confidential

APPLICATION


The Faculty Staff Assistance Program Emergency Loan Fund (FSAP-ELF) is a program designed to assist University of Maryland, College Park faculty and staff members who are experiencing a personal financial emergency and have exhausted all other avenues of support. All loans include a five percent (5%) administrative fee and are repaid to the Bursar's Office every pay period. Loan repayments must be complete within a six month period. Loan defaults are turned over to the State Central Collections Unit, where an additional 17% fee will be added on to the original loan amount.

Eligibility

Active full-time or part-time faculty or staff members in good standing with a minimum of 6 months or more successful employment are eligible for FSAP-ELF loans. Applicants should be able to provide a supervisor's confirmation of continuing employment potential for at least the next six months. They must also provide evidence that all other avenues of assistance have been pursued (such as banks, credit unions, family members). Applicants must show an ability to pay back the loan (i.e., should not have excessive garnishments or debts) and must have paid back all previous ELF loans, as well as other university loans (from an individual's department, etc.). Employees may be eligible for a second loan one year after they have made their last payment on their first loan. Due to limited funds, priority is given to employees who have not used the Emergency Loan Fund previously. The loan fund was set up predominantly for one time use.

The program is NOT designed to provide assistance in cases where other financial options or means are identified or when an individual cannot pay predictable expenses or monthly payments such as housing or child care due to poor planning or budgeting. Employees who are not working due to an Unauthorized Absence are ineligible, as are employees who have been suspended without pay and are seeking a loan to recoup their losses. Multiple requests for a particular type of emergency, such as emergency car repairs, will not be granted. Family members and significant others are not eligible.


Application Procedure

Below is a form requesting the information we need to complete the processing for your application. If you have any questions about the form, please call the secretary at 314-8093. The information you provide will be kept confidential.

When filling out the application, please PRINT this form and then neatly print or type all of your information clearly. Be sure to sign and date the bottom of page two, confirming that the information provided is valid and accurate. Any unauthorized changes to or misinformation in the application on form or procedures invalidates the process. You must provide a copy of a recent pay stub along with your application. Depending on the nature of your request, you may be asked to provide additional documentation, such as a written estimate for car repairs.

When you have finished this application form, call at 314-8170 or 314-8099 to schedule an appointment with a Faculty Staff Assistance Program counselor. The counselor will go over your application and will discuss other resources or options that may be available to you. If your request falls within FSAP-ELF guidelines, the counselor will pass on a summary of your request to the Advisory Committee. You will be notified within 48 hours whether or not your request has been approved.

If your request is approved, you will pick up your check at the Bursar's office. Checks will NOT be paid directly to you, but rather to your creditor(s). If your request is denied, you will have the opportunity to appeal the decision and/or to reapply after changing any of the factors that prevented approval of the loan.


Confidential
Revised 7-1-96

Full Name: _______________________________________ SSN: __________________________________

DATE OF BIRTH: ____________________________ Driver's License:#__________________________________________

HOME ADDRESS:
Street________________________________________________ Phone (day) _________________________
City______________________ State________ Zip___________ Phone (home)________________________
Position (Job Title): _________________________________________________________________________
Department:_____________________ Length of Employment:______________ Percent time employed____
Check one: Faculty/Post-doc: _____ Classified staff: _____ Associate staff: _____ Contract staff: _____

Annual Salary: $_________________________

What is the total amount of money you are requesting? $_________________________
plus 5% admin. fee $_________________________

TOTAL LOAN AMOUNT: $_________________________

Please provide an explanation for your request. Feel free to attach an extra sheet if you need more room. (Please attach documentation, if any. E.g., if request is for automobile repair costs, request must be submitted with a written estimate before repair work is performed. The Committee may request a second estimate of the repair costs.) ___________________________________________________________________________________________ ___________________________________________________________________________________________________________________ ________________________________________________________________________________________________
___________________________________________________________________________________________________________ ___________________________________________________________________________________________________
Have you ever filed for bankruptcy? Yes [ ] No [ ]. If yes, when? ________ Please state details: __________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________
Do you plan to file for bankruptcy? Yes [ ] No [ ]. If yes, please explain:_____________________________________________
____________________________________________________________________________________________
Other places (names and addresses) loans applied for and reason denied: ____________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________
Have you ever sought financial counseling through the Consumer Credit Counseling Service or another organization?
Yes [ ] No [ ]. If yes, when?
_______________________________________________________________________________ ____________________________________________________________________________________
Do you anticipate your employment at UMCP continuing for the next 6 months? Yes [ ] No [ ] If no, please explain: ___________________________________________________________________________________________________________ ____________________________________________________________________________________________
Have you been suspended without pay within the past six months? Yes [ ] No [ ]

FSAP-ELF Loan Application--Page Two

HOUSEHOLD INFORMATION
a. How many individuals are you financially responsible for and what are their ages?________________________________________________________________________________________________________________________________________________
b. Do any of these individuals help pay the monthly household expenses? Yes [ ] No [ ] If yes, be sure to indicate only those portions of monthly expenses that you are personally responsible for:____________________________________________________ Please provide the following financial information.
Your net monthly take-home pay (after taxes) $_________________________
(Please attach copy of paycheck stub.)
Additional income: Monthly amounts $_________________________
Overtime $_________________________
Child Support $_________________________
Spouse $_________________________
Social Security $_________________________
Other Government Program $_________________________
Other (Explain) $_________________________
Total Additional Income $_____________________

Your Assets
Cash & checking account balance $_________________________
Savings account(s) balance $_________________________
Certificates of deposits $_________________________
Other Cash Assets (e.g. investments) $_________________________
Total Assets $_________________________

Estimated Monthly Expenses: Be sure to attach required documentation, including canceled checks, if applicable .
Housing $_________________________
Utilities $_________________________
Car payments $_________________________
Child care $_________________________
Food $_________________________
Credit card payments $_________________________
Other monthly bills/loans $_________________________
Any other essential expenses $_________________________
Total Monthly Expenses $_________________________

FSAP-ELF Loan Application--Page Three

I understand that I am solely responsible for the validity of the information provided on this application form.



Date of Application Signature of employee


Do NOT fill out: For Office Use Only

Request Received (date):__________ Amount of Loan: $_____ _______ Payment Issued to:________________________________
Date Payment Issued: ___________Request Approved (date):________ Request denied [date]:_______________________________
Reason for denial:____________________________________________ _________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________



*A promissory note detailing all of the terms of the contract will be filled out in the counselor's office once the application form is complete and the meeting has taken place.


HOME
Confronting Substance Abuse | Effective Communication | Emergency Loan Fund | FSAP Services |
Healthy Families | How to be a Great Supervisor | Laugh Your Way to Health | Managing Stress and Anger | Meet the FSAP Staff | Overcoming Depression
Comments or suggestions? ruggieri@health.umd.edu