UC Santa Barbara                                Attachment 5825 A
Policies                                              
Issuing Unit:  Administrative Services          Date: June 1, 1986



           UNIVERSITY OF CALIFORNIA, SANTA BARBARA
                EMPLOYEE EMERGENCY LOAN FUND
                      Application Form
                              
                                                                      #EE
Name:                                Department:

Residence:                           Dept. Phone:

City:                 Zip:           Home Phone:

Social Security Number:                   Birth Date:

Current Salary:                 Hourly [  ]   Monthly  [  ]  Date Hired:

Position Held:                            Supervisor:

Hours worked per week:               Next Scheduled Payday:

This loan fund is not to compete with local lending institutions.  It is
designed to fill the needs of University employees that are not being met
by local sources when no other funds are available within the time
necessary to act.

Please state (specifically) the reason for this loan request:




Have you secured a loan with the University and State Employee's Credit
Union?

Yes:         No:      If so, please give dates of previous loans:

Do you have a "payroll advance" from the Accounting Office? Yes    No

If so, what date did you receive the payroll advance?

Amount needed:                  To be paid in (#)        monthly payments,

beginning with:                 payroll deduction.

Applicant's signature:                         Date:


Approved:                                      Date:

NOT Approved:                                  Date:

For questions or comments regarding the format of the above information, please contact webcontact@ucsbuxa.ucsb.edu.

Last Modified By: HMW, 5/21/97

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