Somerset County Campus Foundation George S. Cook Education Fund Deferment Form printable pdf download

SOMERSET COUNTY CAMPUS FOUNDATION

GEORGE S. COOK EDUCATION FUND DEFERMENT FORM

Borrower Information:

Name:

______________________________

SSN __________________

Address:

______________________________

ACM Student ID ____________

City, State & Zip:

______________________________

Telephone – Home:

______________________________

Telephone – Cell:

______________________________

E-mail Address:

______________________________

Deferment Request:

I understand that my George S. Cook Education Fund student loan can be deferred for no more than 3

years after the date in which I complete coursework at Allegany College of Maryland. I meet the

qualifications for the deferment (currently enrolled as a full-time student or a part-time student with at

least 6 credits at another institution) and request that the Somerset County Campus Foundation defer

repayment of my loan(s).

Borrower Understandings and Certifications:

I understand that I am not required to make loan payments during my deferment.

My deferment will begin on the date of subsequent enrollment at another institution.

My deferment will end on the date I cease enrollment at an eligible institution.

I certify that: The information provided above is true and correct.

I will provide additional documentation as required to support my deferment status.

I have read, understand and meet the eligibility requirement (s) for this deferment.

Borrower’s Signature ______________________________________ Date __________________

PLEASE RETURN THIS FORM TO:

Somerset County Campus Foundation of ACM

George S. Cook Education Fund

6022 Glades Pike, Suite 100

Somerset, PA 15501

Authorized Official’s Certification:

I certify, to the best of my knowledge that the borrower named above:

Is enrolled at an eligible institution during the academic period from _____________ to ____________

Is reasonably expected to complete his/her program requirements on __________________

Name of Institution ______________________________________________________

Address _______________________________________________________________

City, State, Zip _________________________________________________________

Name of Authorized Official/Title __________________________________________

Telephone (

) ___________________

Authorized Official’s Signature _______________________________________Date ______________

Authorized official must be the college registrar or staff member with authority to verify enrollment.

Somerset County Campus Foundation George S. Cook Education Fund Deferment Form

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