Form Mil - Deferment Request printable pdf download

DEFERMENT REQUEST:

OMB No. 1845-0080

• MILITARY SERVICE DEFERMENT

Form Approved

• POST-ACTIVE DUTY STUDENT DEFERMENT

Exp. Date 07/31/2013

Federal Family Education Loan Program / William D. Ford Federal Direct Loan Program / Federal Perkins Loan Program

MIL

WARNING: Any person who knowingly makes a false statement or misrepresentation on this form or on any accompanying documents is subject to penalties

that may include fines, imprisonment, or both, under the U.S. Criminal Code and 20 U.S.C. 1097.

SECTION 1: BORROWER IDENTIFICATION

Please enter or correct the following information.

SSN

Name _________________________________________________________

Address ________________________________________________________

City, State, Zip Code ______________________________________________

Telephone - Home (

) _________________________________________

Telephone - Other (

) _________________________________________

E-mail Address (Optional) __________________________________________

SECTION 2: ELIGIBILITY REQUIREMENTS AND DEFERMENT REQUEST

Before completing this deferment request, carefully read the entire form. For the Military Service Deferment, a representative may complete and sign this form on your behalf

if you are unable to do so. Check the appropriate box(es) for the deferment(s) you are requesting. For the Post-Active Duty Student Deferment, enter the required information in

the space provided.

(A) o Military Service Deferment. I meet the eligibility requirements for this deferment as described in Sections 6 and 7 and request that my loan holder defer repayment of my

eligible loan(s) beginning on the date I began performing the military service that qualifies me for the deferment, and ending 180 days following completion of my qualifying

military service. If I am requesting a deferment for military service that ended before October 1, 2007, the deferment period will end on the ending date of my qualifying

military service.

(B) o Post-Active Duty Student Deferment. I meet the eligibility requirements for this deferment as described in Sections 6 and 7 and request that my loan holder defer repayment

of my eligible loan(s) following the completion of my qualifying active duty service and any applicable grace period. My deferment will end the earlier of (a) the date I resume

enrollment at an eligible school on at least a half-time basis, or (b) 13 months following the completion date of my active duty service and any applicable grace period. If I am also

granted a Military Service Deferment, the 180-day period described in Item A above will run at the same time as my Post-Active Duty Student Deferment period.

Enter the name of the school where you were enrolled on at least a half-time basis at the time you were called to active duty or within 6 months before the date you were called to

active duty, and the date you were last enrolled at least half time at the school:

Name of school: _______________________________________________________________________ Date last enrolled at least half time: ______________________________

SECTION 3: BORROWER CERTIFICATIONS AND AUTHORIZATION

I certify that the information I have provided on this form is true and correct, and that I have read, understand, and meet the eligibility requirements and terms and conditions of

the deferment(s) that I have requested, as explained in Sections 2, 6, and 7.

I authorize the school, the lender, the guaranty agency, the U.S. Department of Education, and their respective agents and contractors to contact me regarding my loan(s),

including repayment of my loan(s), at the current or any future number that I provide for my cellular telephone or other wireless device using automated telephone dialing

equipment or artificial or prerecorded voice or text messages.

Signature of Borrower or Borrower’s Representative

Date

Printed Name of Borrower’s Representative (if applicable)

Relationship to Borrower

Address of Borrower’s Representative

Telephone (

)

SECTION 4: AUTHORIZED OFFICIAL’S CERTIFICATION

Note: As an alternative to completing this section, a written statement from the commanding or personnel officer or a copy of the military orders may be attached. The

statement or copy must include all information needed to establish the borrower’s eligibility for the deferment(s) indicated in Section 2, including the period of the qualifying

service. If the borrower is/was serving in an area of hostilities in which service qualifies for special pay under section 310 of title 37, United States Code, the statement or copy

must identify the hostile fire/imminent danger pay area in which the borrower is/was on active duty.

I certify, to the best of my knowledge and belief, that:

The borrower’s service meets the eligibility requirements for the deferment(s) indicated in Section 2 and as described in Sections 6 and 7, as applicable.

The borrower’s service begins/began on

(mm-dd-yyyy) and ends/ended on

(mm-dd-yyyy).

If the borrower is requesting a Military Service Deferment (see Section 2, Item A) —

(1) The borrower is (check one):

o A member of an Armed Force reassigned to a duty station at a location other than the location where the member is normally assigned.

o A Reserve or retired member of an Armed Force called to active duty under 10 U.S.C. 12301(a), 12301(g), 12302, 12304, 12306, or 688.

o On full-time National Guard duty as defined in 10 U.S.C. 101(d)(5) under a call to active duty service authorized by the President or the Secretary of Defense.

Note: If none of the above conditions apply, do not complete this form.

(2) The reassignment/call to active duty/full-time National Guard duty is in connection with a (check one and identify):

o Contingency Operation (identify): o Operation Enduring Freedom o Operation Iraqi Freedom/Operation New Dawn o Other

o National Emergency (identify):

o War (identify):

Note: If the borrower’s service is not in connection with a contingency operation, national emergency, or war, do not complete this form.

(3) o If applicable, by checking this box I further certify that the borrower is/was serving in an area of hostilities in which service qualifies for special pay under section 310 of

title 37, United States Code.

Name of Military Branch or National Guard Component

Address

City, State, Zip Code

Name/Title of Authorized Official

Telephone (

)

Authorized Official’s Signature

Date

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