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GENERAL FORBEARANCE REQUEST

OMB No. 1845-0031

Form Approved

William D. Ford Federal Direct Loan Program

Exp. Date 12/31/2015

WARNING: Any person who knowingly makes a false statement or misrepresentation on this form or on any accompanying document

will be subject to penalties which may include fines, imprisonment, or both, under the U.S. Criminal Code and 20 U.S.C. 1097.

GFB

SECTION 1: BORROWER IDENTIFICATION

Please enter or correct the following information.

Check this box if any of your information has changed.

SSN

Name

Address

City, State, Zip Code

Telephone

Primary (

)

–

Telephone

Alternate (

)

–

E-mail Address (Optional)

SECTION 2: FORBEARANCE REQUEST

Before completing this form, carefully read the entire form, including the instructions and other information in Sections 3, 4, and 5.

 I am willing but unable to make my current Direct Loan payments due to a temporary hardship. I am requesting this forbearance because I am experiencing a temporary hardship

related to one of the following situations (check one):

Financial difficulties

Change in employment

Medical circumstances

Other (explain):

 If this forbearance request is approved, I want to (check one):

Temporarily stop making payments; or

Temporarily make smaller payments of $ _____________ per month.

 If this forbearance request is approved, I am requesting that the U.S. Department of Education (ED) grant a forbearance on my loan(s) beginning (MM-DD-YYYY)

|____| |____|-|____| |____|-|____| |____| |____| |____| and ending (MM-DD-YYYY) |____| |____|-|____| |____|-|____| |____| |____| |____| for a period not to exceed 12 months.

SECTION 3: BORROWER/ENDORSER UNDERSTANDINGS AND CERTIFICATIONS

 I understand that the following terms and conditions apply to this forbearance request:

(1)

ED will not grant this forbearance request unless this form is completed and any required supporting documentation is provided.

(2)

ED may grant a forbearance on my loans for up to 60 days, if necessary, for the collection and processing of documentation related to my forbearance request. ED will not

capitalize interest that accrues during this forbearance.

(3)

If I am past due on payments not covered by this forbearance, ED may grant an additional forbearance on my loan(s) to resolve all payments due when my request is

processed, and all unpaid interest may be capitalized.

(4)

At the end of the forbearance, I may apply to renew the forbearance if I am still experiencing a financial hardship.

(5)

I will continue to receive billing statements for my current payment amount, which I must pay until I am notified by my servicer that my forbearance request has been granted.

(6)

During the forbearance period, I am not required to make payments of loan principal and interest, but interest will be charged on all of my loans.

(7)

If I requested to temporarily stop making payments, I will receive an interest notice, and I may pay the interest at any time. If I do not pay the interest that accrues on my

loan(s), it will be capitalized at the end of the forbearance period.

(8)

If I requested to temporarily make smaller payments, I will receive a monthly notice for the requested payment amount until the forbearance ends, and any unpaid interest

that has accrued during the period will be capitalized at the end of the forbearance period.

 I certify that:

(1)

The information I have provided on this form is true and correct.

(2)

I will provide any additional documentation to ED, as required, to support my continued forbearance status.

(3)

I will notify ED immediately when the condition that qualified me for the forbearance ends.

(4)

I agree to repay my loan(s) according to the terms of my promissory note, regardless of whether the forbearance is granted.

 I authorize the entity to which I submit this request (i.e., the school, the lender, the guaranty agency, ED, and their respective agents and contractors) to contact me regarding my

request or my loan(s), including repayment of my loan(s), at the number that I provide on this form or any future number that I provide for my cellular telephone or other wireless

device using automated dialing equipment or artificial or prerecorded voice or text messages.

BORROWER’S OR ENDORSER’S SIGNATURE:

DATE:

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