In School Deferment / Letter Request

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IN SCHOOL DEFERMENT / LETTER REQUEST
Please Print:
NAME: __________________________________________ DATE: ____________________________
ADDRESS: ______________________________________ *STUDENT #______________________
CITY: _____________________ STATE: ____ ZIP: ______ PHONE # ________________________
*SIGNATURE: ______________________________________________________________________
*SIGNATURE & STUDENT NUMBER ARE REQUIRED FOR PROCESSING
Please Check All That Apply:
CURRENT TERM ONLY
COMPLETE ENROLLMENT HISTORY (ALL TERMS ATTENDED)
SPECIFIC TERMS (PLEASE LIST): ________________________________________
DEGREE VERIFICATION (UMSL DEGREE(S), DATE RECEIVED & GPA)
Please check information you wish to include:
____ Class Schedule ____ Degree Program/Major ____ Academic Standing
____ GPA ____ Anticipated Graduation Date (Month & Year) ___________________
(Please Note: Degrees awarded for the current term will be posted 6 weeks after commencement)
Information for Insurance Verification: ONLY IF YOU NEED LETTER FOR HEALTH INS.
MEMBER NAME (PERSON YOU ARE COVERED UNDER):________________________
EMPLOYER (WHERE THEY ARE EMPLOYED): _________________________________
POLICY # _______________GROUP#_______________ MEMBER# ____________________
Check Lender/Insurance Carrier OR List Complete Address:
___ACS
___Fed Loans
___Benefit Consultants
___AES
___Great Lakes
___Bricklayer’s Local #1
___Campus Partners
___MOHELA
___Carpenter’s
___Chase
___Nelnet
___District 9 I A M & A W
___CitiBank
___Sallie Mae
___I B E W
___Dept of Educ
___Univ Accounting
___Local 682
___Direct Loans
___Wachovia
___Oper Engin Local 513
___ECSI
___Wells Fargo
___Painter’s Dist #2
___EdFinancial
___Xpress Loans
___Plumbers & Pipefitters #562
___Sheetmetal Workers Local 36
NAME: _____________________________________________________________________
ATTN: _____________________________________________________________________
ADDRESS: _________________________________________________________________
CITY: ___________________________________ STATE: ______
ZIP: ______________
FAX# ___________________________________
PICK UP _____
***Please Allow Up to 72 Hours for Processing***
Please Note: Official and Unofficial letters bear the signature of the certifying official
along with the University Seal. Official letters are mailed by the University.
Unofficial letters with the signature of the certifying official and University Seal will
be stamped “Issued to Student.”

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