Application For Hardship/unemployment Deferment Form printable pdf download

APPLICATION FOR HARDSHIP/UNEMPLOYMENT DEFERMENT

(You must fill out both sides of this form)

Name:

___________________________________

Account Number(s) ________________________

Address: ___________________________________

________________________

___________________________________

________________________

Email Address: ______________________________

________________________

Telephone: ____________________ (home)

________________________

____________________ (work)

Social Security No.

________________________

____________________ (cell)

I request deferment of my student loan(s) payments, beginning _______ and ending ______. I meet the qualification(s) I have checked below, and I have

attached the required documentation. I understand that the maximum benefit is three years, which will be granted to me in periods of not more than six

months at a time. Read this entire form before you fill it out. If you do not qualify for any of these benefits, please send a request for forbearance.

1. !

Prolonged illness, starting ______ and ending _______. Attach explanation of how your health affects your ability to pay this loan(s). PROVIDE

PHYSICIAN STATEMENT OF DIAGNOSIS, AND SUBMIT WITH THIS APPLICATION. Complete the Income & Expense Summary

on reverse side. I understand that interest accrues during this type of deferment.

2. !

Unemployed since _______. Provide documentation such as proof that you are collecting unemployment benefits and, if you are still

unemployed, that you are actively seeking employment; or

Working part time and unable to find full-time employment (full time = 30 hours per week for three consecutive months). I have not worked full

time since __________. To receive deferment of payments under this provision, provide one of the following information:

I registered with the following public or private employment agency (does not include school placement offices or temporary employment

agencies):

Name of agency:___________________________________

Address: _______________________________________

Contact:

___________________________________

_______________________________________

Telephone:

___________________________________

_______________________________________

I have not registered with an employment agency (attach explanation).

In the last six months, I have attempted to secure employment. Attach a list of firms where you have applied for employment, including the

firms' name and address, and the name and telephone number of a person to contact for verification.

3. !

I have been granted an Economic Hardship/Unemployment Deferment on my other federal loan(s) for the period starting ________ and ending -

_______, and I request this same deferment, for the same period of time, on my Federal Perkins Loan.

I HAVE ATTACHED

DOCUMENTATION OF THE DEFERMENT I RECEIVED ON MY OTHER FEDERAL LOAN(S).

4. !

I receive payment under a federal or state public assistance program, such as Aid to Families with Dependent Children, Supplemental Security

Income, Food Stamps, or state general public assistance. I HAVE ATTACHED DOCUMENTATION THAT I AM RECEIVING THESE

BENEFITS.

5. I work full time (30 or more hours per week), and

my Total Monthly Gross Income (TMGI) does not exceed the federal minimum wage, or 150% of the poverty line applicable to my family size.

Total monthly gross income (the gross amount you receive from employment and other sources before taxes and other deductions): $____________

(attach copy of last tax return, or most recent pay statement).

! I do not work full time and my TMGI is not greater than twice the federal minimum wage or the poverty line applicable to my family size and when

I subtract the amount of payments I must make on all my federal education loans from my TMGI, the result is not more than the greater of the

federal minimum wage or the poverty line for a family of two. (I have attached documentation of my monthly income and my federal education

loan debt.)

Total monthly payments on federal education loans (list each federal loan lender (school/financial institution), type of federal education loan

(Perkins/NDSL, Stafford, Direct, Consolidation, Health Professions/Nursing, etc.), the amount you borrowed, and the amount of your monthly

payment for each one. Attach copy of monthly bill for each loan.

Lender:

Type of Loan:

Amount Borrowed

Monthly Payment

1. ________________________________

___________________

$______________

$ __________

2. ________________________________

___________________

$______________

$ __________

3. ________________________________

___________________

$______________

$ __________

4. ________________________________

___________________

$______________

$ __________

5. ________________________________

___________________

$______________

$ __________

Signature: ________________________________________

Date: ___________________________

Return form to your School

Hardship..FmM, revised !-09

Application For Hardship/unemployment Deferment Form

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