Application For Forbearance Form printable pdf download

APPLICATION FOR FORBEARANCE

(You must fill out both sides of this form)

Name:

________________________________ Account Number(s)

____________________________

Address: ________________________________ 

____________________________

check if new

________________________________

____________________________

address

Email Address _____________________________

____________________________

Telephone: ____________________ (home)

____________________ (work)

Social Security Number __________________________

____________________ (cell)

I request forbearance 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 I must pay the interest that continues to accrue during this period of

forbearance, and that the maximum benefit is three years, which will be granted to me in periods of not more than six months at a time.

REASON FOR FORBEARANCE: (Check one)

Poor health/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.

The total amount of payments I must make on all my Title IV federal education loans is 20% or more of my total monthly gross

income. To determine your eligibility for forbearance of payments under this provision, provide the following:

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

$_____________ (ATTACH A COPY OF YOUR MOST RECENT PAY STATEMENT); AND

Total monthly payments on federal education loans. List below, or on a separate sheet, each federal loan lender (school/financial

institution), type of Title IV federal loan (Perkins/NDSL, Stafford, Direct, Consolidation loan, etc.), the amount you borrowed, and

the amount of 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. ________________________________

___________________

$______________

$ _____________

Other reason. Please attach a description of the condition(s) that affects your ability to pay this loan(s), as well as documentation to

support your claim.

FORM OF FORBEARANCE (Select one option):

Temporarily stop making payments during the period I have indicated above. I am aware that interest will continue to accrue, and I

wish to pay this interest:

in a lump sum at the end of the forbearance period; or

as it accrues. If I choose this option, I will be billed for accrued interest each month or quarter.*

*If you have an HPSL, NSL, LDS or PCL loan, you are required to make interest payments during the period of forbearance.

Temporarily reducing the amount of my payments from $

to $

per

(month or quarter) during the

period I have indicated above.

Signature:

Date:_______________________________________

Return to: Campus Partners, P.O. Box 2901, Winston-Salem, NC 27102-2901 or Fax: 336-607-2093

E9174 (rev. 08-14)

Application For Forbearance Form

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