Economic Hardship Deferment Request

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ECONOMIC HARDSHIP DEFERMENT REQUEST
DIRECTIONS—
RETURN COMPLETED FORMS TO:
Complete this form to request postponement of principal and
interest payments while you are experiencing an economic hardship. Deferment can-
Student Account Assistance
not exceed 12 months per request. After a granted deferment has ended, there will be
University of Minnesota, Twin Cities
211 Science Teaching & Student Services
a six-month post-deferment grace period before your payments resume.
222 Pleasant St. S.E.
Minneapolis, MN 55455-0239
Phone: (612) 625-8007
Fax: (612) 624-2873
Email: stdtloan@umn.edu
To ensure privacy online, open in Adobe Reader (free at ). Please add the required signature(s) in blue or black ink.
SECTION A. Student information
Name (last, first, middle initial)
University ID (or Social Security number)
Current mailing address (street, apartment or P.O. Box number, city, state, ZIP code, country)
Phone (include area code)
Current email address
Cell phone (include area code)
SECTION B. Deferment Request
Select one of the following reasons for requesting an Economic Hardship deferment. Every deferment requires documentation to
substantiate the request. The documentation is to be submitted with this deferment form and the enclosed worksheet.
FEDERAL REGULATIONS REQUIRE DOCUMENTATION. YOUR REQUEST WILL BE DENIED WITHOUT DOCUMENTATION.
I am requesting temporary deferment of my student loan payments, and certify that I am eligible for the reason checked below
for the following period: From:____________________ To: _____________________
(Complete both blanks, not to exceed 12 months)
Category:
I have been granted an economic hardship for a FFELP loan (other federal loan).
OR
Attach official supporting documentation - copy of approved deferment or letter from the lender.
I am receiving federal or state public assistance. Attach documentation of assistance such as AFDC, Supplemental Security Income
OR
(SSI), food stamps, WIC, Medicaid, or state public assistance.
I do NOT work full-time and my total monthly gross income is less than or equal to 2X poverty amount and gross income minus monthly
federal student loan payments is less than or equal to poverty amount. I must provide documentation of income and educational debt.
(Use the attached worksheet to determine your income in relation to federal poverty guidelines).
The total amount I borrowed for all my federal loans now in repayment (including the loans for which I am requesting deferment) is:
$ ______________________________.
SECTION C. Personal References
Name (last, first, middle initial)
Phone (include area code)
Address (street, apartment or PO Box number, city, state, ZIP code, country)
Name (last, first, middle initial)
Phone (include area code)
Address (street, apartment or PO Box number, city, state, ZIP code, country)
Please continue on reverse side of form
*FA997*
To request copies of this form in an alternative format, please call the Disabilities Services liaison
at 612-625-9578. The University of Minnesota is an equal opportunity employer and educator. This
form is printed on paper made from no less than 20 percent post-consumer waste.
FA997—Page 1 of 2
3/12
200
Please recycle.

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