Boston College Request For Economic Hardship Deferment Of Perkins Loan Page 2
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2part ii - income and expense summary
Reminder: Requests for deferment or forbearance submitted without the required documentation will be denied.
Marital Status:
❒ Single
❒ Married
❒ Widow(er)
❒ Separated/Divorced
Number of Dependents: _______
Relationship: _________________ Age: _____
Relationship: ________________ Age: _____
Relationship: _________________ Age: _____
Relationship: ________________ Age: _____
Monthly income from ALL sources: Attach a copy of your most recent pay receipt and your most recent income tax return.
Gross Monthly Salary/Wages
___________
Spouse’s Monthly Salary/Wages ___________
Child Support
___________
Alimony/Support
___________
Unemployment
___________
Public Assistance
___________
Social Security/Veteran
___________
Stocks, Bonds, and Investments ___________
Other: ______________
___________
Other: ______________
___________
Total Monthly Income: ___________________
Bank Account Balances: Checking ___________
Savings ____________
Other ___________
Monthly Expenses: Attach documents to support expense entries. If your other student loans are on forbearance or
economic hardship, you must provide proof of their deferment status.
Rent/Mortgage
___________
Utilities
___________
Child Care
___________
Car Payments
___________
Other Vehicles
___________
Public Transportation
___________
Insurance
___________
Telephone
___________
Cellular Phone/Pager
___________
Food
___________
Credit Cards
___________
Other Charge Accounts
___________
Medical
___________
Cable/Satellite TV
___________
Entertainment
___________
Clothing/Dry Cleaning
___________
Student Loans (Total Payment)
___________
Other: ___________
___________
Total Monthly Expenses: __________________
This information is being requested to determine your eligibility for deferment or forbearance. It will remain confidential;
however, the Office of Student Services reserves the right to use this information if collection efforts become necessary.
A credit bureau report may be ordered to verify the information provided.
______________________________________________________________________________________________
Borrower’s Signature
Date
Mail or fax forms to:
Boston College Office of Student Services
Phone: 800-294-0294
140 Commonwealth Avenue, Lyons Hall 102
Fax: 617-552-0739
Chestnut Hill, MA 02467
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