Forbearance/deferment Form

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SAIPAN HIGHER EDUCATION FINANCIAL ASSISTANCE
Office of the Mayor
Municipality of Saipan
FORBEARANCE/DEFERMENT FORM
Name of Requestor: _______________________________________________________________________________________
Please circle your request? Forbearance
Deferment
Last term you received assistance? Fall___ Spring____
Student Data
Social Security Number: ___-___-___
Phone Number:
Current Mailing Address:
Permanent CNMI Mailing Address:
Educational Data
Institution (s) Attended
Degree Obtained and Date of Degree Conferral
1.
2.
Are you currently employed: Yes __ No __
If so, please indicate place of employment and employment
period:
Reason for Forbearance or Deferment: *Please attach supporting documents if needed.
1. Are either of you or your spouse serving in the armed force? Yes __ No __ Branch:
Period:
( )Certification: I certify that all information and documents provided is true and complete to the best of my
knowledge. I agree to provide proof of information stated on this form. I understand that if I fail to provide
documents of falsify any information provided my appeal will be denied.
Requestor’s Signature: ___________________________________________
Date: ___/___/___
P.O. Box 10001, PMB 3648 Saipan, MP 96950
Tel: 233-5995 •Telefax: 233-5996
E-mail: contact@saipanshefa.net • Website:

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