Request For Educational Deferment Federal Perkins Loans

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REQUEST FOR EDUCATIONAL DEFERMENT
FEDERAL PERKINS LOANS
PLEASE NOTE: A DEFERMENT MUST BE SUBMITTED EACH QUARTER OR SEMESTER
AFTER OFFICIAL REGISTRATION.
PART I: TO BE COMPLETED BY THE BORROWER (Please complete in ink.)
Name
Account no. (Social Security number)
Address
Check if new. ( )
Home telephone number
City
Cell phone number
State
ZIP
E-mail Address
Borrower signature
Date
I am pursuing a course of study in an institution of higher education
( ) at least half time
( ) full time
( ) Part time
From _____/______/______ To ____/_____/_____ (current term only)
(Altered dates will result in form being voided.)
PART II: TO BE COMPLETED AND CERTIFIED BY REGISTRAR OF SCHOOL
CURRENTLY ATTENDING
I certify that the information stated in Part I is true and correct:
SIGNATURE OF AUTHORIZED OFFICIAL
TITLE
DATE
Name and address of institution of higher education
Actual dates for
Official seal
Where Receiving Education
deferment
(Invalid without
official seal, stamp, or
letter of certification. If
____/_____/____
no seal is available,
include official
____/_____/____
certification on
letterhead.)
Institutional/OPEID code _____________
Public ( ) Private ( ) Nonprofit ( )
FOR WHITWORTH UNIVERSITY USE ONLY
Signature of approving official
Date
Beginning date
RETURN PROPERLY COMPLETED FORM TO
Princ. past due
$
WHITWORTH UNIVERSITY STUDENT LOAN OFFICE
Interest past due $
Ending date
300 W Hawthorne Road
Late charges
$
Spokane WA 99251
Total due
$

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