Acs Unemployment Deferment Form printable pdf download

UNEMPLOYMENT DEFERMENT FORM

To qualify for the Unemployment Deferment on your Federal Perkins Student Loan you must have become

unemployed or began working less than 30 hours per week.

To apply for deferment please complete and submit this form with the required documentation to:

ACS Education Services

PO Box 7060

Utica, NY 13504-7060

Name: ____________________________________________________________________

Address: ____________________________________________________________________

Account Number(s): ____________________________________________________________________

1) I became unemployed or began working less than 30 hours a week on (mm/dd/yy):______________.

2) I registered with the following employment agency:

Name of Employment Agency:_____________________________________________

Address:_______________________________________________________________

Telephone Number:__________________________________

Note: School placement offices and “temporary” agencies do not qualify as employment agencies.

3) In the last six months, I have tried to secure full-time employment at the following firms:

Name of Firm: _______________________________________________________________________

Street Address: _______________________________________________________________________

City, State, Zip: _______________________________________________________________________

Contact Person: __________________________________

Telephone: ______________________

Name of Firm: _______________________________________________________________________

Street Address: _______________________________________________________________________

City, State, Zip: _______________________________________________________________________

Contact Person: __________________________________

Telephone: ______________________

Name of Firm: _______________________________________________________________________

Street Address: _______________________________________________________________________

City, State, Zip: _______________________________________________________________________

Contact Person: __________________________________

Telephone: ______________________

I hereby claim that the above information is true. I agree to notify the lending institution immediately upon

termination of my claimed status.

________________________________________________

__________________

Signature

Date

11/06

Acs Unemployment Deferment Form