Fillable Request For Deferment Form printable pdf download

Request for Deferment Form

We recommend that you read your promissory note carefully in order to become familiar with a number of features, duties, and, more

specifically, what is and is not available relating to a deferment or cancellation before completing this form.

BORROWER'S NAME/ADDRESS:

MAIL FORM TO:

_________________________________

__________________________________

EMAIL ADDRESS:

ACCOUNT NUMBER:

LENDING INSTITUTION:

(Last 4 digits of SSN OR SID)

Section 1 Deferment Type

Refer to the back side of this form for more information

_____ Full – Time student (Perkins, selected institutional loans, Nursing and Health Profession Loans)

_____ At least half – time student (Perkins, selected institutional loans, Nursing and Health Profession Loans)

_____ Internship or Residency (Perkins Prior to 7/1/93, Health Profession Loans and selected institutional loans)

_____ A volunteer in the Peace Corps (Nursing, Health Profession Loans and selected institutional loans)

_____ Graduate / Fellowship (Perkins, selected institutional loans, Nursing and Health Profession Loans)

_____

Enrolled in a course of study that is part of Department approved rehabilitation training program for disabled individuals. (Perkins)

_____ Active duty in the uniformed services (Nursing, Health Profession Loans and selected institutional loans)

_____ Active duty in support of current military contingency operation (Perkins Loans)

Section 2 Certification Period

Deferment Starting Date__________________________________ Ending Date____________________________________

Section 3 Borrower Signature

I declare that the information above is true and correct. I further declare that I will notify my lender or Educational Computer

Systems, Inc. immediately upon any change in my status.

Signature of borrower__________________________________ Date____________ Day Phone ____________ Evening Phone___________

Section 4 Certification by School / Agency / Institution

I certify that the information stated above is true and correct.

Name of School /Program/Unit________________________________________________________ OPEID# _______________________

Program Description_______________________________________________________________________________________________

Address__________________________________________________________________________________________________________

City______________________________________________ State___________ Zip________________ Phone ______________________

Signature of Authorized Official________________________________________________Date___________________________________

Printed Name of Authorized Official ________________________________________Title_______________________________________

PLACE SEAL OR STAMP HERE:

INVALID WITHOUT OFFICIAL SEAL, STAMP OR LETTER ON LETTERHEAD CERTIFICATION

FOR INSTITUTIONAL USE ONLY

Approved_____ Disapproved_____ Official Name____________________________________________ Date______________________

Request For Deferment Form