Forbearance Request And Verification Form

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FORBEARANCE
REQUEST AND VERIFICATION FORM
Name of Borrower
Account Number
Address (Number, Street, Apt #)
Home Telephone Number
Place X
(City, State, Zip Code)
Work Telephone Number
here if this is
a new
address.
E-mail address:
To qualify for Forbearance on your Federal Perkins Student Loan(s), the following eligibility criteria must be met.
Your total monthly payment obligations toward Title IV (Federal) Loans must collectively equal or exceed twenty
percent (20%) of your total gross monthly income OR you have other Title IV (Federal Loans presently in
Forbearance with your other lenders).
You must attach proof of your gross monthly income (or proof of your unemployment status must be provided by
you).
You must attach proof of your monthly Title IV (Federal) Loan obligations and/or proof of your loans’ Forbearance
status with your other loan lenders.
To be considered for Forbearance, COMPLETE THIS FORM AND ATTACH PHOTOCOPIES OF THE
DOCUMENTS INDICATED WHICH SUPPORT YOUR CLAIM. Return this form and required documentation to this
office at the following address:
USD Loan Administration Office
5998 Alcala Park, HC 204
San Diego, California 92110
1)
BORROWER’S TOTAL GROSS MONTHLY INCOME …………………………………….. $__________per month
Required: Provide photocopy of your paycheck stub or earnings statement.
EMPLOYER NAME _________________________________________________
ADDRESS:
_________________________________________________
TELEPHONE:
_________________________________________________
2)
SPOUSE’S TOTAL GROSS MONTHLY INCOME ………………………………………….. $__________per month
Required: Provide photocopy of spouse’s paycheck stub or earnings statement.
SPOUSE’S EMPLOYER
_________________________________________________
ADDRESS:
_________________________________________________
TELEPHONE:
_________________________________________________
3)
OTHER INCOME:
Unemployment ………............................................. $__________per month
Supply photocopy of statements for each. Retirement ………………………………………… $__________per month
OTHER TAXABLE INCOME (SPECIFY):___________________________________________ $__________per month
UNTAXABLE INCOME (SPECIFY) __________________________________ $__________per month
TOTAL GROSS MONTHLY INCOME…………………………………….$________
per month
4)
LIST ALL TITLE IV (FEDERAL) STUDENT LOAN OBLIGATIONS:
Required: Provide a photocopy of a recent bill, statement, or payment coupon for each loan you list.
MINIMUM
REQUIRED
NAME OF LENDER
TYPE OF LOAN
DATE
PRINCIPAL
MONTHLY
OR SERVICER
(Perkins/Stafford, etc)
OBTAINED
BALANCE
PAYMENT
_____________________
____________________
________ ______________
$___________
_____________________
____________________
________ ______________
$___________
_____________________
____________________
________ ______________
$___________
_____________________
____________________
________ ______________
$___________
TOTAL MONTHLY FEDERAL TITLE IV STUDENT LOAN OBLIGATION $_________
Please use other side of this application if more space is needed.
I AFFIRM THAT THE INFORMATION PROVIDED ON THIS APPLICATION IS TRUE AND CORRECT. I UNDERSTAND THAT THE
UNIVERSITY OF SAN DIEGO MAY RUN A CREDIT REPORT TO VERIFY THE INFORMATION PROVIDED. IF MY REQUEST FOR
FORBEARANCE IS GRANTED, I UNDERSTAND THAT INTEREST CONTINUES TO ACCRUE DURING THE FORBEARANCE AND THAT I
AM RESPONSIBLE FOR THE PAYMENT OF ALL INTEREST ACCRUED DURING THE APPROVED FORBEARANCE PERIOD. I
UNDERSTAND THAT THE FORBEARANCE IS FOR A SIX (6) MONTH DURATION UNLESS OTHERWISE SPECIFIED BY THE
UNIVERSITY OF SAN DIEGO LOAN ADMINISTRATION OFFICE.
BORROWER’S SIGNATURE________________________________________________________________DATE: ___________________
Updated: 3/31/04

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