Unemployment Deferment Request And Verification Form printable pdf download

UNEMPLOYMENT DEFERMENT

REQUEST AND VERIFICATION FORM

Name of Borrower:

Account No.:

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 an Unemployment Deferment, on your Federal Perkins Student Loan(s), the following eligibility criteria must be

met:

•

Your loan was disbursed on or after July 1, 1993; and

•

You are unemployed or are working less than 30 hours per week; and

•

You are actively seeking full-time work.

To be considered for an Unemployment Deferment, COMPLETE THE FOLLOWING FORM AND ATTACH A

PHOTOCOPY OF THE DOCUMENTS INDICATED WHICH WILL SUPPORT YOUR CLAIM. Return this form and

the required documentation to:

USD LOAN ADMINISTRATION

5998 ALCALA PARK HC ROOM 204

SAN DIEGO, CALIFORNIA 92110

I BECAME UNEMPLOYED OR BEGAN WORKING LESS THAN 30 HOURS PER WEEK ON ___/___/___

Required: Provide proof of last date of employment or cut in hours.

I AM RECEIVING UNEMPLOYMENT COMPENSATION BENEFITS OF $_______________ PER WEEK.

Required: Provide photocopy of most recent unemployment benefits statement or compensation check stub.

I AM REGISTERED WITH THE FOLLOWING EMPLOYMENT AGENCY AND THIS AGENCY IS

ASSISTING ME IN FINDING A FULL-TIME POSITION.

Required: Provide proof that you are registered with such agency seeking full-time work.

Agency Name: ___________________________________________________________________

Address: ________________________________________________________________________

________________________________________________________________________

Telephone Number: _______________________________________________________________

4) IN THE LAST SIX MONTHS, I HAVE TRIED TO SECURE FULL-TIME EMPLOYMENT WITH AT

LEAST FOUR FIRMS/COMPANIES.

Name of Firm/Company: _____________________________________________________________

Street Address: _____________________________________________________________________

City,State & Zip Code: _______________________________________________________________

Telephone Number: _(___)____________________________________________________________