Federal Perkins Student Loan Program - Slcc
ADVERTISEMENT
1
2Student Loans & Receivables
C/O Student Loans
PO Box 30808
Salt Lake City, UT 84130-0808
Phone: (801) 957-4633
studentloans@slcc.edu
FEDERAL PERKINS STUDENT LOAN PROGRAM
Financial Statement for Forbearance, Economic Hardship or Rehabilitation request
Borrower Information:
Name: ______________________________________________________________Student ID/SSN #_____________
Current Address: ____________________________________________City, State, Zip_________________________
Daytime Phone: (____)_______________Evening Phone: (____)________________Cell Phone: (____)____________
Email Address: ____________________________________________
Dependants:
Name: _________________________________Age: ______ Name: ____________________________Age: ______
Name: _________________________________Age: ______ Name: ____________________________Age: ______
Name: _________________________________Age: ______ Name: ____________________________Age: ______
Borrower’s Employment Information:
Company Name: ________________________________________Phone Number: _____________________________
Street Address: ________________________________________City, State, Zip_______________________________
Spouse’s Information:
Name: _____________________________________________
Cell Number: ______________________________
Place of Employment: __________________________________ Work Number: _____________________________
Company Address: ______________________________________City, State, Zip______________________________
Reference Information:
Name:
_______________________________________________Relationship_____________
(Relative; not living with you)
Street Address: ______________________________City, State, Zip___________________ Phone:_________________
Name:
______________________________________________Relationship___________
(Non-relative; not living with you)
Street Address: ______________________________City, State, Zip___________________ Phone:_________________
INCOME:
****REQUIRED PROOF OF INCOME FOR THE LAST 30 DAYS****
Take home pay:
Gross $________________per month
Other: Gross $___________________per month
Workman’s Comp
$______________
Unemployment $______________
Food Stamps
$______________
Veteran’s Benefits
Child Support
$______________
Welfare
$______________
$______________
Social Security $______________
Alimony
$______________
Family Assistance
$______________
Severance Package $______________
TOTAL INCOME: $___________________________
*IF NO INCOME…Please submit a letter stating that you have no income, written and signed by you.*
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business