Perkins Cancelation Request Form - Slcc
ADVERTISEMENT
1
2Student Loans & Receivables
Mail Stop: CLC
PO Box 30808
Salt Lake City, UT 84130-0808
Phone: (801) 957-4633
Fax: (801) 957-4960
studentloans@slcc.edu
FEDERAL PERKINS REQUEST FOR DEFERMENT AND/OR PARTIAL CANCELLATION
And CERTIFICATION of EMPLOYER
INCOMPLETE FORMS WILL NOT BE PROCESSED
Complete and return this form to the address listed in the upper left hand corner.
Please read through both sides of this form and complete the entire form before returning to us.
No deferment/cancellation will be granted until this completed form is returned to and approved by SLCC.
____________________________________________________________________________S___________________
Last Name
First Name
Student ID
____________________________________________________________________________(____)_______________
Street Address
City, State, Zip
Telephone Number
Please indicate which partial cancellation you are applying for by placing a checkmark in the corresponding box.
Elementary or secondary teaching in a school
Fire Fighter
designated by the Secretary of Education as low
Sworn Officer of the Law, Attorney
income
Nurse or Medical Technician
Special education teacher
Child or Family Service Agency for high risk
Teaching in an area of shortage as determined
children from low income families
by the Secretary of Education
Head Start, fulltime staff member
Early Intervention services for infants and
Military Service in areas of hostilities
toddlers with disabilities
Volunteer Service in Peace Corps of ACTION
Tribal College or University Faculty/ Low Income
programs
Librarian/Low Income
Speech Pathologist
I WILL BE EMPLOYED FULL TIME NEXT YEAR
Y__ N__
A DETAILED JOB DESCRIPTION ON COMPANY LETTERHEAD AND SIGNED BY YOUR
SUPERVISOR OR CERTIFIED AUTHORITY IS REQUIRED FOR ALL ENTITLEMENTS!
C
B
ERTIFICATION OF
ORROWER
I understand and agree that a deferment/cancellation can be granted only if I qualify according to Federal
guidelines applicable to my loan fund(s).
Signature of Borrower
Date
C
E
ERTIFICATION OF
MPLOYER
I certify that the above Perkins Loan borrower has worked full time from __________________ to __________________
Date
Date
___________________________________________________________________________(___)_________________
NAME OF EMPLOYER (COMPANY NAME)
TELEPHONE NUMBER
________________________________________________________________________________________________
STREET ADDRESS
CITY
STATE
ZIP
________________________________________________________________________________________________
SIGNATURE OF AUTHORIZED OFFICIAL
TITLE
DATE
***SEE REVERSE SIDE FOR BRIEF DEFINITIONS***
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial