Deferment Form printable pdf download

NORTH CAROLINA STATE UNIVERSITY

Request for Deferment Form

Federal Perkins and NC State Institutional Loans

Please refer to the instructions on page two of this form. Incomplete forms cannot be processed and will be returned to

the borrower. Forms may be returned by mail, fax or scanned and sent via e-mail.

BORROWER'S NAME/ADDRESS:

MAIL FORM TO:

ECSI

181 MONTOUR RUN ROAD

CORAOPOLIS, PA 15108-9408

(888) 549-3274

EMAIL ADDRESS:

ACCOUNT NUMBER:

(SOCIAL SECURITY #)

LENDING INSTITUTION:

NC STATE UNIVERSITY

Section 1 Deferment Type

Refer to the back side of this form for more information

A. _____

At least half – time student (Federal Perkins and NC State University Institutional Loans)

B. _____

Internship or Residency (Federal Perkins and NC State Institutional Loans Prior to 7/1/93)

C. _____

A volunteer in the Peace Corps (NC State University Institutional Loans ONLY)

D. _____

Graduate / Fellowship (Federal Perkins and NC State University Institutional Loans)

E. _____

Enrolled in a course of study that is part of Department approved rehabilitation training program for

disabled individuals (Federal Perkins and NC State University Institutional Loans)

F. _____

Active duty in support of current military contingency operation (NC State University Institutional Loans)

Must attach copy of Military Orders

** Federal Perkins Loan borrowers must use federal Military Deferment Form (MIL) **

Section 2 Certification Period

Deferment Starting Date______________________________ Ending Date____________________________________

NOTE: Deferments are granted by semester. Borrower will need to re-apply for each period of enrollment.

Section 3 Borrower Signature

I declare that the information above is true and correct. I further declare that I will notify NC State University or

ECSI immediately upon any change in my status.

Signature of borrower_______________________________ Date____________ Phone Number___________________

Section 4 Certification by School / Agency / Institution

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

Place official stamp here. If no

Name of School/Agency/Institution___________________________________________

stamp is available, form must

include certification on letterhead.

Federal OPEID (if applicable) __________________

Address__________________________________________________________

City_____________________________ State___________ Zip______________

Phone ___________________________

Signature of Authorized Official_________________________________________

Title_____________________________________________________________________

Date___________________________

Defer. Rev. 09-07 NSCU/ECSI

INVALID WITHOUT OFFICIAL SEAL, STAMP OR LETTERHEAD

FOR INSTITUTIONAL USE ONLY

Approved_____ Disapproved_____ Official Name__________________________________________ Date___________

THIS FORM WILL BE RETURNED TO THE BORROWER IF IT IS INCOMPLETE

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Deferment Form

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