In School Deferment / Letter Request printable pdf download

IN SCHOOL DEFERMENT / LETTER REQUEST

Please Print:

NAME: __________________________________________ DATE: ____________________________

ADDRESS: ______________________________________ *STUDENT #______________________

CITY: _____________________ STATE: ____ ZIP: ______ PHONE # ________________________

*SIGNATURE: ______________________________________________________________________

*SIGNATURE & STUDENT NUMBER ARE REQUIRED FOR PROCESSING

Please Check All That Apply:

CURRENT TERM ONLY

COMPLETE ENROLLMENT HISTORY (ALL TERMS ATTENDED)

SPECIFIC TERMS (PLEASE LIST): ________________________________________

DEGREE VERIFICATION (UMSL DEGREE(S), DATE RECEIVED & GPA)

Please check information you wish to include:

____ Class Schedule ____ Degree Program/Major ____ Academic Standing

____ GPA ____ Anticipated Graduation Date (Month & Year) ___________________

(Please Note: Degrees awarded for the current term will be posted 6 weeks after commencement)

Information for Insurance Verification: ONLY IF YOU NEED LETTER FOR HEALTH INS.

MEMBER NAME (PERSON YOU ARE COVERED UNDER):________________________

EMPLOYER (WHERE THEY ARE EMPLOYED): _________________________________

POLICY # _______________GROUP#_______________ MEMBER# ____________________

Check Lender/Insurance Carrier OR List Complete Address:

___ACS

___Fed Loans

___Benefit Consultants

___AES

___Great Lakes

___Bricklayer’s Local #1

___Campus Partners

___MOHELA

___Carpenter’s

___Chase

___Nelnet

___District 9 I A M & A W

___CitiBank

___Sallie Mae

___I B E W

___Dept of Educ

___Univ Accounting

___Local 682

___Direct Loans

___Wachovia

___Oper Engin Local 513

___ECSI

___Wells Fargo

___Painter’s Dist #2

___EdFinancial

___Xpress Loans

___Plumbers & Pipefitters #562

___Sheetmetal Workers Local 36

NAME: _____________________________________________________________________

ATTN: _____________________________________________________________________

ADDRESS: _________________________________________________________________

CITY: ___________________________________ STATE: ______

ZIP: ______________

FAX# ___________________________________

PICK UP _____

***Please Allow Up to 72 Hours for Processing***

Please Note: Official and Unofficial letters bear the signature of the certifying official

along with the University Seal. Official letters are mailed by the University.

Unofficial letters with the signature of the certifying official and University Seal will

be stamped “Issued to Student.”

In School Deferment / Letter Request

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