Fillable Economic Hardship Deferment Request printable pdf download

ECONOMIC HARDSHIP DEFERMENT REQUEST

DIRECTIONS—

RETURN COMPLETED FORMS TO:

Complete this form to request postponement of principal and

interest payments while you are experiencing an economic hardship. Deferment can-

Student Account Assistance

not exceed 12 months per request. After a granted deferment has ended, there will be

University of Minnesota, Twin Cities

211 Science Teaching & Student Services

a six-month post-deferment grace period before your payments resume.

222 Pleasant St. S.E.

Minneapolis, MN 55455-0239

Phone: (612) 625-8007

Fax: (612) 624-2873

Email: stdtloan@umn.edu

To ensure privacy online, open in Adobe Reader (free at ). Please add the required signature(s) in blue or black ink.

SECTION A. Student information

Name (last, first, middle initial)

University ID (or Social Security number)

Current mailing address (street, apartment or P.O. Box number, city, state, ZIP code, country)

Phone (include area code)

Current email address

Cell phone (include area code)

SECTION B. Deferment Request

Select one of the following reasons for requesting an Economic Hardship deferment. Every deferment requires documentation to

substantiate the request. The documentation is to be submitted with this deferment form and the enclosed worksheet.

FEDERAL REGULATIONS REQUIRE DOCUMENTATION. YOUR REQUEST WILL BE DENIED WITHOUT DOCUMENTATION.

I am requesting temporary deferment of my student loan payments, and certify that I am eligible for the reason checked below

for the following period: From:____________________ To: _____________________

(Complete both blanks, not to exceed 12 months)

Category:

I have been granted an economic hardship for a FFELP loan (other federal loan).

Attach official supporting documentation - copy of approved deferment or letter from the lender.

I am receiving federal or state public assistance. Attach documentation of assistance such as AFDC, Supplemental Security Income

(SSI), food stamps, WIC, Medicaid, or state public assistance.

I do NOT work full-time and my total monthly gross income is less than or equal to 2X poverty amount and gross income minus monthly

federal student loan payments is less than or equal to poverty amount. I must provide documentation of income and educational debt.

(Use the attached worksheet to determine your income in relation to federal poverty guidelines).

The total amount I borrowed for all my federal loans now in repayment (including the loans for which I am requesting deferment) is:

$ ______________________________.

SECTION C. Personal References

Name (last, first, middle initial)

Phone (include area code)

Address (street, apartment or PO Box number, city, state, ZIP code, country)

Name (last, first, middle initial)

Phone (include area code)

Address (street, apartment or PO Box number, city, state, ZIP code, country)

Please continue on reverse side of form

*FA997*

To request copies of this form in an alternative format, please call the Disabilities Services liaison

at 612-625-9578. The University of Minnesota is an equal opportunity employer and educator. This

form is printed on paper made from no less than 20 percent post-consumer waste.

FA997—Page 1 of 2

3/12

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Please recycle.

Economic Hardship Deferment Request

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