Scribd
Upload
152 views

Cps Deferment Form

This document is a request form for deferment of federal student loan payments. It requests information such as the borrower's name, address, account number, phone numbers, driver's license number, birthdate, dates for the deferment period requested, and signature. The form provides information on eligible deferment conditions for Perkins, Nursing, and Health Professions Student Loans, such as being a half-time or full-time student, participating in certain fellowship or training programs, unemployment, military service, or volunteering with organizations like the Peace Corps. It must be certified and signed by an official from the borrower's school or employer to confirm their eligibility for deferment.

Uploaded by

1tonsils
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
152 views

Cps Deferment Form

This document is a request form for deferment of federal student loan payments. It requests information such as the borrower's name, address, account number, phone numbers, driver's license number, birthdate, dates for the deferment period requested, and signature. The form provides information on eligible deferment conditions for Perkins, Nursing, and Health Professions Student Loans, such as being a half-time or full-time student, participating in certain fellowship or training programs, unemployment, military service, or volunteering with organizations like the Peace Corps. It must be certified and signed by an official from the borrower's school or employer to confirm their eligibility for deferment.

Uploaded by

1tonsils
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

REQUEST FOR DEFERMENT - FEDERAL PERKINS LOAN, NURSING STUDENT LOAN, HEALTH PROFESSIONS STUDENT LOAN, LOANS FOR

DISADVANTAGED STUDENTS www.acs-education.com


(Please complete in ink)

Name Address

Lending Institution

16 digit Account Number

Home phone: ( Work Phone: ( Cell Phone: (

) ) )

Dates Requested (mm/dd/yy): Begin Date: _______________ End Date: ________________

Return Form to: ACS Education Services Campus Products and Services P.O. Box 7060 Utica, NY 13504-7060

Email: Drivers License #/State

Birthdate:

You may qualify for one of the following deferment benefits, even if they are not specifically listed in your original promissory note. Please visit our website for further information or clarification: www.acs-education.com Perkins Deferment Conditions: At least half-time student Enrolled in a Rehabilitation Training Program Graduate Fellowship Unemployment separate form required Military Service (combat) Branch of Service:___________________________ Military Operations Military Demobilization Performing Service eligible for Cancellation Other: ______________________________ (Only for loans received prior to July 1, 1993) Name of School or Employing Agency ___________________________________________________ ___________________________________________________ City State Zip At least half-time in a Nursing Program Advanced Professional Training Peace Corp/Volunteer Military Service (active duty): Branch of Service ________________________ Health Professions Deferment Conditions: Pursuing a full-time course of study toward a degree in health professions Internship/Residency prior to professional practice Program: _____________________ Fellowship Training Program Advanced Professional Training Peace Corps Volunteer Officer in the US Public Health Services Commissioned Corps Military Service (active duty): Branch of Service ________________________ Nursing Deferment Conditions:

I declare that the information shown above is true and accurate. I further declare that I will notify my lender immediately upon any change in my status. If I am unable to complete the year for which I have applied for deferment, I will begin loan repayment immediately. Borrower Signature: ______________________________________________________ Date: ____________________________ CERTIFICATION of DEFERMENT STATUS Name of School/Unit/Employer: ________________________________________ Address: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ Phone: ( )_________________________________________________________ I certify that the information stated above is correct. Status : ____ Full Time ____ At least Half-Time ____ Less than Half-Time To:_____________ OPEID# _________________________ INTERNAL USE ONLY: Deferment Approved/Processed Date Processed: ______________ Processor: _________________ Official Stamp or Seal (If no stamp or seal is available, please provide supporting documentation on official letterhead)

Dates - From:____________

Signature of Certifying Official: ________________________________________ Title of Certifying Official: ____________________________________________ Date: _______________________
Ver042010

You might also like