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The University of Georgia Student Accounts‐Loan Servicing 424 East Broad Street, 110 Business Services Building, Athens, Georgia 30602‐4226 Phone: (706) 542‐6834, Fax: (706) 542‐3959, Email: ugaloans@uga.edu Federal Perkins Loan Deferment Request for Economic Hardship –OR– Forbearance –OR– Unemployment All proof and documentation required must accompany and support this request form. All incomplete request forms will be denied. Answer all items. Complete and initial by only one type of deferment below. ECONOMIC HARDSHIP DEFERMENT REQUEST: _____ (Initial to apply for this benefit) *Deferment may be granted for up to six months per request with a maximum of 36 months over the life of the loan. *Deferment allows the temporary suspension of principal and interest repayments in which interest continues to accrue. *I am requesting an Economic Hardship deferment from __________ to __________. *I know that I have the option to pay the interest amounts during the deferment period. *I will immediately notify the Student Accounts‐Loan Servicing Department at the above contact information of any changes in my employment or financial status. *I am requesting an Economic Hardship deferment based on one or more of the following reasons: 1. I have been granted an Economic Hardship deferment on another federal student loan for the same time period for which I am requesting this one. 2. I am receiving federal or state public assistance. 3. I am working full time and earn a monthly income that does not exceed one of the following: a. Monthly earnings minus my monthly student loan payments is less than or equal to the poverty line for my family size or b. Monthly earnings less than or equal to 200% of the poverty line for my family size. 4. I am volunteering in the Peace Corps. Required certification and documentation that must accompany and support this request form: *Attach a copy of approval letter of granted Economic Hardship deferment on another federal student loan Page 1 of 4 *Attach a copy of award letter of federal or state public assistance *Attach a copy of proof of monthly gross income (such as: last 3 pay check stubs, 1099‐SSA, tax return, federal or state state public assistance award letter, etc.) *Attach a copy of proof of monthly student loan payment amounts. *Attach a copy of the verification letter from the Peace Corps. FORBEARANCE DEFERMENT REQUEST: _____ (Initial to apply for this benefit) *Deferment may be granted for up to six months per request with a maximum of 36 months over the life of the loan. *Deferment allows the temporary suspension of principal and interest repayments in which interest continues to accrue. *I am requesting a Forbearance deferment from __________ to __________. *I know that I have the option to pay the interest amounts during the deferment period. *I will immediately notify the Student Accounts‐Loan Servicing Department at the above contact information of any changes in my employment or financial status. *I am requesting a Forbearance deferment based on one or more of the following reasons: 1. My title IV Student Financial Aid loan payments are equal to or greater than 20% of my total monthly income 2. I am experiencing a period of “Poor Health” 3. I am caring for a dependent who is disabled 4. Other acceptable reason: Please explain and use additional paper if necessary: _____________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Required certification and documentation that must accompany and support this request form: *Attach a copy of proof of monthly gross income (such as: last 3 pay check stubs, 1099‐SSA, tax return, federal or state state public assistance award letter, etc.) *Attach a copy of proof of monthly student loan payment amounts. *Attach a copy of proof of “Poor Health” *Attach a copy of proof of caring for a dependent who is disabled *Attach a copy of proof supporting other acceptable reason Page 2 of 4 UNEMPLOYMENT DEFERMENT REQUEST: _____ (Initial to apply for this benefit) *Deferment may be granted for up to six months per request with a maximum of 36 months over the life of the loan. *Deferment allows the temporary suspension of principal and interest repayments in which interest does not accrue. *Deferment allows a six month grace period as soon as the deferment ends. *You must be currently unemployed (or employed less than 30 hours per week). *You must be actively seeking full time employment. *You must be registered with an employment agency. *I am requesting an Unemployment deferment from __________ to __________. *I will immediately notify the Student Accounts‐Loan Servicing Department at the above contact information of any changes in my employment or financial status. *I understand the deferment will terminate immediately upon my securing full‐time employment. Required certification and documentation that must accompany and support this request form: *Attach a copy of approval letter of granted Unemployment deferment on another federal student loan *Attach a copy of unemployment compensation letter. *On‐line employment agency user, attach a copy of your job application history. *Non on‐line employment agency user, have employment agency complete the below information and affix the employment agency’s seal. If employment agency does not have a seal, employment agency employee certifying must sign a sheet of employment agency’s letterhead paper and attach. I hereby certify that above person has been registered with our employment agency since __________ to __________. Employment Agency Employee Signature and Title: ________________________________________________________ Employment Agency Name: ______________________________ Employment Agency Telephone Number: __________ Employment Agency Address: _________________________________________________________________________ Employment Agency City/State/Zip: _____________________________________________________________________ PERSONAL INFORMATION: Full Name: _________________________________________ Last 4 of SSN: xxx‐xx‐________ UGA ID: _______________ Date of Birth: _______ Home Address: __________________________________________________________________ City/State/Zip: ________________________________________ E‐Mail Address: ________________________________ Page 3 of 4 Telephone Numbers (Day): _________________ (Evening): _________________ (Cellular): ________________________ Employer: ________________________________ Date Employed:__________ Department:_______________________ Employer Phone Number: _______________ Employer Address: _____________________________________________ City/State/Zip:_________________________________________ Hours worked per week:_________ How Paid: Weekly _____ Bi‐weekly _____ Monthly _____ Semi‐monthly _____ Number of Dependents: _____ Spouse’s Full Name: _________________________________ Spouse’s Employer: _______________________________ Monthly Family Income: Monthly Family Expenses: $________ My gross wages $________ Mortgage/Rent $________ Car Insurance $________ Credit Cards $________ Spouse’s gross wages $________ Food $________ Gas, Parking $________ Alimony $________ Unemployment $________ Utilities $________ Medical/Dental Bills $________ Child Support/Care $________ Other income $________ Phone $________ Medical/Dental Insurance $________ Car Payment $________ Other Student Loan Payments Please explain the reason you are delinquent on your loan(s) at this time and provide any additional information that you feel may be helpful in determining your eligibility for a deferment. Please use additional paper if necessary. __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________
__________________________________________________________________________________________________ Authorization and Release: I hereby certify that the information above is true and correct. I hereby authorize any person, including financial institutions, insurance companies, creditors, caseworkers, employment counselors, credit counselors, landlords, employers and credit reporting agencies with any knowledge or records of my personal finances, either at the present time or in the future, to provide such information to the University of Georgia and its representatives. I forever release such persons, University of Georgia and its representatives from any and all liability arising there from. Clear Form
Borrower’s Signature: ______________________________________ Date: ______________________ Print Form
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