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Deferment Application. - Loyola Marymount University

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					                                       LOYOLA MARYMOUNT UNIVERSITY
                                  FEDERAL PERKINS STUDENT LOAN
                          FORBEARANCE OR UNEMPLOYMENT DEFERMENT REQUEST


If you are experiencing financial difficulties which prevent you from making timely payments on your Federal Perkins Student
Loan(s) with Loyola Marymount University, you may be eligible for a forbearance, unemployment deferment or economic hardship
deferment. These may be granted no more than six (6) months at a time. During a forbearance period, payments to principal are
postponed. Interest however, is due and payable.

Name:                                                                SS#

Address:

City:                                                           State:                              Zip:

Home telephone number:                                                   Alternate telephone number:

I understand that LMU may pull my credit profile to substantiate information on this request.
    Section 1 – Deferment Request – Must be completed in full and signed in ink below.



•     Are you unemployed?    YES              NO
•     If yes, how long?                                Are you receiving unemployment benefits?
•     Are you unemployed due to illness or disability?        YES           NO

You must submit the following applicable information:
IF EMPLOYED:                                           IF UNEMPLOYED:                             IF ILLNESS OR DISABILITY:
- 1040 Tax return (most recent year)                   - Termination letter (if available)        - Statement from physician
- Current Wage Statement (check stub)                  - Provide evidence that you are              regarding illness or disability
  or W-2 form (most recent year)                         actively seeking employment:
- A letter requesting the forbearance                    statement from unemployment office,
                                                         school placement office or a list of
                                                         agencies (names and addresses) you are
                                                         listed with
                                                       - If receiving unemployment, provide evidence

                   If you are not able to submit this information, please include a detailed letter explaining why.
                        If this information is not provided with this application, your request may be denied.

I certify that the above information and the information on the back of this form is true and correct. I also certify that I will
immediately notify the Controller’s Loan Office at Loyola Marymount University of any change in my employment status or change in
my financial situation. LMU reserves the right to obtain a copy of my credit report. Additional debt incurred or preferential
payments to other creditors could result in the denial or termination of my request. I understand that anyone who makes a false
statement or false representation of material fact to avoid payment of an obligation under the Federal Perkins Student Loan Program
may be subject to penalties which may include fines or imprisonment under the United States Criminal Code and 20 U.S.C. 1097.

BORROWER SIGNATURE                                                   DATE
                                    (REMEMBER TO COMPLETE BOTH FORMS)

                                                       FOR OFFICE USE ONLY

Date Reviewed:_____/_____/_____             By:________________________________                _____Approved      _____Denied

        Loyola Marymount University/Student Financial Services-Student Loans, One LMU Drive, Suite 250, Los Angeles, CA 90045-2659
                                   (A-L call 310-338-1942 and M-Z call 310-258-5449) Fax (310)338-7304
                                             INCOME AND EXPENSES SUMMARY
1.    Marital Status:                                                6. Monthly Expenses:

           Single                                                    Rent/Mortgage:                     $ ________________
           Married
           Widow(er)                                                 Food:                              $ ________________
           Separated/Divorced
                                                                     Utilities:                         $ ________________

2.    Number of Dependents: __________                                Child Care:                       $ ________________

      Relationship: ______________ Age: ___________                   Car Payments:                     $ ________________
                     ______________      ___________
                   ______________      ____________                   Other Vehicle(s)                  $ _________________
                   ______________      ____________
                                                                      Public Transportation:            $ _________________
Monthly income from ALL Sources:
                                                                      Student Loan Payment(s)
      Gross Monthly Salary/Wages       $ ________________
                                                                       Type: ________________           $__________________
      Spouse’s Monthly Salary/Wages    $ ________________                    ________________           $ __________________
                                                                             ________________           $ __________________
      Child Support                    $ ________________
                                                                       Insurance:                       $ __________________
     Alimony/Support                  $ ________________
                                                                       Telephone:                       $ __________________
     Unemployment                     $ ________________
                                                                       Cellular Phone/Pager             $ __________________
     Public Assistance                 $ ________________
                                                                       Credit Card(s)                   $ __________________
     Social Security/Veteran          $ ________________
                                                                       Other Charge Accounts:           $ __________________
     Stocks, Bonds & Investments       $ ________________
                                                                       Medical:                         $ __________________
     Other: ___________________        $ ________________
                                                                       Cable/Satellite TV:              $ __________________
     Total Monthly Income:            $ _________________
                                                                       Entertainment:                   $ __________________

4. Checking Account Balance:          $ __________________              Clothing:                       $ __________________

5. Savings Account Balance:           $ __________________              Dry Cleaning:                   $ __________________

                                                                       Cleaning/Yard Service:           $ __________________

                                                                       Other: _________________         $ __________________
                                                                               _________________        $ __________________
                                                                               _________________        $ __________________

                                                                         Total Monthly Expenses:        $ _________________



     IF YOU NEED ADDITIONAL SPACE, PLEASE ATTACH A SEPARATE SHEET OF PAPER.

Be sure to submit the applicable supporting documents along with this form. IF THIS INFORMATION IS NOT INCLUDED WITH THIS
APPLICATION, YOUR REQUEST MAY BE DENIED.



________________________________________                             __________________________
Borrower Signature                                                   Date

				
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