Request for Student Deferment - Purdue University by jianghongl

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									                                                Request for Student Deferment                                                                                                    Print Form
                                                         National Defense Student Loan Program
                                      National Direct Student Loan Program • Federal Perkins Student Loan Program

                                                                       PLEASE PRINT IN INK OR TYPE

PART I -- GENERAL INFORMATION (TO BE COMPLETED BY BORROWER)
(Borrower is responsible to advise the University Collections office of permanent mailing address)      Return Completed and certified form to:

                                                                                                                     University Collections Office
                                                                                                                     Schleman Hall of Student Services, Room 350
Name of Borrower:
                                                                                                                     475 Stadium Mall Drive
                                                                                                                     West Lafayette, IN 47907-2050
Street Address:                                                                 New Address                          Phone: (765)-494-5365 Fax: (765) 494-9154
                                                                                                                     Email: uco@purdue.edu
City, State, Zip:                                                                                       Loan Number

Phone Number:                                         Email:

                                                      Month/Day/Year                                Month/Day/Year

 Deferment is requested from                          /           /             to              /              /             Do NOT have form certified before
 status begins. All forms must be completed upon request by Purdue. Student deferment may not be requested
 beyond current enrollment period and must be submitted each semester. Check the type of deferment requested.
 Mark only ONE box.


  Anticipated date for ending the above status:

         Enrolled as at least a half-time student in an institution of higher education.

 I claim exemption from payment of principal and accrual of interest (when applicable) on my NDSL/Perkins Loans during the period indicated
 above. I agree to notify the lending institution immediately if my status changes during this period.

  Signature of Borrower:                                                                                      Date:



PART II --- CERTIFICATION (To be completed by appropriate official)
I certify that the above information stated in part I above is true and correct; the person name above is (was) enlisted or
called to active duty As:
                        Full Time Student                                         Less than Half-Time Student

                        At Least a Half-Time Student
 SPECIFIC DATES:                           /              /            TO                   /             /
                                         Month/Day/Year                                   Month/Day/Year
Signature (Registrar):                                                    Post Secondary Education Code:
                                                                                                                          Date:
                                                                                                                            Official Seal or Stamp of School (If none, the appropriate
Name of Institution:                                                                                                        official must verify your status on official letterhead.)




Address (City, State, and Zip Code):                                      Phone Number:



PART III --- UNIVERSITY COLLECTIONS OFFICE USE ONLY
    Approved               Name of Official ________________________________________________________ Date ______________________

    Disapproved            Reason for Disapproval______________________________________________________________________________

								
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