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| CENTRAL WASHINGTON UNIVERSITY |
| Hardship Deferment / Forbearance
Request Form |
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Name of Borrower ( Last, First, Middle)
- please print or type
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Social Security No. |
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| Address
of Borrower (Number, Street, City, State,
and ZIP Code) |
Account Number |
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| Daytime Phone |
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| I am requesting temporary deferment
or forbearance of the payments on my student loan. I certify that
I am eligible for deferment/forbearance for the reason(s) listed
below for the period of: |
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| From: |
To: |
(requested period must not
exceed 12 months) |
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| (Complete all sections that apply and provide
required documentation) |
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| For
Institutional Use Only: |
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| Deferment
Approved For: |
Type
_____________________ |
From
___________________ |
To
____________________ |
| Date: By: Interest
to be Billed: |
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| Title IV ( Perkins, NDSL, Stafford,
SLS, PLUS) Loans in Repayment |
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| Lender |
Account
Number |
Balance |
Monthly Payments |
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| Unemployment Certification |
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| 1. |
I certify that I am currently unemployed
or am not employed full-time (that is, working more than 29 hours
per week in a job expected to last at least three months) and am
actively seeking full-time employment. |
| 2. |
In order to verify that I
am actively seeking employment, I have registered or will register
with an employment agency and have this form certified by that agency. |
| 3. |
I affirm that I have read
this entire form carefully and fully understand its contents. I
affirm all statements made on this form are true and correct. I
understand that Central Washington University has the right to verify
authenticity of my unemployment and make any necessary inquiry in
connection with the review of information concerning my ability
to repay. |
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| Borrower Signature
____________________________________________ |
Date _____________________________________ |
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| Employment
Agency Certification |
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I certify that the above named individual has been
duly registered with this employment agency since __________________________
and is currently seeking employment. |
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Name
of Agency:
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Area
Code / Telephone Number |
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Agency
Address:
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Signature
of Employment Service Representative:
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Date: |
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