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125 Thomas Boyd Hall • Baton Rouge, LA 70803 • P 225-578-3092 • F 225-578-3969 • perkinsloan@lsu.edu
Louisiana State University
Office of Accounting Services
Bursar Operations – Perkins Loan
125 Thomas Boyd Hall
FEDERAL PERKINS LOAN PROGRAM – DEFERMENT REQUEST DUE TO STUDENT ENROLLMENT/EDUCATION
WARNING: Any person who knowingly makes a false statement or misrepresentation on this form or on any accompanying
documents shall be subject to penalties which may include fines, imprisonment or both, under the U.S. Criminal Code and 20
U.S.C. section 1097.
SECTION 1: BORROWER IDENTIFICATION
Name: __________________________________ LSUID: __________________________________________
Mailing Address: _____________________________________________________________________________
City:
____________________________________ State: ________ Zip Code: __________________________
E-mail:
__________________________________ Phone Number: ___________________________________
D
eferment Period Requested: From: (MM/DD/YEAR)
________________To: (MM/DD/YEAR) __________________
I
meet the qualifications for the deferment checked below and request that my loan holder defer repayment of my
loan(s): Note: Eligibility varies for each deferment category depending on the type of loan you have and other specific
requirements.
________ Enrolled at least half time at an eligible postsecondary school;
________ Enrolled in a full time course of study in a graduate fellowship program;
________ Enrolled in an approved full time rehabilitation program for individuals with disabilities;
I claim exemption from payment of the principal on my Federal Perkins Loan(s) during the period indicated above. I
agree to notify the LSU Perkins Loan Collections office immediately upon change of my claimed status. I further agree to
provide documentation as required to support my continued deferment status. I declare that information shown above
is true and correct.
_____________________________________________ ______________________________
Signature of Borrower Date
***Section 2, on the back of this form, must be completed prior to submitting***
