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 UNEMPLOYMENT
WARNING: Any person who knowingly makes a false statement or misrepresentation on this form shall be subject to a
fine of no more than $10,000 or imprisonment for not more than five years or both, under the provision of Sec. 20 U.S.C.
1097.
A. BORROWER INFORMATION
The following documentation is required to be attached and submitted with this application in order to process the request
for deferment due to unemployment. Final responsibility for completion and return of this form and documentation rests
solely with the borrower.
• Documentation of your last date of employment. (i.e. pay stub).
• Letter from your previous employer stating your last day of employment.
Note: An institution may permit a borrower to defer payments on his/her Perkins Loan if the borrower is seeking, but
unable to find, full-time employment. Full-time employment is defined as working at least 30 hours per week in a position
which is expected to last at least three months. The normal length of an unemployment deferment is three (3) months.
B. REQUEST FOR DEFERMENT OF REPAYMENT (To be completed by the borrower)
Last Date of Employment: _____________________
List the business names and addresses below where you have applied for employment along with the last
contact date for each.
I c
ertify that: (1) The information provided above is true and correct; (2) I will provide additional documentation,
as required, to Louisiana State University to support my request for deferment; (3) I will notify Louisiana State
University immediately when the condition(s) that qualified me for deferment ends; and (4) I have read,
understand, and meet the terms and conditions of the deferment for which I have applied.
_____________________________________________ ______________________________
Signature of Borrower Date
FOR ACCOUNTING SERVICES USE ONLY
Approved Disapproved From: (MM/DD/YEAR) _______________To: (MM/DD/YEAR) _________________
Reviewed by ______________________________________________ Date ___________________
Name LSU ID
Mailing Address Phone Number
City State Zip Code
Business Name Business Address Last Contacted Date
