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 ECONOMIC HARDSHIP
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
Payments are deferred and principal nor interest accrues. Final responsibility for completion and return of this form rests
solely with the borrower.
• Deferment is a period during which the borrower is entitled to postpone repayment of the principal and interest
balance of the loan.
• Total Monthly Gross Income is the gross amount of income I received from employment (both full-time and part-
time), public assistance programs (food stamps, welfare, AFDC, etc.) and from other services.
• Full-Time employment is working at least 30 hours per week in a position expected to last at least three months.
B. REQUEST FOR DEFERMENT OF PAYMENT (To be completed by the borrower)
I meet the qualifications stated below for an Economic Hardship Deferment and request that Louisiana State University
defer repayment of my loan(s) FROM: _______________ TO: _______________. (NOT TO EXCEED 12 MONTHS)
(MM/DD/YEAR) (MM/DD/YEAR)
To qualify, one of the following must be true (check the appropriate fields):
________ I have been granted an economic hardship for either a Stafford or PLUS Loan for the same time period for
which I am requesting the deferment for my Perkins Loan.
Documentation/proof of status must be attached.
________ I am receiving federal or state public assistance, such as Temporary Assistance to Needy Families,
Supplemental Security Income, Food Stamps, or state general public assistance.
Documentation/proof of status must be attached.
I am working full time (see Section A. Borrower Information) and earn a total monthly gross income (see
Section A. Borrower Information) which does not exceed the greater of:
(a) the monthly gross income of a minimum wage earner or
(b) an amount equal to 150% of the poverty line for my family’s size, divided by 12.
The number of people in my family or household is _________. (Required for this option.)
Documentation of most recent total monthly gross income from all sources (i.e. pay stubs) and most recent
monthly payments due on all other Federal loans must be attached.
I am serving as a volunteer in the Peace Corps. Documentation/proof of status must be attached.
I certify that: (1) The documentation I have provided in section B is true and correct; (2) I will provide additional
documentation, as required, to Louisiana State University to support my continued deferment status; (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
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FOR ACCOUNTING SERVICES USE ONLY
Approved Disapproved Approval: From: (MM/DD/YEAR) _____________________To: (MM/DD/YEAR) _____________________
Reviewed by ____________________________________________________________ Date _________________________
Name LSU ID
Mailing Address Phone Number
City State Zip Code
________
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