Federal Perkins Loan Student Deferment Form
TAX & REVENUE SERVICES
P.O. BOX 70732
JOHNSON CITY, TN 37614
PLEASE TYPE OR PRINT THE INFORMATION REQUESTED.
NAME: _____________________________________________________
ADDRESS: __________________________________________________
E #: ________________________________________
DATE: ______________________________________________________
DEFERMENT APPLICATION PART 1: To be completed by the borrower.
I hereby apply for an interest-free deferment of my student loan repayments. I am pursuing at least half-time study
in the higher education institution certified below. I waive any unexpired portion of my original grace period. I
understand though there is no overall maximum limit for student deferments, I must re-apply each term.
I intend to continue thru the ______________ term which ends on _________________________
I’m seeking a degree or a certificate as … (Select one)
at least a half-time student
a full-time student
My daytime telephone number is ____________________
Signed: ________________________________________ Date: ______________________________________
PART 2: To be completed by the school you are now attending.
I hereby certify that the information stated by the student above is true and correct to the best of my knowledge.
Enrollment is verified from __________________________ thru __________________________
Name of Institution: ______________________________________________________________
City & State: ____________________________________________________________________
Telephone: _____________________________________________________________________
Title IV Institution OPE ID Code: ___________________________________________________
Signed: ________________________________________________________________________
Name: ________________________________________________________________________
Title: ________________________________________________________________________
Date: ________________________________________________________________________
Version 1/15/2019
