Fillable Heartland ESCI - Request for Perkins Deferment and/or Cancellation

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Heartland ESCI - Request for Perkins Deferment and/or Cancellation

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  • 12 check-boxes
  • 52 other fields

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File type: PDF

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Request for Perkins Deferment and/or Cancellation
Qualifying Teaching, Speech Language Pathologist, and Librarian Services
SECTION 1: BORROWER IDENTIFICATION
Last Name:
First Name:
MI:
Student ID number or last 4 digits of Social Security number:
Current mailing address:
City:
State:
Zip:
Phone number: ( ) -
Email address:
Lender/school name:
School code:
SECTION 2: INSTRUCTIONS
A cancellation/deferment may be available if you are employed full-time as a:
Teacher in a federally designated low-income school or education services agency
Special education teacher of disabled children
Teacher in a shortage field
Faculty member at a Tribal college or university
Speech language pathologist with a master’s degree working exclusively for low income schools
Librarian with a master’s degree in library science employed in a low-income school or public library servicin
low-income schools
A deferment is a temporary postponement of payments. During a deferment, interest does not accrue. If you
are working in a position which you believe will qualify you for a cancellation, you may request a deferment at
the beginning of employment to suspend billing and defer payments of principal and interest.
A cancellation is “loan forgiveness.” Following a year of service in one of the roles listed above, a portion of
your Perkins loan balance may be cancelled. Cancellation rates are as follows:
1
st
year of service: 15%
2
nd
year of service: 15%
3
rd
year of service: 20%
4
th
year of service: 20%
5
th
year of service: 30%
For qualifying teaching, speech pathologist, and library services cancellations, a deferment should be
requested prior to the first year of service. After that, request a cancellation and deferment each year on the
anniversary of your original deferment.
With the exception of teachers in a federally designated low-income school, all teaching and librarian servic
With the exception of teachers in a federally designated low-income school, all teaching and librarian services
deferments/cancellations require that an employer-certified job description be included with this form.
Librarians and Speech Pathologists must provide documentation evidencing a master’s degree.
SECTION 3: APPLICANT STATEMENT
I am/was employed full-time as:
☐ A teacher in a federally designated low-income school or educational services agency located (school and county
are required).
School Name County Where School Is Located
A special education teacher of disabled children.
☐ A teacher in a shortage field. I am teaching as a:
☐ A faculty member at a Tribal college or university.
☐ A librarian with a master’s degree in library science employed in a low-income school or public library serving
low-income schools.
☐ A speech language pathologist with a master’s degree working exclusively for low-income schools.
Start date of employment:
/ / .
Are you still employed? ☐ Yes ☐ No
If no, end date of employment
/ / .
I am requesting:
☐
Deferment from
/ to / /
☐
Cancellation from / / to / /
as I anticipate completing one full year of service.
as I have completed one full year of service.
SECTION 4: EMPLOYER CERTIFICATION
This section must be completed by your employer.
Employer/Company/School Name:
Name of Authorized Official:
Telephone Number: ( ) -
Title of Authorized Official:
Address:
City:
State:
Zip:
Authorized Official Signature:
Date: / /
_________________________________________
PLACE OFFICIAL SEAL OR STAMP HERE
(NOTARY SEAL NOT ACCEPTABLE)
If an employer does not have an official stamp or seal, please attach a typed and signed letterhead certification by the
employer verifying full-time employment and hire date.
/
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SECTION 5: BORROWER CERTIFICATION AND AUTHORIZATION
I understand that: (1) This request will not be granted unless all applicable sections of the form are completed and
requested documents are submitted; (2) All final decisions regarding my deferment/cancellation eligibility will be made
in accordance with applicable Federal regulations.
I certify that: (1) The information I have provided on this form is true and correct; (2) I will provide additional
documentation, as required, to support my continued deferment/cancellation status; (3) I will notify my student loan
office or Heartland ECSI immediately when the condition(s) that qualified me for this deferment/cancellation end; (4) I
have read, understand, and meet the terms and conditions of the deferment/cancellation for which I have applied.
Signature: ______________________________
Date: / /
SECTION 6: ADDITIONAL INFORMATION
Please forward completed form and requested supporting documents to:
University of Wisconsin - Stevens Point (L9)
c/o Heartland ECSI
P.O. Box 1278
Wexford, PA 15090
Phone: 888-549-3274
https://heartland.ecsi.net
Before sending your application, verify that:
The form is filled out completely. All sections are required.
An official stamp or seal is on the form. If no stamp or seal is available, a typed and signed letterhead certification
by the employer verifying full-time employment and hire date must be submitted.
Included a copy of an employer-certified job description. (Exception: teachers at low-income schools do not need to
submit a job description).
Librarians and Speech Pathologists must include a copy of a master’s degree.
Applications are typically processed within 10 business days. You will be notified of the status of your deferment/cancellation
via email using the address provided in Section 1 of this form. In order to prevent negative credit bureau reporting, continue
to make on-time payments until you have been notified that a deferment/cancellation has been posted.
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Heartland ESCI - Request for Perkins Deferment andor Cancellation

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Completed 24 May 2020

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