Income Sensitive Repayment Form
City / State / Zip
E-Mail Address
Account Number
Telephone - Home
Telephone - Work
Records Code: LS200/AASI
Updated: 06/12/2020
For Federal Family Education Loan Program Loans
Stafford/SLS/PLUS/Consolidation Loans
To apply for an Income Sensitive Repayment Schedule for the next 12 months, complete this application and submit documentation of your most
recent total monthly gross income from all sources (i.e. pay stub). Your monthly payment amount will be the greater of the monthly interest accrual
on the loan(s) for which you are requesting an Income Sensitive Repayment Schedule or 4% of you total monthly gross income unless you request
a higher amount.
Telephone - Alternate
(with area code)
(with area code)
(with area code)
1. Monthly Gross Income:
2. Estimated Monthly Interest Accrual:
Attach documentation of your gross monthly income from employment
and other sources.
Multiply the Principal Balance of each loan by
the Interest Rate and then divide by 12.
Monthly Gross Income
Monthly Interest
3. 4% Of lncome:
Multiply your Monthly Gross Income by 4% (.04).
4% of Income
4. Estimated Monthly Payment:
Enter the greater of lines 2 and 3.
Estimated Monthly Payment
5. Requested Monthly Payment
If you would like your payment amount to be higher than the amount on line 4,
indicate your requested payment amount here.
Requested Monthly Payment
When we determine your payment amount based on the formula explained above, it may be necessary to increase it in order to comply with federal
regulations that require us to ensure no single installment amount in an Income Sensitive Repayment Schedule is more than three times greater
than any other installment amount.
I understand that any payments that are past due on my loan(s) prior to the Income Sensitive Repayment Schedule will be covered by a
forbearance and any outstanding accrued interest will be added to the principal balance of my loan. I understand that if my payments are currently
postponed with a deferment or a forbearance, that it will be removed and my loans will be due for repayment under the Income Sensitive
Repayment plan. I certify that all of the information I have provided on this form and in any accompanying documentation is true, complete, and
correct to the best of my knowledge and belief and that I will repay my loans according to the terms of my promissory note and repayment schedule.
By providing a telephone number(s), I am expressly consenting to my schools, Department of Education, servicer, guarantor, owner, holder of my
loans(s) or any of their respective agents or affiliates to contact me via automatic telephone dialing system or similar device and/or using a
prerecorded or artificial voice or message and/or by text message utilizing the telephone number(s) I provide which are associated with any wireless
(mobile/cellular) phone or similar device or any other type of telephone number (including VoIP) regardless of the purpose of the communication,
even if such a communication incurs an access fee/charge from my provider/plan.
Borrower's Signature
Co-Maker's Signature
(if applicable)
For More Information Visit Our Website at
or call us toll free at 1-800-233-0557
Return Completed Form To:
American Education Services
P.O. Box 2461
Harrisburg, PA 17105-2461