Fillable Teaching, Speech Lan, Librarian Deferment/Cancellation Request (ECSI)

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Teaching, Speech Lan, Librarian Deferment/Cancellation Request (ECSI)

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Teaching, Speech Lan, Librarian Deferment/Cancellation Request
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: INFORMATION
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
servicing 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:
2
nd
year of service
3
rd
year of service:
4
th
year of service:
5
th
year of service:
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
Request for Perkins Deferment and/or Cancellation
Qualifying Teaching, Speech Language Pathologist, and Librarian Services
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 in the following
county:
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 / / as I anticipate completing one full year of
service.
Cancellation from / / to / / as I have completed one full year of service.
SECTION 4: EMPLOYER CERTIFICATION
This section must be completed by your employer.
Employer/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)
NOTE: If an employer does not have an official stamp or seal, please attach a typed and signed letterhead certification. The
letter must specifically state that the borrower is a full time employee and must include the hire date and job description.
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 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.
I authorize the entity to which I submit this request and its agents to contact me regarding my request or my loans at
any cellular telephone number that I provide now or in the future using automated telephone dialing equipment or
artificial or prerecorded voice or text messages.
Signature: _________________________________________
Date: / /
SECTION 6: INSTRUCTIONS
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.
NOTE: 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.
Please forward completed form and and requested support documents to:
ECSI
P.O. Box 1278
Wexford, PA 15090
If you have any questions, please visit us at heartland.ecsi.net or call us toll-free at 888.549.3274.
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Teaching, Speech Lan, Librarian DefermentCancellation Request (ECSI)

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Completed 6 July 2021

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