Request for Economic Hardship Deferment/Forbearance Do NOT use this form for Federal Perkins Loans. Please use the form designated for Perkins Loans.

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Bernice Sherman
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1 Request for Economic Hardship Deferment/ Do NOT use this form for Federal Perkins Loans. Please use the form designated for Perkins Loans. 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: ( ) - address: Lender/school name: School code: SECTION 2: INSTRUCTIONS A deferment or forbearance may be available if you are temporarily unable to make student loan payments for economic reasons. During a deferment, you are not required to make payments and interest does not accrue during the deferment period. During a forbearance, you are not required to make your regular payments. However, interest will continue to accrue during a forbearance period. Whether you qualify for a deferment or forbearance depends on your situation. In order to qualify for a deferment, you must: Be able to provide documentation stating that you have been granted an economic hardship deferment for another Federal student loan program such as Stafford, PLUS, Perkins loan, etc. Or be able to provide documentation stating that you are currently receiving Federal or state public assistance. Or be able to provide documentation that proves you are working full time and earning a monthly gross income that does not exceed $ per month. Or able to provide documentation that proves you are working full-time and earning a total monthly gross income that does not exceed 150% of the poverty line. Or able to provide documentation that proves your total monthly payments on federal postsecondary education loans cause a financial hardship as calculated in Section 7 of this form. In order to qualify for a forbearance, you must: Be able to provide documentation that proves your monthly Federal student loans payments are equal to or greater than 20% of your monthly gross income. Or be able to provide documentation that proves that you are experiencing financial hardship for any other reason. Note: Your monthly gross income is your income before taxes or other deductions. It does not include your spouse s income. Based on the information you provide, Heartland ECSI will first verify if you qualify for a deferment. If you do not, a forbearance will be considered. Please follow the instructions included in the form carefully so that Heartland ECSI can determine the solution that best matches your situation.

2 SECTION 3: ECONOMIC HARDSHIP DEFERMENT THROUGH OTHER FEDERAL LOAN SERVICER Are you currently in an economic hardship deferment for a Federal student loan, e.g. Stafford, Direct Loan, PLUS, etc.? My deferment covers the time period starting / / and ending / / Attach documentation that includes the current loan status, start dates of the deferment, and end dates for the deferment. Proceed to Section 11. No Please continue to Section 4. SECTION 4: DEFERMENT REQUEST BASED ON FEDERAL OR STATE ASSISTANCE Are you receiving payment under a Federal or state public assistance program such as Temporary Assistance to Needy Families, Supplemental Security Income, or Supplemental Nutrition Assistance Program? I began receiving these benefits on / /. Please attach your most recent determination or other verification. Continue to Section 11. No Please continue to Section 5. SECTION 5: DEFERMENT REQUEST BASED ON MONTHLY GROSS INCOME BELOW $ Are you working full-time and earning a total monthly gross income that does not exceed $ per month, which is equal to someone working full-time and earning minimum wage? My monthly gross income is $. I have been earning minimum wage or less since / /. Please attach your last two (2) pay stubs and evidence of any other income. If this is not your first request for economic hardship, also include a copy of your most recent Federal Income Tax Return. Continue to Section 11. No Please continue to Section 6.

3 SECTION 6: DEFERMENT REQUEST BASED ON MONTHLY GROSS INCOME BELOW 150% OF THE POVERTY LINE Are you working full-time and earning a total monthly gross income that does not exceed 150% of the poverty line for your state? Family Size 48 Contiguous States and the District of Columbia * For families with more than 8 persons, add $ for each additional person Alaska * For families with more than 8 persons, add $ for each additional person Hawaii * For families with more than 8 persons, add $ for each additional person 1 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ My monthly gross income is $ and has been below the annual poverty line since / /. My family size is. Please attach your last two (2) pay stubs and evidence of any other income. If this is not your first request for economic hardship, also include a copy of your most recent Federal Income Tax Return. Continue to Section 11. No Please continue to Section 7. SECTION 7: DEFERMENT REQUEST BASED ON FEDERAL STUDENT LOAN PAYMENTS CAUSING HARDSHIP Is your income less than double the amount listed in Section 6 that corresponds with your state and family size? My monthly gross income is $. My family size is. If yes, is your monthly income minus your monthly Federal Student Aid loan payments less than or equal to the amount listed in Section 6? Monthly Income $. Monthly Federal Student Aid loan payments: - (minus) $. = (equals) $ Please attach your last two (2) pay stubs and evidence of any other income. Also include evidence of your monthly Federal Student Aid loan payments such as billing statements. Continue to Section 11. No Please continue to Section 8.

4 SECTION 8: FORBEARANCE REQUEST BASED ON FEDERAL STUDENT LOAN PAYMENTS EXCEEDING 20% OF INCOME Is the amount you are required to pay on all monthly Federal Student Aid loans equal to or greater than 20% of your gross monthly income? Total monthly gross income is defined as the gross amount of all income received through employment and other sources. My monthly federal loan payments are 20% of more of my monthly gross income. Monthly Federal Student Aid loan payments: $. Monthly gross income: (divided by) $. % of income: = (equals) % Please attach your last two (2) pay stubs and evidence of any other income. Also include evidence of your monthly Federal Student Aid loan payments such as billing statements. Continue to Section 10. No Please continue to Section 9. SECTION 9: FORBEARANCE REQUEST BASED ON OTHER ACCEPTABLE REASONS If you are unable to make your loan payments for any other reason not already outlined in this form (including service in AmeriCorps), please attach a letter written and signed by you describing those reasons. Attach documentation (e.g. pay stubs, billing statements, etc.) to support your statements. Heartland ECSI will review the information that you provide and determine if you qualify for an Economic based on other acceptable reasons. Continue to section 10. SECTION 10: FORBEARANCE INTEREST If you qualify for a forbearance, you will be required to pay interest that accrues during the forbearance period. You may opt to pay the interest during the forbearance or may opt to make a payment of all accrued interest at the end of the forbearance. The actual loan interest cost will depend on your interest rate and length of forbearance. Paying the loan interest during the period of forbearance prevents the need to make a large lump sum payment, as depicted in the chart below. Treatment of Interest During Loan Amount Interest Rate Regular Monthly Payment Monthly Interest Payments During First Payment After 6-month Pay During $8,200 5% $86.97 $34.17 $86.97 Pay After $8,200 5% $86.97 $0.00 $291.99

5 If granted a forbearance, I wish to: Postpone principal payments only and pay interest each month as it accrues during the forbearance. Postpone both principal and interest payments. I understand that I will be billed for all accrued interest at the conclusion of the forbearance. Please continue to Section 11. SECTION 11: 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 or forbearance 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 or forbearance status; (3) I will notify my student loan office or Heartland ECSI immediately when the condition(s) that qualified me for this deferment or forbearance end; (4) I have read, understand, and meet the terms and conditions of the deferment or forbearance for which I have applied. Signature: Date: / / SECTION 12: 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 If you have any questions, please visit or call toll-free at Applications are typically processed within 10 business days. You will be notified of the status of your deferment or forbearance via the 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 or forbearance has been posted.

First Name: Last Name: MI SID: -or- Last 4 of SSN Current Mailing Address: City: State: Zip: Phone Number: Cell Phone Number:

Economic Hardship/Unemployment Deferment or Forbearance Request First Name: Last Name: MI SID: -or- Last 4 of SSN Current Mailing Address: City: State: Zip: Phone Number: Cell Phone Number: Email: You