IMPORTANT: USE THIS FORM TO CANCEL FOR LAST YEAR'S TEACHING SERVICE AND/OR TO
POSTPONE BILLING ON YOUR LOAN FOR THE COMING YEAR.

INSTRUCTIONS
1. Complete Part I and have Part II completed by the appropriate authorizing official.
2. Submit cancellations only upon completion of the academic year.  Cancellations submitted prior to completion of the academic year will not be accepted.
3. If you intend to teach during the next academic year, please check the appropriate section in PART I to stop billing until the end of the academic year.
    You will then receive a bill, with forms enclosed, for the entire year and need only submit the request for cancellation.

** If your status changes before you receive a bill, please notify this office immediately and you will be sent a revised billing. 

REQUEST FOR PARTIAL CANCELLATION OF LOAN DUE TO TEACHING SERVICE
PERKINS/NATIONAL DIRECT STUDENT LOAN PROGRAM

PART I - GENERAL AND CERTIFICATION OF TEACHING INFORMATION (to be completed by borrower)
ACCOUNT NUMBER NAME AND ADDRESS OF LENDING SCHOOL 
   University of Maryland 
   1118 Lee Bldg. Office of the Bursar 
   College Park, Maryland 20742-5151
NAME (LAST, FIRST, INITIAL)
 
ADDRESS (STREET, CITY, STATE & ZIP CODE)            _____CHECK IF NEW ADDRESS
_____________________________________________________________________ _____________________________________________________________________ 
NAME OF SCHOOL (NOT SCHOOL DISTRICT) AND ADDRESS WHERE EMPLOYED 

.
DESCRIPTION OF EXACT DUTIES: 
Attach sheet if necessary
ACADEMIC YEAR STARTING: MONTH DAY YEAR   ACADEMIC YEAR TERMINATING: MONTH DAY  YEAR 
CHECK APPROPRIATE BOXES FOR FULL-TIME TEACHER CANCELLATION ENTITLEMENT BELOW:
    Type Elementary School Secondary School Higher Education (Defense only) Teacher of the Handicapped
PUBLIC 
Other Nonprofit . . . .
I DECLARE that I was employed as a full-time teacher in a public or other nonprofit elementary or secondary school or institution of higher education in a state, or in an elementary or secondary school overseas of the Armed Forces of the United States, for a complete academic year or its equivalent as stated. I request cancellation of the appropriate amount of principal and interest for such service in accordance with my entitlement under the law and in accordance with regulations and instructions issued by the U.S. Commissioner of Education. 

____ I DO INTEND TO TEACH DURING THE NEXT ACADEMIC YEAR: ___________ TO ____________.  
____ I DO NOT INTEND TO TEACH DURING THE NEXT ACADEMIC YEAR.  

SIGNATURE OF BORROWER_____________________________________DATE_______________ 

 

PART II - CERTIFICATION BY SCHOOL OFFICIAL IN WHICH BORROWER TAUGHT
I CERTIFY that the borrower's declaration as to his employment as a full-time teacher, the completion of his service, and the description of his duties is true and correct. 
SCHOOL OR SCHOOL DISTRICT 
.
SIGNATURE OF AUTHORIZED OFFICIAL INVALID WITHOUT OFFICIAL SEAL OR STAMP
ADDRESS (City, County, State, Zip Code) 


.
Title                               Date
 

PART III - COMPLETED BY LENDING SCHOOL
APPROVED AT: 10%_____ 15%_____ 20%_____ 30%_____ DISAPPROVED (See attached) 
LOAN PRINCIPAL CANCELED  
. 
.
INTEREST CANCELED TOTAL CANCELED NEW BALANCE POSTPONEMENT ENDS
SIGNATURE OF APPROVING OFFICER 
__________________________________
TITLE DATE
 

INSTRUCTIONS TO BORROWERS:

1. Insure that PART I and PART II are fully completed before sending.
2. Return forms to: University of Maryland
                               Office of the Bursar
                               Lee Building
   College Park, Maryland 20742-5151

Next Bill Date:___________
CLEAR: C.Due Prin________ Int___________