University of Maryland
Office of the Bursar
NDSL/Perkins Collections Unit
College Park, Maryland 20742
 
Request For Hardship Deferment

I request a hardship deferment on my NDSL/Perkins Student Loan. I understand that all information and supporting documents will be held in confidence and will not be subject to dissemination outside the requirements of the University of Maryland. I also understand that, if granted, this hardship deferment is for no more than one year's duration, and that interest continues to accure during the deferment.
 
Name:__________________________________________    Acct.#____________________
Address:________________________________________    Telephone: Res.____________________
              ________________________________________                       Work___________________

Birth Date:__________________________                                Dependents:
Martial Status:                                                                               Relationship                Age
  _______Single    ________Widow(er)                                      __________                _____
  _______Married ________Seperated/Divorced                        __________                _____
Spouse Name:___________________________                         __________                _____
Spouse Employer:____________________________

Employment: Position:________________________________________________
Employer: _________________________________________________________
Address: __________________________________________________________
Net Monthly Income: $________________      Other Income: $________________
Bank: _____________________________      Savings: $____________________
                                                                          Checking: $___________________
Source of Other Income:______________________________________________

List Monthly Expenses:
Rent/Mortgage $_____________
Utilities $_____________
Food $_____________
Car $_____________
Other $_____________
Other Outstanding 
Liabilities
$_____________
(Please itemize all outstanding liabilities on the back of this form or attach a separate sheet of paper.)
 
How long do you estimate your hardship will continue:
  3 months________ 6 months________
  9 months________ 12months________

I CERTIFY THAT ALL STATEMENTS MADE ABOVE ARE TRUE AND CORRECT.  I ALSO CERTIFY THAT I WILL IMMEDIATELY NOTIFY YOUR OFFICE OF ANY CHANGES IN MY EMPLOYMENT STATUS OR SIGNIFICANT CHANGE IN MY FINANCIAL SITUATION.

Signature______________________________ Date_______________

For Questions Call: 301-405-9029/9031/9032