www.slscndus.com ● E-mail: ndus.slsc@ndus.nodak.edu

Please complete the Borrower Information and sign the form.

Check the appropriate type of deferment and fill in the dates.

The form must be certified to be processed by our office.

BORROWER INFORMATION:

BORROWER’S NAME: _____________________________________________________ SS#:______________________

Please print

ADDRESS: ________________________________________ Telephone #: (_____) ________________ ____/____/____

(date)

____________________________________________ SIGNATURE_______________________________

THIS IS TO CERTIFY THAT I AM/WAS (complete one category below) Expected Graduation Date:_____________

DEFERMENT – PERKINS LOANS From (m/d/y) To (m/d/y)

Pursuing a course of study in an institution of higher education ( ) At least half time ( ) Full Time ________ _________

Full time member of the ( ) Peace Corps ( ) Vista ________ _________

Full time member of the Armed Forces (for loans made prior to 7/93) ________ _________

DEFERMENT – NURSING LOANS

Pursuing a full time course of study in Nursing . ( ) Associate ( ) Baccalaurate degree ________ _________

Full time Member of the ( ) Uniformed Services ( ) Peace Corps ________ ________

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TO BE COMPELTED BY CERTIFYING OFFICAL, REGISTRAR OR COMMANDING OFFICER

I certify that the information stated above is true and correct. Actual Dates for deferment

From(mo/day/yr): ________________

To (mo/day/yr) : ________________

__________________________________________________ _______________________________ ___/___/__

Signature Title Date

______________________________________________________ ______________________________

Print Name Phone

______________________________________________________________________________________

School or organization Name & Address