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<col style="width: 3%" />
<col style="width: 6%" />
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<col style="width: 2%" />
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<tbody>
<tr class="odd">
<td><img src="media/image1.bmp" /></td>
<td colspan="10"><h2 id="loan-debt-burden-forbearance-request">LOAN DEBT
BURDEN FORBEARANCE REQUEST</h2>
<h3 id="william-d.-ford-federal-direct-loan-program">William D. Ford
Federal Direct Loan Program</h3>
<p><strong>WARNING:</strong> Any person who knowingly makes a false
statement or misrepresentation on this form or on any accompanying
documents will be subject to penalties which may include fines,
imprisonment, or both, under the U.S. Criminal Code and 20 U.S.C.
1097.</p></td>
<td></td>
</tr>
<tr class="even">
<td colspan="12"><h5
id="section-1-borrower-endorser-identification-please-print-legibly-in-blue-or-black-ink">SECTION
1: BORROWER / ENDORSER IDENTIFICATION PLEASE PRINT LEGIBLY IN BLUE OR
BLACK INK</h5></td>
</tr>
<tr class="odd">
<td colspan="3" rowspan="14"></td>
<td colspan="9"><p>Please correct or, if information is missing, enter
below.</p>
<p>SSN |__|__|__|-|__|__|-|__|__|__|__|</p></td>
</tr>
<tr class="even">
<td colspan="9"></td>
</tr>
<tr class="odd">
<td>Name</td>
<td colspan="8"></td>
</tr>
<tr class="even">
<td colspan="9"></td>
</tr>
<tr class="odd">
<td colspan="2">Address</td>
<td colspan="7"></td>
</tr>
<tr class="even">
<td colspan="9"></td>
</tr>
<tr class="odd">
<td colspan="3">City, State, Zip</td>
<td colspan="6"></td>
</tr>
<tr class="even">
<td colspan="9"></td>
</tr>
<tr class="odd">
<td colspan="5">Telephone - Home ( )</td>
<td colspan="4"></td>
</tr>
<tr class="even">
<td colspan="9"></td>
</tr>
<tr class="odd">
<td colspan="5">Telephone - Other ( )</td>
<td colspan="4"></td>
</tr>
<tr class="even">
<td colspan="9"></td>
</tr>
<tr class="odd">
<td colspan="4">E-mail Address (optional)</td>
<td colspan="5"></td>
</tr>
<tr class="even">
<td colspan="9"></td>
</tr>
<tr class="odd">
<td colspan="12"><h4 id="section-2-forbearance-request">SECTION 2:
FORBEARANCE REQUEST</h4></td>
</tr>
<tr class="even">
<td colspan="12"><p>Before completing this form, carefully read the
entire form, including the instructions and other information in
Sections 4, 5, and 6. YOU MUST ATTACH TO THIS FORM THE DOCUMENTATION
LISTED IN SECTION 6.</p>
<p>If this forbearance request is approved, I want to (check one):</p>
<ul>
<li><p>temporarily stop making payments; or</p></li>
<li><p>make smaller payments of $__________ per month.</p></li>
</ul>
<p><strong>I meet the required condition stated</strong> below and
request that the U.S. Department of Education (ED) grant a forbearance
on my loan(s) beginning</p>
<p>(MM-DD-YYYY) |__|__|-|__|__|-|__|__|__|__| and ending (MM-DD-YYYY)
|__|__|-|__|__|-|__|__|__|__| for a period not to exceed 12 months. At
the end of the forbearance, I may apply to renew the forbearance if I
meet the required conditions. My maximum eligibility for this type of
forbearance is three years.</p>
<p><strong>I am currently making a TOTAL MONTHLY PAYMENT ON MY ELIGIBLE
FEDERAL EDUCATION LOAN(S) that is equal to or greater than 20% of my
TOTAL MONTHLY GROSS INCOME.</strong></p>
<blockquote>
<p>The total monthly payment on my eligible Federal education loan(s),
including the loan(s) for which I am requesting forbearance, is
$_______________ , and I have attached documentation of this total
monthly payment amount (see Section 6).</p>
<p>My total monthly gross income from all sources is $_______________ ,
and I have attached documentation of this income (see Section 6).</p>
</blockquote></td>
</tr>
<tr class="odd">
<td colspan="12"><p
id="section-3-borrower-endorser-understandings-and-certifications"
class="heading">SECTION 3: BORROWER / ENDORSER UNDERSTANDINGS AND
CERTIFICATIONS</p></td>
</tr>
<tr class="even">
<td colspan="12"><p><strong>I understand</strong> that the following
terms and conditions apply to this forbearance request:</p>
<blockquote>
<p><strong>(1)</strong> I will continue to receive billing statements
for my current payment amount which I must pay until I am notified by
the Direct Loan Servicing Center that my forbearance request has been
granted.</p>
<p><strong>(2)</strong> ED may grant me a forbearance on my loans for up
to 60 days, if necessary, for the collection and processing of
documentation related to my forbearance request. ED will not capitalize
interest that accrues during this forbearance.</p>
<p><strong>(3)</strong> ED will not grant this forbearance request
unless this form is completed and any required documentation is
provided.</p>
<p><strong>(4)</strong> During the forbearance period, I am not required
to make payments of loan principal and interest, but interest will be
charged on all of my loans.</p>
<p><strong>(5)</strong> If I requested a temporary suspension of
payments, I will receive a quarterly interest statement, and I may pay
the interest at any time. If I do not pay the interest that accrues on
my loan(s), it will be capitalized at the end of the forbearance
period.</p>
<p><strong>(6)</strong> If I requested a reduced payment forbearance, I
will receive a monthly bill for the requested payment amount until the
forbearance ends, and any unpaid interest that has accrued during the
period will be capitalized at the end of the forbearance period.</p>
</blockquote>
<p><strong>I certify</strong> that:</p>
<blockquote>
<p><strong>(1)</strong> The information I have provided on this form is
true and correct.</p>
<p><strong>(2)</strong> I will provide additional documentation to the
Direct Loan Servicing Center, as required, to support my continued
forbearance status.</p>
<p><strong>(3)</strong> I will notify the Direct Loan Servicing Center
immediately when the condition that qualified me for the forbearance
ends.</p>
<p><strong>(4)</strong> I have read, understand, and meet the
eligibility requirements of the forbearance for which I have
applied.</p>
<p><strong>(5)</strong> Upon termination of this forbearance, I will
repay my loan(s) according to the terms of my promissory note and
repayment schedule.</p>
</blockquote></td>
</tr>
<tr class="odd">
<td colspan="2"><p id="borrowers-or-endorsers-signature"
class="heading">BORROWER’S OR ENDORSER'S SIGNATURE</p></td>
<td colspan="6"></td>
<td></td>
<td><p id="date" class="heading">DATE</p></td>
<td colspan="2"></td>
</tr>
</tbody>
</table>

+-----------------------------------+-----------------------------------+
| ##### SECTION 4: INSTRUC          |                                   |
| TIONS FOR COMPLETING THE LOAN DEB |                                   |
| T BURDEN FORBEARANCE REQUEST FORM |                                   |
+-----------------------------------+-----------------------------------+
| Type or print using dark ink.     |                                   |
| Report dates as month-day-year.   |                                   |
| For example, show "January 31,    |                                   |
| 2007" as "01-31-2007".            |                                   |
| ***REMEMBER TO SIGN AND DATE THE  |                                   |
| FORM AND ATTACH TO THIS FORM THE  |                                   |
| DOCUMENTATION LISTED IN SECTION   |                                   |
| 6.***                             |                                   |
+-----------------------------------+-----------------------------------+
| Send the completed form and any   | If you need help completing this  |
| required documentation to:        | form, call:                       |
|                                   |                                   |
| ###                               | **1-800-848-0979**                |
| #### U.S. Department of Education |                                   |
|                                   | If you use a telecommunications   |
| **Direct Loan Servicing Center**  | device for the deaf (TDD), call:  |
|                                   |                                   |
| **P.O. Box 5609**                 | **1-800-848-0983**                |
|                                   |                                   |
| ##### Greenville, TX 75406-5609   | Direct Loan Servicing Center web  |
|                                   | site:                             |
|                                   |                                   |
|                                   | ##### www.dl.ed.gov               |
+-----------------------------------+-----------------------------------+
| ##### SECTION 5: DEFINITIONS      |                                   |
+-----------------------------------+-----------------------------------+
| If unpaid interest is             |                                   |
| **capitalized**, this means that  |                                   |
| it is added to the principal      |                                   |
| balance of your loan(s). This     |                                   |
| will increase the principal       |                                   |
| amount and the total cost of your |                                   |
| loan(s).                          |                                   |
|                                   |                                   |
| **Eligible Federal education      |                                   |
| loans** that may be used in       |                                   |
| determining your eligibility for  |                                   |
| a loan debt burden forbearance    |                                   |
| are loans made under Title IV of  |                                   |
| the Higher Education Act of 1965, |                                   |
| as amended and include all        |                                   |
| William D. Ford Federal Direct    |                                   |
| Loan Program loans, Federal       |                                   |
| Family Education Loan Program     |                                   |
| loans, and Federal Perkins Loan   |                                   |
| Program loans (see definitions).  |                                   |
|                                   |                                   |
| An **endorser** is someone who    |                                   |
| promises to repay a PLUS loan or  |                                   |
| the PLUS portion of a             |                                   |
| consolidation loan if the parent  |                                   |
| borrower does not repay it.       |                                   |
|                                   |                                   |
| The **Federal Family Education    |                                   |
| Loan (FFEL) Program** includes    |                                   |
| Federal Stafford Loans            |                                   |
| (subsidized and unsubsidized),    |                                   |
| Federal Supplemental Loans for    |                                   |
| Students (SLS), Federal PLUS      |                                   |
| Loans, Federal Consolidation      |                                   |
| Loans, Guaranteed Student Loans   |                                   |
| (GSL), Federal Insured Student    |                                   |
| Loans (FISL), and Auxiliary Loans |                                   |
| to Assist Students (ALAS).        |                                   |
|                                   |                                   |
| The **Federal Perkins Loan        |                                   |
| (Perkins Loan) Program** includes |                                   |
| Federal Perkins Loans, National   |                                   |
| Direct Student Loans (NDSL), and  |                                   |
| National Defense Student Loans    |                                   |
| (NDSL).                           |                                   |
|                                   |                                   |
| #####  A forbearance allows you t |                                   |
| o temporarily postpone making pay |                                   |
| ments on your loan(s) or lets you |                                   |
|  temporarily make smaller payment |                                   |
| s than previously scheduled. Inte |                                   |
| rest is charged during a forbeara |                                   |
| nce on all types of Direct Loans. |                                   |
|                                   |                                   |
| The **William D. Ford Federal     |                                   |
| Direct Loan (Direct Loan)         |                                   |
| Program** includes Federal Direct |                                   |
| Stafford/Ford (Direct Subsidized) |                                   |
| Loans, Federal Direct             |                                   |
| Unsubsidized Stafford/Ford        |                                   |
| (Direct Unsubsidized) Loans,      |                                   |
| Federal Direct PLUS (Direct PLUS) |                                   |
| Loans, and Federal Direct         |                                   |
| Consolidation (Direct             |                                   |
| Consolidation) Loans. These loans |                                   |
| are known collectively as "Direct |                                   |
| Loans".                           |                                   |
+-----------------------------------+-----------------------------------+
| ##### SE                          |                                   |
| CTION 6: ELIGIBILITY REQUIREMENTS |                                   |
+-----------------------------------+-----------------------------------+
| #####                             |                                   |
| You may temporarily postpone maki |                                   |
| ng payments or make smaller payme |                                   |
| nts than previously scheduled dur |                                   |
| ing the period that you meet the  |                                   |
| condition described in Section 2. |                                   |
|                                   |                                   |
| You must reapply every year if    |                                   |
| you continue to meet the          |                                   |
| requirements for a loan debt      |                                   |
| burden forbearance. You may       |                                   |
| receive a loan debt burden        |                                   |
| forbearance for a maximum of      |                                   |
| three years.                      |                                   |
|                                   |                                   |
| You must provide the Direct Loan  |                                   |
| Servicing Center with             |                                   |
| documentation of your most recent |                                   |
| monthly payments due on all of    |                                   |
| your eligible Federal education   |                                   |
| loans, such as monthly            |                                   |
| statements, coupons, and/or       |                                   |
| cancelled checks.                 |                                   |
|                                   |                                   |
| You must provide the Direct Loan  |                                   |
| Servicing Center with             |                                   |
| documentation of your monthly     |                                   |
| gross income from all sources,    |                                   |
| such as pay stubs, W-2 forms,     |                                   |
| dividend statements, and/or       |                                   |
| cancelled checks.                 |                                   |
+-----------------------------------+-----------------------------------+
| #                                 |                                   |
| #### SECTION 7: IMPORTANT NOTICES |                                   |
+-----------------------------------+-----------------------------------+
| ## Privacy Act Noti               |                                   |
| ce. The Privacy Act of 1974 (5 U. |                                   |
| S.C. 552a) requires that the foll |                                   |
| owing notice be provided to you:  |                                   |
|                                   |                                   |
| The authority for collecting the  |                                   |
| requested information from and    |                                   |
| about you is §451 *et seq.* of    |                                   |
| the Higher Education Act (HEA) of |                                   |
| 1965, as amended (20 U.S.C. 1087a |                                   |
| *et seq.*) and the authorities    |                                   |
| for collecting and using your     |                                   |
| Social Security Number (SSN) are  |                                   |
| §484(a)(4) of the HEA (20 U.S.C.  |                                   |
| 1091(a)(4)) and 31 U.S.C.         |                                   |
| 7701(b). Participating in the     |                                   |
| William D. Ford Federal Direct    |                                   |
| Loan (Direct Loan) Program and    |                                   |
| giving us your SSN are voluntary, |                                   |
| but you must provide the          |                                   |
| requested information, including  |                                   |
| your SSN, to participate.         |                                   |
|                                   |                                   |
| The principal purposes for        |                                   |
| collecting the information on     |                                   |
| this form, including your SSN,    |                                   |
| are to verify your identity, to   |                                   |
| determine your eligibility to     |                                   |
| receive a loan or a benefit on a  |                                   |
| loan (such as a deferment,        |                                   |
| forbearance, discharge, or        |                                   |
| forgiveness) under the Direct     |                                   |
| Loan Program, to permit the       |                                   |
| servicing of your loan(s), and,   |                                   |
| if it becomes necessary, to       |                                   |
| locate you and to collect and     |                                   |
| report on your loan(s) if your    |                                   |
| loan(s) become delinquent or in   |                                   |
| default. We also use your SSN as  |                                   |
| an account identifier and to      |                                   |
| permit you to access your account |                                   |
| information electronically.       |                                   |
|                                   |                                   |
| The information in your file may  |                                   |
| be disclosed, on a case-by-case   |                                   |
| basis or under a computer         |                                   |
| matching program, to third        |                                   |
| parties as authorized under       |                                   |
| routine uses in the appropriate   |                                   |
| systems of records notices. The   |                                   |
| routine uses of this information  |                                   |
| include, but are not limited to,  |                                   |
| its disclosure to federal, state, |                                   |
| or local agencies, to private     |                                   |
| parties such as relatives,        |                                   |
| present and former employers,     |                                   |
| business and personal associates, |                                   |
| to consumer reporting agencies,   |                                   |
| to financial and educational      |                                   |
| institutions, and to guaranty     |                                   |
| agencies in order to verify your  |                                   |
| identity, to determine your       |                                   |
| eligibility to receive a loan or  |                                   |
| a benefit on a loan, to permit    |                                   |
| the servicing or collection of    |                                   |
| your loan(s), to enforce the      |                                   |
| terms of the loan(s), to          |                                   |
| investigate possible fraud and to |                                   |
| verify compliance with federal    |                                   |
| student financial aid program     |                                   |
| regulations, or to locate you if  |                                   |
| you become delinquent in your     |                                   |
| loan payments or if you default.  |                                   |
| To provide default rate           |                                   |
| calculations, disclosures may be  |                                   |
| made to guaranty agencies, to     |                                   |
| financial and educational         |                                   |
| institutions, or to state         |                                   |
| agencies. To provide financial    |                                   |
| aid history information,          |                                   |
| disclosures may be made to        |                                   |
| educational institutions. To      |                                   |
| assist program administrators     |                                   |
| with tracking refunds and         |                                   |
| cancellations, disclosures may be |                                   |
| made to guaranty agencies, to     |                                   |
| financial and educational         |                                   |
| institutions, or to federal or    |                                   |
| state agencies. To provide a      |                                   |
| standardized method for           |                                   |
| educational institutions to       |                                   |
| efficiently submit student        |                                   |
| enrollment status, disclosures    |                                   |
| may be made to guaranty agencies  |                                   |
| or to financial and educational   |                                   |
| institutions. To counsel you in   |                                   |
| repayment efforts, disclosures    |                                   |
| may be made to guaranty agencies, |                                   |
| to financial and educational      |                                   |
| institutions, or to federal,      |                                   |
| state, or local agencies.         |                                   |
|                                   |                                   |
| In the event of litigation, we    |                                   |
| may send records to the           |                                   |
| Department of Justice, a court,   |                                   |
| adjudicative body, counsel,       |                                   |
| party, or witness if the          |                                   |
| disclosure is relevant and        |                                   |
| necessary to the litigation. If   |                                   |
| this information, either alone or |                                   |
| with other information, indicates |                                   |
| a potential violation of law, we  |                                   |
| may send it to the appropriate    |                                   |
| authority for action. We may send |                                   |
| information to members of         |                                   |
| Congress if you ask them to help  |                                   |
| you with federal student aid      |                                   |
| questions. In circumstances       |                                   |
| involving employment complaints,  |                                   |
| grievances, or disciplinary       |                                   |
| actions, we may disclose relevant |                                   |
| records to adjudicate or          |                                   |
| investigate the issues. If        |                                   |
| provided for by a collective      |                                   |
| bargaining agreement, we may      |                                   |
| disclose records to a labor       |                                   |
| organization recognized under 5   |                                   |
| U.S.C. Chapter 71. Disclosures    |                                   |
| may be made to our contractors    |                                   |
| for the purpose of performing any |                                   |
| programmatic function that        |                                   |
| requires disclosure of records.   |                                   |
| Before making any such            |                                   |
| disclosure, we will require the   |                                   |
| contractor to maintain Privacy    |                                   |
| Act safeguards. Disclosures may   |                                   |
| also be made to qualified         |                                   |
| researchers under Privacy Act     |                                   |
| safeguards.                       |                                   |
|                                   |                                   |
| **Paperwork Reduction Notice.**   |                                   |
| According to the Paperwork        |                                   |
| Reduction Act of 1995, no persons |                                   |
| are required to respond to a      |                                   |
| collection of information unless  |                                   |
| it displays a currently valid OMB |                                   |
| control number. The valid OMB     |                                   |
| control number for this           |                                   |
| information collection is         |                                   |
| 1845-0011. The time required to   |                                   |
| complete this information         |                                   |
| collection is estimated to        |                                   |
| average 0.16 hours (10 minutes)   |                                   |
| per response, including the time  |                                   |
| to review instructions, search    |                                   |
| existing data resources, gather   |                                   |
| and maintain the data needed, and |                                   |
| complete and review the           |                                   |
| information collection. **If you  |                                   |
| have comments concerning the      |                                   |
| accuracy of the time estimate(s)  |                                   |
| or suggestions for improving this |                                   |
| form, please write to:** U.S.     |                                   |
| Department of Education,          |                                   |
| Washington, DC 20202-4537. ***Do  |                                   |
| not send the completed form to    |                                   |
| this address.***                  |                                   |
|                                   |                                   |
| ##### If you h                    |                                   |
| ave questions about the status of |                                   |
|  your individual submission of th |                                   |
| is form, contact the Direct Loan  |                                   |
| Servicing Center (see Section 5). |                                   |
+-----------------------------------+-----------------------------------+