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UNEMPLOYMENT DEFERMENT FORM To qualify for the Unemployment Deferment on your Federal Perkins Student Loan you must have become unemployed or began working less than 30 hours per week. To apply for deferment please complete and submit this form with the required documentation to ACS Education Services PO Box 7060 Utica NY 13504-7060 Name Address Account Number s 1 I became unemployed or began working less than 30 hours a week on mm/dd/yy. UNEMPLOYMENT DEFERMENT FORM To qualify for the Unemployment Deferment on your Federal Perkins Student Loan you must have become unemployed or began working less than 30 hours per week. To apply for deferment please complete and submit this form with the required documentation to ACS Education Services PO Box 7060 Utica NY 13504-7060 Name Address Account Number s 1 I became unemployed or began working less than 30 hours a week on mm/dd/yy. 2 I registered with the following employment agency Name of Employment Agency Telephone Number Note School placement offices and temporary agencies do not qualify as employment agencies. 3 In the last six months I have tried to secure full-time employment at the following firms Name of Firm Street Address City State Zip Contact Person Telephone Name of Firm I hereby claim that the above information is true. I agree to notify the lending institution immediately upon termination of my claimed status. Signature Date 11/06. To apply for deferment please complete and submit this form with the required documentation to ACS Education Services PO Box 7060 Utica NY 13504-7060 Name Address Account Number s 1 I became unemployed or began working less than 30 hours a week on mm/dd/yy. 2 I registered with the following employment agency Name of Employment Agency Telephone Number Note School placement offices and temporary agencies do not qualify as employment agencies. 2 I registered with the following employment agency Name of Employment Agency Telephone Number Note School placement offices and temporary agencies do not qualify as employment agencies. 3 In the last six months I have tried to secure full-time employment at the following firms Name of Firm Street Address City State Zip Contact Person Telephone Name of Firm I hereby claim that the above information is true. 3 In the last six months I have tried to secure full-time employment at the following firms Name of Firm Street Address City State Zip Contact Person Telephone Name of Firm I hereby claim that the above information is true. I agree to notify the lending institution immediately upon termination of my claimed status. Signature Date 11/06. To apply for deferment please complete and submit this form with the required documentation to ACS Education Services PO Box 7060 Utica NY 13504-7060 Name Address Account Number s 1 I became unemployed or began working less than 30 hours a week on mm/dd/yy. 2 I registered with the following employment agency Name of Employment Agency Telephone Number Note School placement offices and temporary agencies do not qualify as employment agencies. 3 In the last six months I have tried to secure full-time employment at the following firms Name of Firm Street Address City State Zip Contact Person Telephone Name of Firm I hereby claim that the above information is true. .

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