GENERAL INFORMATION

Name Account Number
Address
City, State, Zip
Home Phone Number
Work Phone #

 Minnesota State Colleges & Universities
FINANCIAL COLLECTIONS
Wells Fargo Place
30 7 th St E., Suite 350
St Paul , MN 55105-7804
Tel: (651) 917-4700 Fax: (651) 917-4711
Website: www.slsc.mnscu.edu
Email: loans@csu.mnscu.edu

FOR ALL NDSL AND PERKINS LOANS

STUDENT STATUS (At least half-time)

FOR NURSING STUDENT LOAN PROGRAM

STUDENT STATUS
(Must be at least half-time in continuing nursing education)

MILITARY SERVICE

PEACE CORPS OR VISTA

OFFICER IN U.S. PUBLIC
HEALTH SERVICE

NATIONAL OCEANIC AND ATMOSPHERIC
ADMINISTRATION

INTERNSHIP (please state field)

RESIDENCY (please state field)

GRADUATE FELLOWSHIP (Excludes medical internship/residency)

GRADUATE OR POST GRADUATE FELLOWSHIP (Supported study outside the United States )

REHABILITATION TRAINING for DISABLED

PART II: TO BE COMPLETED BY SCHOOL
OR APPROPRIATE OFFICIAL

Name of institution or organization _______________________________
Address__________________________________

City State Zip

Phone Number (Including Area Code)___________________________

SPECIFIC DATES: from _______________________to ____________

I certify that the deferment status and period requested are true and correct.

INSTITUTION OPE ID NUMBER
___________________________

 INSTITUTIONAL SEAL
(Where available)

PART III: FOR MnSCU OFFICE USE ONLY

Deferment Decision: Deferred FROM TO Rejected_________________
Reason If Rejected_____________________
Signature __________________ Date ___________________________