REHABILITATION REQUEST (print friendly, .pdf)

This is a new revised repayment agreement negotiated to rehabilitate my defaulted Perkins Loan. Provisions of the original promissory note will remain in effect under this agreement. I may, at my option, and without penalty, repay all or part of the principal, plus the accrued interest at any time.

I agree to begin rehabilitation repayment in the amount of $_____________ (payment amount must be approved with Financial Collections) with the first payment being due ___________ 1, _______. All payments are due on the first of the month. I will return this form, completed with my first payment.

I understand that to rehabilitate my loan, I must make twelve consecutive, on time payments and that if I miss one payment this agreement will be null and void.

I understand that if I complete rehabilitation the following will occur:

•  The loan will return to regular status, restoring rights and benefits of the promissory note.

•  The Credit Bureaus will be instructed to remove default from credit history.

I will provide the following information:

Address: _____________________________________________________

City: _______________________ State _____ Zip _______________

Home Telephone Number________________________________________­

Work Telephone Number_________________________________________

Name of Employer______________________________________________

List (1) Reference_______________________________________________

Address_______________________________________________­­­__

Telephone Number_____________________________________________

_______________________________ __________________________

Signature of Borrower Date

Return completed form to:

Minnesota State Colleges & Universities
Financial Collections
Wells Fargo Place
30 7 th St. E., Suite 350
St Paul , MN 55101-7804

RehabiliationRequest.doc