I request a FORBEARANCE on my Pratt Loan. I understand that all information and supporting documents given will be held in strictest confidence and will not be subject to dissemination outside requirements of Pratt Institute. I also understand that if granted, this FORBEARANCE is for no more than six months duration during which time interest will continue to accrue.
| 1. EMPLOYMENT INFORMATION | ||
| _____ | I am working part-time | |
| _____ | I am unemployed | |
| Date continuous unemployment began:_______________ | ||
| _____ | I have received the maximum allowable unemployment benefits | |
| _____ | I did not work long enough to receive unemployment benefits | |
| _____ | I am receiving monthly unemployment benefits totaling $_______________ | |
| [Please attach a copy of your unemployment check stub] | ||
| 2. PERSONAL INFORMATION | |
| _____Married _____Single _____Separated/Divorced _____Widow(er) | |
| 3. MONTHLY INCOME/EXPENSES | ||||
| Income | ||||
| Total Monthly Income (from all sources, i.e., Checking account, Savings account, Child Support, Unemployment etc.) $__________ | ||||
| Expenses | ||||
| Rent/Mortgage | $_______________ | Car | $_______________ | |
| Utilities | $_______________ | *Other | $_______________ | |
| Total Monthly Expenses | $_______________ | |||
| * Please use the back of this form in conveying any circumstances, not listed above, that you feel would have a bearing on your request for this FORBEARANCE. | ||||
| I certify that all statements made above are true and correct. I also certify that I will immediately notify your office of any NAME, ADDRESS or EMPLOYMENT CHANGES which may occur after completing this FORBEARANCE form. | ||||
| Borrower's Signature: | ______________________________ | Date: _______________ | |
| Borrower's Address: | ______________________________ | ||
| ______________________________ | |||
| Borrower's Telephone Number: | ______________________________ |