Use this form to provide the necessary information for this office to make an informed decision concerning your eligibility for postponement or cancellation. If you have questions about what you need to include for documentation, or about this form in general, contact our office.

IF YOU DID NOT COMPLETE A YEAR OF ELIGIBLE EMPLOYMENT: Send us verification of your last date of employment. You are eligible for a six-month grace period following your last date of employment.
1. Fill out your name, address, phone, e-mail address, and social security number at the top of the form.
2. Put a check mark by the line that you think best fits your employment situation.
3. If you are a teacher, you must fill out the “TEACHERS ONLY” BOX. If you teach in more than one school, we will need the exact names of all schools and all grades/subjects you teach. Be sure your county is also listed because that is how we must search the database for your school.
4. In the CANCELLATION SECTION: Put in your dates of employment for the last twelve months. For instance, assume today’s date is January 1, 1997. If you started full-time work on January 12, 1996, your cancellation dates would be from 1/12/96 to 1/12/97. OR, if it is now the end of an academic year of teaching and the date is May 18, 1999, you would enter the dates of the academic year 98/99. For example, 8/25/98 to 6/3/99.
5. In the POSTPONEMENT SECTION: Put in your dates of employment for the upcoming twelve months. For instance, if you filled in cancellation dates of 1/12/96 to 1/12/97, your postponement dates will be from 1/12/97 to 1/12/98. Or, on an academic year, if you filled in cancellation dates of 8/25/98 to 6/3/99 your postponement dates will be 8/26/99 to 6/4/2000.
6. Sign and date the form.

BEFORE YOU MAIL YOUR FORM BE SURE:
1. Your form is certified by an appropriate official.
2. Your form has an official seal or stamp. A return address rubber stamp is acceptable.
3. You have signed your form.
4. Your name and address information is filled out at the top.

You MUST include an OFFICIAL JOB DESCRIPTION if your employment is:
• Special Education teacher
• Provider of early intervention services to infants/ toddlers under the Disabilities Act
• Law enforcement or corrections officer
• Provider of services for a child or family service agency
• Nurse or medical technician

You MUST include a copy of your LICENSE, REGISTRATION, OR CERTIFICATION if you are:
• A speech pathologist, audiologist, psychologist, psychiatrist, occupational therapist, or recreational therapist and working for a school system or area agency.
• A nurse or medical technician.

Incomplete forms will be returned to you, delaying the process.

University of Northern Iowa Controller’s Office, Gilchrist 256 ATTN: Perkins Loans Cedar Falls, IA 50614-0008

(319)273-3539 or 273-6441 fax: (319)273-2001 e-mail: penny.becker@uni.edu OR joyce.willms@uni.edu