Deferment We recommend that you read your promissory note carefully in order to become familiar with a number of features, duties, and, more specifically, what is and is not available relating to a deferment or cancellation before completing this form. BORROWER'S NAME/ADDRESS: MAIL FORM TO: ACCOUNT NUMBER: Section 1 Deferment Type Refer to the specific section on the back side of this form _____ Full – Time student (Perkins, Nursing, Health profession loans)    Section A _____ At least half – time student (Perkins)  Section A _____ A volunteer in the Peace Corps or Domestic volunteer act of 1973  Section B _____ A full - time member/officer of U.S. Armed Forces or in the U.S. Public Health Service (Loan Prior 7/1/93)  Section C _____ Internship or Residency (Perkins Prior to 7/1/93)  Section D _____ A member of the Oceanic and Atmospheric Administration Corp (Perkins 17 only)  Section E _____ Mother of preschool age children who entered/reentered the work force, and is making $1.00 or less above            Minimum Wage (Perkins 17/19 only)  Section F _____ I am pregnant, caring for my newborn, or caring for child immediately after adoption  Section G           ______Graduate / Fellowship  Section H Section 2 Certification Period Deferment Starting Date__________________________________ Ending Date____________________________________ Section 3 Borrower Signature I declare that the information above is true and correct.  I further declare that I will notify my lender or Educational Computer Systems, Inc. immediately upon any change in my status. Signature of borrower__________________________________ Date____________ Day Phone ____________ Evening Phone___________ Section 4 Certification by School / Agency / Institution I certify that the information stated above is true and correct. Name of School /Service unit / Employ____________________________________________________ School_______________________ Address__________________________________________________________________________________________________________ City______________________________________________ State___________ Zip________________ Phone ______________________ Signature of Authorized official________________________________________________________________________________ Title_______________________________________________________________________ Date___________________________ Defer. Rev. 10-99 ECSI INVALID WITHOUT OFFICIAL SEAL, STAMP OR LETTERHEAD FOR INSTITUTIONAL USE ONLY Approved_____ Disapproved_____ Official Name____________________________________________ Date______________________ Please return this form within the next (10) days to claim exemption of payment and eliminate past due notice.  This form will be returned to the borrower if it is incomplete. Heartland ECSI PO Box 1278 Wexford, PA  15090 11/22/1999