Loan Adjustment Request Form

Please complete and submit this form if you would like to cancel or reduce your loan(s).

Student Name Student Name * First Last
Student ID Number *
Must be 7 digits. Currently Entered: 0 digits.
Email *
Student Type: *

Student Type: Undergraduate Graduate
Do you attend a traditional, on-campus program or an online program? *

Do you attend a traditional, on-campus program or an online program? Traditional On-Campus Program Online - Library Science or Nutrition Online - Social Work, Nursing, or Behavior Analysis Online - Public Health, MBA, or HCMBA
Expected Graduation Date Expected Graduation Date / MM / DD YYYY
Adjustment Request
Loan Type: *

Loan Type: Direct Stafford (Subsidized or Unsubsidized) Parent PLUS Graduate PLUS Private
Lender/Bank Name *
I would like to: *

I would like to: Cancel my loan Adjust my loan Reinstate my loan

Cancel: You do not wish to borrow for the term/year

Adjust: You wish to change the amount of your loan for the term/year

Reinstate: You've previously requested your loan be cancelled or reduced, and have changed your mind
Which loan(s): *

Which loan(s): Direct Subsidized Loan Direct Unsubsidized

Select all that apply.
I would like to cancel my loan for the *

I would like to cancel my loan for the Year (2021-2022) Term
I would like to cancel my loan for the following term: *

Ex: Fall 2019 or Winter 2020
I would like to adjust my loan for the *

I would like to adjust my loan for the Year (2021-2022) Term
I would like to adjust my loan for the following term: *

Ex: Fall 2019 or Winter 2020
I will enroll in the following semesters and specified number of credits (not classes).

Fall '20 - # credits
Spring '21 - # credits
Summer '21 - # credits
Please adjust my loan *

Please adjust my loan To cover my balance only To give me a refund of: To leave a balance of: To reinstate my loan to the full amount

Cover my balance: You wish to take out only enough to cover your balance for the term/year

Receive a refund: after all your aid has been used to cover your balance, you wish to receive a specific refund amount for the term/year

Leave a Balance: You wish to make a payment towards your bill before your aid is applied to cover the remaining balance for the term/year
$ Dollars . Cents
Enrollment Plans

Please enter the number of credits for which you will enroll at Simmons during each semester. Enter 0 if you will not enroll.
Please note, if you are enrolled in less than 5 credits for a graduate student, or less than 6 credits for an undergraduate student, you will not be eligible for federal student loans.
Fall 2021 - Number of Credits *

Please check Workday or consult your academic advisor for this information if you are unsure of the number of credits. Do NOT enter the number of classes.
Winter 2022 - Number of Credits *

Please check Workday or consult your academic advisor for this information if you are unsure of the number of credits. Do NOT enter the number of classes.
Winter 2022 - Number of Credits *

Please check Workday or consult your academic advisor for this information if you are unsure of the number of credits. Do NOT enter the number of classes.
Spring 2022 - Number of Credits *

Please check Workday or consult your academic advisor for this information if you are unsure of the number of credits. Do NOT enter the number of classes.
Summer 2022 - Number of Credits *

Please check Workday or consult your academic advisor for this information if you are unsure of the number of credits. Do NOT enter the number of classes.
Signature(s)
Student Name Student Name * First Last
Today's Date Today's Date * / MM / DD YYYY
Draw your signature into the box below. *

Clear
Parent's Name Parent's Name * First Last
Today Date Today Date * / MM / DD YYYY
Draw your signature into the box below. *

Clear
Type the letters you see in the image below.

Loan Adjustment Request Form

Loan Adjustment Request Form

Adjustment Request

Enrollment Plans

Signature(s)