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

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
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 (2020-2021) 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 (2020-2021) 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:

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.
Summer 2021 - Number of Credits *

Please check AARC for this information if you are unsure of the number of credits. Do NOT enter the number of classes.
Fall 2021 - Number of Credits *

Please check AARC 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 AARC 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 AARC 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 AARC 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 AARC 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)