Private Loan Adjustment Request

NJIT Student ID Number *

Last Name *

First Name *

UCID Email Address *

Award Year *

Contact Number *

Please Cancel My Private Loan: *

Cancel Private Loan

Cancel Private Loan from (Lender's Name): *

Please complete the form carefully and provide the total loan amount with a clear breakdown between the Fall and Spring semesters. The Fall and Spring loan amounts should add up to the total loan amount. Incomplete forms will not be processed.

Total Private Loan Amount to be Cancelled: * $

Fall Private Loan Amount to be Cancelled: * $

Spring Private Loan Amount to be Cancelled: * $

Additional Information for Cancelling Private Loans:

Please Reinstate My Private Loan: *

Reinstate Private Loan

Reinstate Private Loan from (Lender's Name): *

Total Private Loan Amount to be Reinstated: * $

Fall Private Loan Amount to be Reinstated: * $

Spring Private Loan Amount to be Reinstated: * $

Additional Information for Reinstating Private Loans:

Please Adjust My Private Loan: *

Adjust Private Loan

Adjust Private Loan from (Lender's Name): *

Adjust Private Loan New Total Amount: * $

Adjust Private Loan New Fall Amount: * $

Adjust Private Loan New Spring Amount: * $

Additional Information for Adjusting Private Loans:

By signing (printing) your name below, you certify that you are the loan borrower and all of the information reported on this form is correct. Student must sign this form.

Electronic Signature (Student Name) *

Date:

12-19-24

Leave this field blank