Scholarship Deferment Form

This deferment request is for students who are currently receiving funds from the Florida Fund for Minority Teachers who:

Will not be enrolled for the upcoming semester or
Enrolled for less than 12 credit hours

Please complete this deferment to assure that your account remains in good standing with FFMT. Failure to complete the deferment for the reasons above may affect your future eligibility.

If you are no longer a recipient of the MTES scholarship and are in need of a deferment, please complete the Attachment C which can be found at http://www.ffmt.org/graduate-forms or http://www.ffmt.org/ineligible-forms.

Identification Information

Name

First Name

Last Name

Social Security Number

Email Address

Phone

(###)

###

####

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Institution

Please select one

Deferment Start (Semester/Year)

Semester

Fall

Spring

Year

Deferment End (Semester/Year)

Semester

Fall

Spring

Year

Reason for Deferment

Please select one

Comments

Please explain deferment