School Closure

LOAN DISCHARGE APPLICATION: SCHOOL CLOSURE

OMB No. 1845-0058
DRAFT FORM
Exp. Date XX/XX/XXXX

William D. Ford Federal Direct Loan (Direct Loan) Program
Federal Family Education Loan (FFEL) Program
Federal Perkins Loan Program
WARNING: Any person who knowingly makes a false statement or misrepresentation on this form or on
any accompanying document is subject to penalties that may include fines, imprisonment, or both, under
the U.S. Criminal Code and 20 U.S.C. 1097.
SECTION 1: BORROWER IDENTIFICATION
Please enter or correct the following information.
Check this box if any of your information has changed.
SSN
Name
Address
State

City

Zip Code

Telephone - Primary
Telephone - Alternate
Email (Optional)
SECTION 2: SCHOOL CLOSURE INFORMATION
Carefully read the entire application before completing it. Complete Section 2 in its entirety.
1. You are applying for this loan discharge as a:
Student borrower - Skip to Item 4.
Parent PLUS borrower - Continue to Item 2. Unless
otherwise noted, "you" means the student you
borrowed the PLUS Loan for.
2. Student Name (Last, First, MI):

8. Did you complete the program before the school
closed?
Yes - You are not eligible for this discharge.
No - Continue to Item 9.
9. Were you on an approved leave of absence when the
school closed?
Yes - Provide the dates of the leave of absence, then
skip to Item 13:

3. Student SSN:

First Date:

OR

Don't Know

Last Date:
No - Continue to Item 10.

4. Closed School Name:

5.

10. Were you still enrolled in the program when the school
closed?
Yes - Skip to Item 13.

Closed School Address (street, city, state, zip code):

No - Continue to Item 11.

6. First and last dates that you attended the closed school:
First Date:

OR

11. Did you withdraw from the school before the school
closed?
Yes - Continue to Item 12.
No - Continue to Item 13.

Don't Know

Last Date:
7. Name the program you were last enrolled in before the
school closed:

12. On what date did you withdraw from the school? See
Section 6 for a description of the impact that your
withdraw date has on your eligible for this discharge.

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Borrower Name

Borrower SSN

SECTION 2: SCHOOL CLOSURE INFORMATION (CONTINUED)
13. Select the option that most closely describes your
efforts to complete your program of study after your
school closed:
I haven't enrolled in any program at another school
since my school closed - Skip to Item 16.
I enrolled in a program that was not comparable to
the program I attended at the closed school - Skip
to Item 16.
I enrolled in a teach-out program at another school
- Continue to Item 14.
I enrolled in the same or a comparable program at
another school - Continue to Item 14.
14. Select the option that most closely describes your
enrollment status in the program identified in Item 13:
I completed a teach-out program - You are not
eligible for this discharge.
I completed the same or comparable program Continue to Item 15.
I withdrew from the program - Skip to Item 16.
I am still enrolled in the teach-out program - You
are not eligible for this discharge.
I am still enrolled in the same or comparable
program - Continue to Item 15.

18. Explain why the money was refunded:

19. Have you (or the student) requested or received a
refund or payment from the closed school or any third
party (see Section 6) for any loan that you are
requesting be discharged?
Yes - Continue to Items 20-22.
No - Sign and date the application in Section 3.
Submit it to the address in Section 7.
Don't Know - Sign and date the application in
Section 3. Submit it to the address in Section 7.
20. Provide the name, address, and telephone number of
the party who you made a claim to or received a
payment from:
Name:
Address (street, city, state, zip code):

15. Select the option that most closely describes how your
new school gave you credit for the training you
received at the closed school:
My new school accepted transfer credits from my
closed school - You are not eligible for discharge.
My new school exempted me from completing core
credit for the program after evaluating my
competency through testing or interviews, or by
other comparable means - You are not eligible for
this discharge.
My new school did not accept any transfer credit
from the closed school or give me credit by any
other means - Continue to Item 16.
16. Did we receive any money back (a refund) from the
closed school on your behalf?
Yes - Continue to Items 17-19.

17. What was the amount of the refund? $

Telephone Number:
21. What is the amount and the status of the claim?
Amount:
Status:
22. What was the amount of any payment received? If
none, write "none".

Sign and date the application in Section 3. Submit the
application to address in Section 7.

No - Skip to Item 19.
Don't Know - Skip to Item 19.

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Borrower Name

Borrower SSN

SECTION 3: BORROWER CERTIFICATIONS, ASSIGNMENT, AND AUTHORIZATION
I certify that:
• I (or the student) was enrolled at the school when it closed, was on an approved leave of absence on the date that
the school closed, withdrew from the school not more than 120 days before it closed, or withdrew more than 120
days before it closed due to exceptional circumstances described in Section 6.
• Due to the school's closure, I (or the student) did not complete the program of study at the closed school.
• I or the student did not complete, am not currently completing, and have not made arrangements to complete the
same or a comparable program of study at another school through a teach-out, by transferring credits or hours
earned at the closed school to another school, or by any other comparable means.
• I have read and agree to the terms and conditions for loan discharge, as specified in Section 6.
• Under penalty of perjury, all of the information I have provided on this application and in any accompanying
documentation is true and accurate to the best of my knowledge and belief.
By signing this form I assign and transfer to the U.S. Department of Education (the Department) any right I have to a refund
on the amount discharged from the school and/or from any owners, affiliates, or assignees of the school, and from any third
party that pays claims for a refund because of the actions of the school.
I authorize the organization I submit this request to and its agents to contact me regarding my request or my loans at the
cellular telephone number that I provide now or in the future using automated telephone dialing equipment or artificial or
prerecorded voice or text messages.

Date

Borrower's Signature

SECTION 4: INSTRUCTIONS FOR COMPLETING THE FORM
When completing this form, type or print using dark ink. Enter dates as month-day-year (mm-dd-yyyy). Use only numbers.
Example: March 14, 2018 = 03-14-2018. If you need more space to answer any of the items, continue on separate sheets of
paper and attach them to this application. Indicate the number of the Items you are answering and include your name and
Social Security Number (SSN) on pages 2 and 3 of the application and all attached pages. Return the completed application
and documentation to the loan holder in Section 7.
SECTION 5: DEFINITIONS
The William D. Ford Federal Direct Loan (Direct Loan)
Program includes Federal Direct Stafford/Ford (Direct
Subsidized) Loans, Federal Direct Unsubsidized Stafford/
Ford (Direct Unsubsidized) Loans, Federal Direct PLUS
(Direct PLUS) Loans, and Federal Direct Consolidation
(Direct Consolidation) Loans.
The Federal Family Education Loan (FFEL) Program
includes Federal Stafford Loans (both subsidized and
unsubsidized), Federal Supplemental Loans for Students
(SLS), Federal PLUS Loans, and Federal Consolidation Loans.
The Federal Perkins Loan (Perkins Loan) Program
includes Federal Perkins Loans, National Direct Student
Loans (NDSL), and National Defense Student Loans (Defense
Loans).

The date a school closed is the date that the school
stopped providing educational instruction in all programs
as determined by the U.S. Department of Education (the
Department).
A leave of absence from school is considered to be an
approved leave of absence only if it meets certain
requirements specified in the Department's regulations. A
student who is on an approved leave of absence is
considered to still be enrolled at the school.
The holder of your Direct Loan Program loans is the
Department. The holder of your FFEL Program loans may be
a lender, a guaranty agency, or the Department. The holder
of your Perkins Loans may be a school or the Department.
Your loan holder may use a servicer to handle billing and
other communications related to your loans. References to
“your loan holder”, "we", or "us" on this form mean either
your loan holder or your servicer.

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SECTION 5: DEFINITIONS (CONTINUED)
If your loan is discharged, this means that you (and any
endorser) are not required to repay the remaining portion
of the loan, and you will be reimbursed for any payments
on the loan that you made voluntarily or that we received
through forced collection (for example, through wage
garnishment or Treasury offset). For a consolidation loan,
only the portion that represents the original loans you
received and that are eligible for discharge will be
discharged. The loan holder reports the discharge to all
consumer reporting agencies to which the holder
previously reported the status of the loan and requests the
removal any adverse credit history previously associated
with the loan.
The student refers to the student the parent borrower
obtained a Direct PLUS Loan or Federal PLUS Loan for.

Program of study means the instructional program
leading to a degree or certificate you (or the student) were
enrolled in.
School means the school's main campus, or any location
or branch of the main campus.
Teach-out agreement means a written agreement
between schools that provides for the equitable treatment
of students and a reasonable opportunity for students to
complete their program of study if a school ceases to
operate before all students have completed their program
of study.
Third party refers to any entity that may provide
reimbursement for a refund owed by the school, such as a
State or other entity offering a tuition recovery program.

SECTION 6: TERMS AND CONDITIONS FOR LOAN DISCHARGE BASED ON SCHOOL CLOSURE
By signing this application, you are agreeing to provide,
Only loans made on or after January 1, 1986 are eligible
upon request, testimony, a sworn statement, or other
for this type of discharge.
documentation reasonably available to you that
You are eligible for loan discharge based on school
demonstrates to the satisfaction of the Department or its
closure only if the location or campus that you or the
designee that you meet the qualifications for loan discharge,
student were attending closed. If you or the student were
or that supports any statement you made on this application
taking distance education classes, you are eligible for
or in any accompanying documents.
discharge only if the main campus of the school closed.
By signing this application, you are agreeing to cooperate
You or the student must have been enrolled at the school
with the Department or the Department's designee in any
or on an approved leave of absence on the date that the
enforcement action related to this application.
school closed, or must have withdrawn from the school not
We may deny your application or revoke your discharge if
more than 120 days before it closed to be eligible for this
you fail to provide testimony, a sworn statement, or
form of discharge.
documentation upon request, or if you provide testimony, a
If you or the student withdrew more than 120 days
sworn statement, or documentation that does not support
before the school closed, you may be eligible for discharge
the material representations you made on this application or
based on school closure if the Department determines that
in any accompanying documents.
exceptional circumstances related to the school's closing
justify an extension of this 120-day period.
Examples of exceptional circumstances include, but are
not limited to:
• The closed school's loss of accreditation;
• The closed school's discontinuation of the majority
of its academic programs;
• Action by the State to revoke the closed school's
license to operate or award academic credentials in
the State; or
• A finding by a State or Federal government agency
that the closed school violated State or Federal law
while you or the student were enrolled at the school.

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SECTION 7: WHERE TO SEND THE COMPLETED APPLICATION
Return the completed application and any documentation to:
(If no address is shown, return to your loan holder.)

If you need help completing this application, call:
(If no telephone number is shown, call your loan holder.)

SECTION 8: IMPORTANT NOTICES
Privacy Act Notice. The Privacy Act of 1974 (5 U.S.C.
552a) requires that the following notice be provided to you:
The authorities for collecting the requested information
from and about you are §421 et seq., §451 et seq., and §461
et seq. of the Higher Education Act of 1965, as amended (20
U.S.C. 1071 et seq., 20 U.S.C. 1087a et seq., and 20 U.S.C.
1087aa et seq.), and the authorities for collecting and using
your Social Security Number (SSN) are §§428B(f) and 484(a)
(4) of the HEA (20 U.S.C. 1078-2(f) and 1091(a)(4)) and 31
U.S.C. 7701(b). Participating in the Federal Family Education
Loan (FFEL) Program, the William D. Ford Federal Direct
Loan (Direct Loan) Program, or the Federal Perkins Loan
(Perkins Loan) Program and giving us your SSN are
voluntary, but you must provide the requested information,
including your SSN, to participate.
The principal purposes for collecting the information on
this form, including your SSN, are to verify your identity, to
determine your eligibility to receive a loan or a benefit on a
loan (such as a deferment, forbearance, discharge, or
forgiveness) under the FFEL, Direct Loan Programs, and/or
Perkins Loans to permit the servicing of your loans, and, if it
becomes necessary, to locate you and to collect and report
on your loans if your loans become delinquent or default.
We also use your SSN as an account identifier and to permit
you to access your account information electronically.

To assist program administrators with tracking refunds
and cancellations, disclosures may be made to guaranty
agencies, to financial and educational institutions, or to
federal or state agencies. To provide a standardized method
for educational institutions to efficiently submit student
enrollment statuses, disclosures may be made to guaranty
agencies or to financial and educational institutions. To
counsel you in repayment efforts, disclosures may be made
to guaranty agencies, to financial and educational
institutions, or to federal, state, or local agencies.
In the event of litigation, we may send records to the
Department of Justice, a court, adjudicative body, counsel,
party, or witness if the disclosure is relevant and necessary
to the litigation. If this information, either alone or with
other information, indicates a potential violation of law, we
may send it to the appropriate authority for action. We may
send information to members of Congress if you ask them
to help you with federal student aid questions. In
circumstances involving employment complaints,
grievances, or disciplinary actions, we may disclose relevant
records to adjudicate or investigate the issues. If provided
for by a collective bargaining agreement, we may disclose
records to a labor organization recognized under 5 U.S.C.
Chapter 71. Disclosures may be made to our contractors for
the purpose of performing any programmatic function that
requires disclosure of records. Before making any such
disclosure, we will require the contractor to maintain Privacy
Act safeguards. Disclosures may also be made to qualified
researchers under Privacy Act safeguards.

The information in your file may be disclosed, on a caseby-case basis or under a computer matching program, to
third parties as authorized under routine uses in the
appropriate systems of records notices. The routine uses of
Paperwork Reduction Notice. According to the
this information include, but are not limited to, its disclosure
Paperwork Reduction Act of 1995, no persons are required
to federal, state, or local agencies, to private parties such as
to respond to a collection of information unless it displays a
relatives, present and former employers, business and
valid OMB control number. The valid OMB control number
personal associates, to consumer reporting agencies, to
for this information collection is 1845-0058. Public reporting
financial and educational institutions, and to guaranty
burden for this collection of information is estimated to
agencies in order to verify your identity, to determine your
average 30 minutes per response, including time for
eligibility to receive a loan or a benefit on a loan, to permit
reviewing instructions, searching existing data sources,
the servicing or collection of your loans, to enforce the
gathering and maintaining the data needed, and
terms of the loans, to investigate possible fraud and to verify
completing and reviewing the information collection. The
compliance with federal student financial aid program
obligation to respond to this collection is required to obtain
regulations, or to locate you if you become delinquent in
or retain a benefit (34 CFR 674.33(g)(4), 682.402(d)(3), or
your loan payments or if you default. To provide default rate
685.214(c)). If you have comments or concerns regarding
calculations, disclosures may be made to guaranty agencies,
the status of your individual submission of this form,
to financial and educational institutions, or to state
contact your loan holder directly.
agencies. To provide financial aid history information,
disclosures may be made to educational institutions.
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