Form 1845-0053 Federal Direct Consolidation Loan Request to Add Loans

Direct Consolidation Loan Additional Loan Listing Sheet

William D. Ford Federal Direct Loan Program FINAL FOR OMB APPROVAL 04/12/2016

OMB No. 1845-0053

Form Approved

Exp. Date xx/xx/xxxx

WARNING: Any person who knowingly makes a false statement or misrepresentation on this form or 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.

Before You Begin

Read the Instructions for Completing the Direct Consolidation Loan Application and Promissory Note (“Instructions”). Use this form only if you need additional space to list loans in the Loans You Want to Consolidate section or the Loans You Do Not Want to Consolidate section of your Note.

Borrower Information

Last Name: ______________________________________________ First Name: ___________________________________________ Middle Initial: __________

Social Security Number: ___ ___ ___ - ___ ___ - ___ ___ ___ ___

LOANS YOU WANT TO CONSOLIDATE

List each federal education loan that you want to consolidate, including any Direct Loan Program loans that you want to include in your Direct Consolidation Loan. List each loan separately. We will send you a notice before we consolidate your loans. This notice will (1) provide you with information about the loans and payoff amounts that we have verified, and (2) tell you the deadline by which you must notify us if you want to cancel the Direct Consolidation Loan, or if you do not want to consolidate one or more of the loans listed in the notice. The notice will include information about loans that you listed in this section. If you have additional loans with a holder of a loan that you listed in this section, the notice may also include information about those additional loans. See the Instructions for more information about the notice we will send. IN THIS SECTION, LIST ONLY LOANS THAT YOU WANT TO CONSOLIDATE.

13. Loan Code (see Instructions)	14. Loan Holder/Servicer Name, Address, and Area Code/Telephone Number (see Instructions)	15. Loan Account Number	16. Estimated Payoff Amount

LOANS YOU DO NOT WANT TO CONSOLIDATE

List all education loans that you are not consolidating, but want us to consider when we calculate the maximum repayment period for your Direct Consolidation Loan (see Item 11 of the Borrower’s Rights and Responsibilities Statement that accompanies your Note). Remember to include any Direct Loan Program loans that you do not want to consolidate. List each loan separately. We will send you a notice before we consolidate your loans. This notice will (1) provide you with information about the loans and payoff amounts that we have verified, and (2) tell you the deadline by which you must notify us if you want to cancel the Direct Consolidation Loan, or if you do not want to consolidate one or more of the loans listed in the notice. The notice may also include information about any loans you listed in this section, but these loans listed will not be consolidated. See the Instructions for more information about the notice we will send. IN THIS SECTION, LIST ONLY LOANS THAT YOU DO NOT WANT TO CONSOLIDATE.

18. Loan Code (see Instructions)	19. Loan Holder/Servicer Name, Address, and Area Code/Telephone Number (see Instructions)	20. Loan Account Number	21. Current Balance