Direct Consolidation Loan Application and Promissory Note and Related Forms

Direct Consolidation Loan Additional Loan Listing Sheet

William D. Ford Federal Direct Loan Program 30-DAY CLEARANCE DRAFT 04/23/2019

OMB No. 1845-0007

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 I Want to Consolidate section or the Loans I Do Not Want to Consolidate section of your Note.

Borrower Information

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

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

LOANS I 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. 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 I 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. 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

NOTICE ABOUT LOANS TO BE CONSOLIDATED OR NOT CONSOLIDATED

We will send you a notice before we consolidate your loans. This notice will (1) identify all of your loans that will be consolidated and show the verified payoff amounts for those loans, 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. If you have any loans that will not be consolidated, the notice will also identify those loans. See the Instructions for more information about the notice we will send.