Form 1845-0059 Teacher Loan Forgiveness Forbearance Request

TEACHER LOAN FORGIVENESS FORBEARANCE REQUEST
William D. Ford Federal Direct Loan (Direct Loan) Program
Federal Family Education Loan (FFEL) Program

TLFF

OMB No. 1845-0059
DRAFT FORM
Exp. Date XX/XX/XXXX

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
City

State

Zip Code

Telephone - Primary
Telephone - Alternate
Email (Optional)
SECTION 2: LOAN FORGIVENESS FORBEARANCE REQUEST
READ SECTIONS 5 - 8 BEFORE COMPLETING THE FORM.
I request forbearance of payments on my eligible Direct Loan and/or FFEL program loans while I am performing qualifying
teaching service as a full-time teacher at an elementary or secondary school or for an educational service agency. During the
period that qualifies me for this forbearance, I am teaching (check one):
at an eligible elementary school

at an eligible secondary school

for an eligible educational service agency

AND I am (check all that apply):
A highly qualified full-time special education teacher for elementary school children with disabilities (forgiveness of up to
$17,500).
A highly qualified full-time special education teacher for secondary school children with disabilities (forgiveness of up to
$17,500).
A highly qualified full-time mathematics teacher for secondary school students (forgiveness of up to $17,500).
A highly qualified full-time science teacher for secondary school students (forgiveness of up to $17,500).
A highly qualified full-time secondary education teacher, or (only if my teaching service began before 10/30/2004) a fulltime secondary education teacher in a subject area relevant to my academic major (forgiveness of up to $5,000).
A highly qualified full-time elementary education teacher, or (only if my teaching service began before 10/30/2004) a fulltime elementary education teacher and I demonstrated knowledge and teaching skills in reading, writing, mathematics,
and other areas of the elementary school curriculum (forgiveness of up to $5,000).

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Borrower Name

Borrower SSN

SECTION 2: LOAN FORGIVENESS FORBEARANCE REQUEST (CONTINUED)
The current academic year of teaching service for which I am requesting forbearance begins/began on (show dates as mmdd-yyyy)
.
and ends on
I expect to complete my fifth year of qualifying teaching service on

.
I am/will be performing my qualifying teaching service at the following school or educational service agency (ESA):
School (not school district) or ESA Name
Check here if this is a school operated by the Bureau of Indian Education (BIE) or operated on an Indian reservation by
an Indian tribal group under contract with the BIE.
School or ESA Address (Street, City, State, Zip Code)
School or ESA Website
School District

County

Telephone
SECTION 3: UNDERSTANDINGS, CERTIFICATIONS, AND AUTHORIZATION
I understand that: (1) this forbearance is granted in twelve-month increments and if I choose to extend it, I must reapply
each year during the five consecutive, complete years of required employment; (2) any unpaid interest that accrues during
the forbearance period may be capitalized, as permitted by law; (3) I qualify for this forbearance only if my loan holder
determines that the expected forgiveness amount for which I am performing qualifying service (up to $5,000 or up to
$17,500, as applicable) will satisfy the anticipated outstanding balance of my eligible loans at the end of my fifth year of
qualifying service; and (4) if I am past due on payments not covered by this forbearance, my loan holder may grant a separate
forbearance to resolve the delinquency on these payments at the time my request is processed.
I certify that: (1) the information I provided in Section 2 is true and correct; (2) after the forbearance ends, I agree to repay
the loans according to the terms of my promissory notes and repayment schedules; (3) I will notify my loan holder
immediately if my teaching service at an eligible school or ESA ends or I otherwise become ineligible for the Teacher Loan
Forgiveness Program; and (4) I meet the eligibility requirements and have read and understand the definitions and terms and
conditions for the Teacher Loan Forgiveness Program in Sections 6-8.
I authorize the entity to which I submit this request and its agents to contact me regarding my request or my loans at any
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: WHERE TO SEND THE COMPLETED TEACHER LOAN FORGIVENESS FORBEARANCE REQUEST
Return the completed form and any documentation to:
(If no address is shown, return to your loan holder.)

If you need help completing this form, call:
(If no information is shown, call your loan holder.)

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SECTION 5: INSTRUCTIONS FOR COMPLETING THE FORM
Throughout this form, all references to “the Department” mean the U.S. Department of Education.
Before completing Sections 2 and 3, carefully read the entire form. Be sure to provide all requested information. Enter your
name and Social Security Number at the top of page 2. Type or print using dark ink. Show dates as mm-dd-yyyy (for example,
show “January 31, 2018” as “01-31-2018”).
If you do not qualify for this forbearance this year, you may contact your loan holders for other forbearance options or
reapply for this forbearance in a year when you are completing one of your five consecutive, complete years of teaching
service.
Return the completed form to the address shown in Section 4. If you are applying for forbearance of loans that are held
by different loan holders, you must submit a separate form to each loan holder.
SECTION 6: DEFINITIONS
A forbearance is a period of time during which you are
not required to make payments or temporarily allowed to
make smaller payments than previously scheduled, or an
extension of time for making payments. You are responsible
for any interest that accrues on a loan during forbearance. If
you do not pay the interest that accrues on the loan, the
interest may be capitalized.
Capitalization is the addition of unpaid interest to the
principal balance of your loan. This will increase the
principal and total cost of your loan.
A teacher is a person who provides direct classroom
teaching or classroom-type teaching in a non-classroom
setting, including special education teachers (see below).
NOTE: School librarians, guidance counselors, and other
administrative staff are not considered teachers for the
purposes of this loan forgiveness program.
Special education means specially designed
instruction, at no cost to parents, to meet the unique needs
of a child with a disability (see below), including instruction
conducted in the classroom, in the home, in hospitals and
institutions, and in other settings; and instruction in physical
education (see below).
A child with a disability is a child who needs special
education and related services because the child has an
intellectual disability, a hearing impairment (including
deafness), a speech or language impairment, a visual
impairment (including blindness), a serious emotional
disturbance, an orthopedic impairment, autism, a traumatic
brain injury, another health impairment, or a specific
learning disability. For a child age 3 through 9, the term “a
child with a disability” may, at the discretion of the state and
the local educational agency, include a child who needs
special education and related services because the child is
experiencing developmental delays, as defined by the state

and as measured by appropriate diagnostic instruments and
procedures, in one or more of the following areas: physical
development, cognitive development, communication
development, social or emotional development, or adaptive
development.
Physical education means the development of physical
and motor fitness, fundamental motor skills and patterns,
and skills in aquatics, dance, and individual and group
games and sports (including intramural and lifetime sports),
and includes special physical education, adapted physical
education, movement education, and motor development.
An elementary school is a public or nonprofit private
school that provides elementary education as determined
by state law or, if the school is not in a state, by the
Department.
A secondary school is a public or nonprofit private
school that provides secondary education as determined by
state law or, if the school is not in a state, by the
Department.
An educational service agency is a regional public
multiservice agency (not a private organization) authorized
by state statute to develop, manage, and provide services or
programs to local educational agencies (such as public
school districts), as defined in section 9101 of the
Elementary and Secondary Education Act of 1965, as
amended.

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SECTION 6: DEFINITIONS (CONTINUED)
An academic year is:

Loans that are eligible for forgiveness are:

• One complete school year at the same school or for
the same educational service agency, or

• Federal Direct Stafford/Ford Loans (Direct
Subsidized Loans);
• Federal Direct Unsubsidized Stafford/Ford Loans
(Direct Unsubsidized Loans);
• Subsidized Federal Stafford Loans;

• Two complete and consecutive half years at
different schools or for different educational service
agencies, or

• Unsubsidized Federal Stafford Loans; and

• Two complete and consecutive half years from
different school years at either the same school or
for the same educational service agency or at
different schools or for different educational service
agencies.
Half years do not include summer sessions. Two half
years generally fall within a 12-month period. For schools or
educational service agencies that have a year-round
program of instruction, a minimum of nine months is
considered an academic year.
Full time means the standard used by a state in
defining full-time employment as a teacher. If you teach in
more than one school or educational service agency, full
time is based on the combination of all of your qualifying
employment.

• Any portion of a Federal Direct Consolidation Loan
or Federal Consolidation Loan that paid off an
eligible Direct Subsidized Loan, Direct Unsubsidized
Loan, Subsidized Federal Stafford Loan, or
Unsubsidized Federal Stafford Loan.
Direct PLUS Loans, Federal PLUS Loans, and any portion
of a Direct Consolidation Loan or Federal Consolidation
Loan that paid off a PLUS loan are not eligible for
forgiveness.
The holder of your Direct Loan Program loans is the
Department. The holder of your FFEL Program loans may be
a lender, secondary market, guaranty agency, 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” on this form mean either
your loan holder or your servicer.

SECTION 7: DEFINITION OF HIGHLY QUALIFIED
PUBLIC SCHOOL TEACHERS
To be a highly qualified teacher, a teacher of public
elementary or secondary school students or a teacher
employed by an educational service agency must:

In addition, a teacher of elementary school students
who is new to the profession also is considered highly
qualified if the teacher:

• Have obtained full state certification as a teacher
(including certification obtained through alternative
routes to certification) or passed the state teacher
licensing examination, and hold a license to teach in
that state, except that when used with respect to
teaching in a public charter school, the term “highly
qualified teacher” means that the teacher meets the
requirements set forth in the state's public charter
school law; and
• Not have had certification or licensure requirements
waived on an emergency, temporary, or provisional
basis.

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• Holds at least a bachelor's degree; and
• Has demonstrated, by passing a rigorous state test,
subject knowledge and teaching skills in reading,
writing, mathematics, and other areas of the basic
elementary school curriculum (which may consist of
passing a state-required certification or licensing
test or tests in reading, writing, mathematics, and
other areas of the basic elementary school
curriculum).

SECTION 7: DEFINITION OF HIGHLY QUALIFIED (CONTINUED)
A teacher of middle or secondary school students
who is new to the profession also is considered highly
qualified if the teacher:
• Holds at least a bachelor's degree; and
• Has demonstrated a high level of competency in
each of the academic subjects in which the teacher
teaches by: (1) passing a rigorous state academic
subject test in each of the academic subjects in
which the teacher teaches (which may consist of a
passing level of performance on a state-required
certification or licensing test or tests in each of the
academic subjects in which the teacher teaches); or
(2) successful completion, in each of the academic
subjects in which the teacher teaches, of an
academic major, a graduate degree, coursework
equivalent to an undergraduate academic major, or
advanced certification or credentialing.
A teacher of elementary, middle, or secondary
school students who is not new to the profession also is
considered highly qualified if the teacher holds at least a
bachelor's degree and:
• Meets the applicable standards of a teacher of
elementary, middle, or secondary school students
who is new to the profession; or
• Demonstrates competence in all the academic
subjects in which the teacher teaches based on a
high objective, uniform state standard of evaluation
that: (1) is set by the state for both grade

appropriate academic subject matter knowledge and
teaching skills; (2) is aligned with challenging state
academic content and student academic achievement
standards and developed in consultation with core content
specialists, teachers, principals, and school administrators;
(3) provides objective, coherent information about the
teacher's attainment of core content knowledge in the
academic subjects in which a teacher teaches; (4) is applied
uniformly to all teachers in the same academic subject and
the same grade level throughout the state; (5) takes into
consideration, but is not based primarily on, the time the
teacher has been teaching in the academic subject; (6) is
made available to the public upon request; and (7) may
involve multiple, objective measures of teacher
competency.
PRIVATE SCHOOL TEACHERS
To be a highly qualified teacher, a teacher in a private,
non-profit elementary or secondary school who is not a
highly qualified teacher as defined above must satisfy
rigorous subject knowledge and skills tests by taking
competency tests in applicable grade levels and subject
areas. The competency tests must be recognized by five or
more states for the purposes of fulfilling the highly qualified
teacher requirements under section 9101 of the Elementary
and Secondary Education Act of 1965. The teacher must also
achieve a score on each test that equals or exceeds the
average passing score for those states.

SECTION 8: TERMS AND CONDITIONS
The Teacher Loan Forgiveness Program is intended to
encourage individuals to enter and continue in the teaching
profession. Under this program, if you teach full time for five
consecutive, complete academic years at certain elementary
and secondary schools or for certain educational service
agencies that serve low-income families and meet other
qualifications, you may be eligible for forgiveness of up to a
combined total of $17,500 in principal and interest on your
Direct Loan and/or FFEL program loans.
Your loan holder will not return any payments you make
during the period in which you meet the qualifications for
this loan forgiveness. This forbearance is intended to assist
borrowers who are expected to qualify for forgiveness of
their total loan amounts, by allowing them to not make
payments during this period.
You may qualify for forbearance while performing
qualifying teaching service only if your loan holder

determines that the expected forgiveness amount for which
you are performing the service (up to $5,000 or up to
$17,500, as applicable) will satisfy the anticipated
outstanding balance of your eligible loans at the end of your
fifth year of qualifying teaching service.
To qualify for loan forgiveness, you must not have had
an outstanding balance on a Direct Loan or FFEL program
loan on October 1, 1998, or on the date that you obtained a
Direct Loan or FFEL program loan after October 1, 1998.
You are not eligible to receive forgiveness on a
defaulted loan unless you have first made satisfactory
repayment arrangements with the holder of the defaulted
loan.
Any loan for which you are seeking forgiveness must
have been made before the end of your five consecutive,
complete academic years of qualifying teaching service.

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SECTION 8: TERMS AND CONDITIONS (CONTINUED)
You may not receive benefits through the AmeriCorps
Program under Subtitle D of Title I of the National and
Community Service Act of 1990 or loan forgiveness under
the Direct Loan Public Service Loan Forgiveness Program for
the same period of teaching service for which you receive
forgiveness under this Teacher Loan Forgiveness Program.
You must have been employed as a full-time teacher for
five consecutive, complete academic years at an elementary
or secondary school or for an educational service agency
that is listed in the Annual Directory of Designated LowIncome Schools for Teacher Cancellation Benefits (TCLI
Directory). The TCLI Directory is available online at
www.tcli.ed.gov. If this directory is not available before May
1 of any year, the previous year's directory may be used. To
qualify for inclusion in the TCLI Directory, a school or
educational service agency must: (1) be in a school district
that qualifies for funds under Title I of the Elementary and
Secondary Education Act of 1965, as amended; and (2) have
been selected by the Department based on a determination
that more than 30% of the school's or educational service
agency's total enrollment is made up of children who
qualify for services provided under Title I.
All elementary and secondary schools operated by the
Bureau of Indian Education (BIE) or operated on Indian
reservations by Indian tribal groups under contract with the
BIE qualify as schools serving low-income students.
If your school or educational service agency is included
in the TCLI Directory for at least one qualifying year of your
teaching service, but does not qualify for inclusion in the
TCLI Directory during subsequent years, your subsequent
years of teaching at that school or educational service
agency may be counted toward the required five years of
teaching. Any years of teaching before the school or
educational service agency qualified for inclusion in the TCLI
Directory may not be counted.
If you were unable to complete an academic year of
teaching, that year may still be counted toward the required
five consecutive, complete academic years if: (1) you
completed at least one-half of the academic year; (2) your
employer considers you to have fulfilled your contract
requirements for the academic year for the purposes of
salary increases, tenure, and retirement; and (3) you were
unable to complete the academic year because: (A) you
returned to postsecondary education, on at least a half-time
basis, in an area of study directly related to the performance
of the teaching service described above; or (B) you had a
condition covered under the Family and Medical Leave Act
of 1993 (FMLA); or (C) you were called or ordered to active
duty status for more than 30 days as a member of a reserve
component of the Armed Forces.

Absence due to a period of postsecondary education, a
condition covered under the FMLA, or active duty service,
including the time needed for you to resume teaching no
later than the beginning of the next regularly scheduled
academic year, is not considered a break in the required five
consecutive, complete academic years.
You may qualify for forgiveness based on qualifying
teaching service at any combination of eligible elementary
schools, secondary schools, or educational service agencies.
Teaching at an eligible elementary or secondary school
may be counted only if at least one of the five years of
teaching was after the 1997 -1998 academic year.
Teaching for an eligible educational service agency may
be counted only if the consecutive five-year period includes
qualifying service for an eligible educational service agency
performed after the 2007 -2008 academic year.
You may receive up to $5,000 in loan forgiveness if you
were a highly qualified full-time teacher for elementary or
secondary school students or (only if your qualifying
teaching service began before October 30, 2004) you were
(1) a full-time teacher for elementary school students and
you demonstrated knowledge and teaching skills in
reading, writing, mathematics, and other areas of the
elementary school curriculum, or (2) a full-time teacher for
secondary school students and you taught in a subject area
that was relevant to your academic major.
You may receive up to $17,500 in loan forgiveness if
you were: (1) a highly qualified full-time teacher of
mathematics or science to secondary school students; or (2)
a highly qualified full-time special education teacher whose
primary responsibility was to provide special education to
children with disabilities, and you taught children with
disabilities that corresponded to your area of special
education training and have demonstrated knowledge and
teaching skills in the content areas of the curriculum that
you taught.
If you are determined to be eligible for loan forgiveness
under this program, your loan holder will not refund any
payments that you made or that were made on your behalf
before the determination of eligibility.
You are not eligible for forgiveness of more than a
combined total of $17,500 of principal and interest of your
Direct Loan and/or FFEL program loans. You must repay any
loan balance that remains after forgiveness has been
granted.
If you receive loan forgiveness based on any false,
fictitious, or fraudulent statements that you make on this
form or on any accompanying documents, you may be
required to repay the amount forgiven and may be subject
to civil and criminal penalties under applicable federal law.

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SECTION 9: 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 428(b)(2)(A) et seq. and 451 et seq. of
the Higher Education Act of 1965, as amended (20 U.S.C.
1078(b)(2)(A) et seq. and 20 U.S.C. 1087a et seq.) and the
authority for collecting and using your Social Security
Number (SSN) is 484(a)(4) of the HEA (20 U.S.C. 1091(a)(4)).
Participating in the Federal Family Education Loan (FFEL)
Program or the William D. Ford Federal Direct Loan (Direct
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 and/or Direct Loan Programs, 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.
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
this information include, but are not limited to, its disclosure
to federal, state, or local agencies, to private parties such as
relatives, present and former employers, business and
personal associates, to consumer reporting agencies, to
financial and educational institutions, and to guaranty
agencies in order to verify your identity, to determine your
eligibility to receive a loan or a benefit on a loan, to permit
the servicing or collection of your loans, to enforce the
terms of the loans, to investigate possible fraud and to verify
compliance with federal student financial aid program
regulations, or to locate you if you become delinquent in
your loan payments or if you default. To provide default rate
calculations, disclosures may be made to guaranty agencies,
to financial and educational institutions, or to state
agencies. To provide financial aid history information,
disclosures may be made to educational institutions.

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 qualified
researchers under Privacy Act safeguards.
Paperwork Reduction Notice. According to the
Paperwork Reduction Act of 1995, no persons are required
to respond to a collection of information unless it displays a
valid OMB control number. The valid OMB control number
for this information collection is 1845-0059. Public reporting
burden for this collection of information is estimated to
average 20 minutes (0.33 hours) per response, including
time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and
completing and reviewing the information collection. The
obligation to respond to this collection is required to obtain
a benefit in accordance with 34 CFR 682.216(e) and 34 CFR
685.217(c)(13). If you have comments or concerns
regarding the status of your individual submission of
this form, contact your loan holder at the address shown
in Section 4.

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