TEACH Grant Suspension/Military Discharge Request Forms

MIL

TEACH GRANT SERVICE OBLIGATION SUSPENSION/DISCHARGE REQUEST:

MILITARY SERVICE

Teacher Education Assistance for College and Higher Education (TEACH) Grant Program
REVISED FINAL FOR OMB APPROVAL 2020-09-18

OMB No. 1845-0158

Form Approved

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.

GENERAL INFORMATION AND INSTRUCTIONS

NOTE: Throughout this form, the words “we,” “us,” and “our” refer to the U.S. Department of Education or to your TEACH Grant servicer, acting on behalf of the U.S. Department of Education. The word “Agreement” refers to the Agreement to Serve or Repay that you signed before you received your TEACH Grants.

How do I use this form?

As explained in your Agreement, you can request a suspension of the 8-year period for completing your TEACH Grant service obligation if you are temporarily unable to teach due to qualifying military service, and you may qualify for a discharge of some or all of your 4-year service obligation based on extended periods of qualifying military service. You may use this form to request a suspension of the 8-year period for completing your service obligation if you are temporarily unable to teach because of your qualifying military service, or to request a discharge of some or all of your service obligation based on extended military service. See Sections 4A and 4B of the form for specific eligibility requirements.

How do I complete the form?

• Before you begin, carefully read the entire form. Be sure to provide all requested information. Print using dark ink.

• If you are unable to complete the form, a representative may complete the form on your behalf.

• Your name, address, and other information may be preprinted in Section 1. If any of this information is not shown, or if any of the preprinted information is incorrect, enter or correct the information on the right side of Section 1. If any of your information has changed since the last time you reported it to your TEACH Grant servicer, check the box in Section 1 to indicate this.

• Depending on your reason for submitting the form, you are only required to complete certain sections:

  • If you are requesting a suspension of your 8-year service obligation period based on military service, complete Section 2A of the form and have an authorized official complete Section 2B, or attach documentation as described in Section 2A. In Section 2A, enter the beginning and ending dates (month and year only) of the school year for which you are requesting a suspension of the 8-year service obligation period. For example, if you are requesting a suspension to cover a school year that begins in August 2021 and ends in June 2022, you would enter “0 8 - 20 2 1” as the beginning date and “0 6 - 20 2 2” as the ending date.

  • If you are requesting a discharge of some or all of your 4-year TEACH Grant service obligation based on extended military service, enter your name and Social Security Number (SSN) at the top of page 3, then complete Section 3A of the form and have an authorized official complete Section 3B, or attach other documentation of your extended call or order to active duty as described in Section 3A.

• Sign and date the form in the section that you are required to complete. Enter the date as month-day-year. For example, if you signed the form on August 25, 2021, you would enter “0 8 - 2 5 - 20 2 1”).

• Make sure that all sections are complete, then send us the completed form by one of the following means:

  • Mail the form and any required documentation to the following address:

U.S. Department of Education
FedLoan Servicing
P.O. Box 69184
Harrisburg, PA 17106-9184

• Fax the form to 717-720-1628.

• Upload the form via Account Access at myfedloan.org.

Who can I contact if I have questions?

The U.S. Department of Education uses a servicer (FedLoan Servicing) to monitor your progress toward completing your TEACH Grant service obligation, and to answer any questions you may have about your service obligation. If you change your address, email address, or telephone number, it is very important to make sure that your TEACH Grant servicer has your current contact information. If you need help completing this form, or if you have questions about the status of your request after you have submitted the form, contact your TEACH Grant servicer:

FedLoan Servicing
1-800-699-2908

International: 717-720-1985

myfedloan.org

TEACH GRANT SERVICE OBLIGATION MILITARY SERVICE SUSPENSION/DISCHARGE REQUEST

SECTION 1: GRANT RECIPIENT INFORMATION

See the instructions on page 1.

SSN ___ ___ ___ - ___ ___ - ___ ___ ___ ___

Name ___________________________________________________

Address ___________________________________________________

City, State, Zip _______________________________________________

Telephone – Primary ( _______ ) _______ - _________________

Telephone – Alternate ( _______ ) _______ - _________________

Email (optional) ___________________________________________

Check this box if you are changing any preprinted information.

SECTION 2A: MILITARY SERVICE SUSPENSION REQUEST, UNDERSTANDINGS, AND CERTIFICATIONS

I request that the U.S. Department of Education (ED) grant a temporary suspension of the period for completing my TEACH Grant service obligation during the full elementary or secondary school year beginning ___ ___ - 20 ___ ___ and ending ___ ___ - 20 ___ ___. I am/was unable to complete a full year of teaching service during this school year due to my qualifying military service as described in Section 4A. I have had an authorized official complete Section 2B, or I have attached documentation from the official that includes all of the information requested in Section 2B and a certification that I meet the qualifying military service conditions described in Section 4A.

I understand that (1) I may receive a suspension for a consecutive 12-month period; (2) if I continue to qualify for a suspension at the end of one suspension period, I may reapply for another 12-month suspension, but I may not receive a total of more than 3 years of suspension based on qualifying military service; (3) if I do not begin teaching or do not continue to perform qualifying teaching service within a timeframe that would allow me to complete my required 4 years of teaching within the 8-year period required by my Agreement, my TEACH Grants will be converted to Direct Unsubsidized Loans that I must repay; (4) my TEACH Grant servicer must receive my suspension request before my TEACH Grants are converted to Direct Unsubsidized Loans; and (5) ED will not approve my suspension request unless this form is complete and I have provided any required documentation.

I certify that: (1) the information I have provided on this form is true and correct; (2) I have read, understand, and meet the eligibility requirements of the suspension that I have requested, as explained in Section 4A; and (3) upon request, I will provide additional documentation to my TEACH Grant servicer to support my suspension request.

Grant Recipient’s or Representative's Signature __________________________________________________ Date ___ ___ - ___ ___ - 20 ___ ___

Printed Name of Representative (if applicable) & Relationship _____________________________________________________________________

Representative’s Address/Telephone Number ___________________________________________________ ( _______ ) _______ - _____________

SECTION 2B: AUTHORIZED OFFICIAL’S CERTIFICATION OF YOUR QUALIFYING MILITARY SERVICE (FOR SUSPENSION REQUEST ONLY)

An authorized official who may complete this section is the grant recipient’s commanding or personnel officer.
BE SURE TO SIGN AND DATE THE FORM.

Carefully read Section 4A. Return the form to the TEACH Grant recipient or the recipient’s representative.

I certify to the best of my knowledge and belief that: (1) the TEACH Grant recipient identified in Section 1 meets all conditions described in Section 4A; and (2) the information that I have provided in this section is true and correct.

The TEACH Grant recipient’s qualifying military service began or will begin on (mm-dd-yy) ___ ___- ___ ___ - 20 ___ ___ and ended or will end on (mm-dd-yy) ___ ___- ___ ___ - 20 ___ ___

Name of Reserve Component of the Armed Forces, or National Guard Component ___________________________________________________

________________________________________________________________________________________________________________________

Address (Street, City, State, Zip Code) ________________________________________________________________________________________

Authorized Official’s Name and Title (printed) __________________________________________________________________________________

Telephone ( _______ ) _______ - _____________ Email __________________________________________________________________________

Authorized Official’s Signature _______________________________________________________________ Date ___ ___ - ___ ___ - 20 ___ ___

TEACH GRANT SERVICE OBLIGATION MILITARY SERVICE SUSPENSION/DISCHARGE REQUEST

Grant Recipient’s Name _______________________________________________________________ SSN ___ ___ ___ - ___ ___ - ___ ___ ___ ___

SECTION 3A: MILITARY SERVICE DISCHARGE REQUEST, DOCUMENTATION, UNDERSTANDINGS, AND CERTIFICATIONS

I request that the U.S. Department of Education grant a proportional discharge of my 4-year TEACH Grant service obligation, as explained in Section 4B, based on the fact that:

1. I have received the maximum 3 years of suspension of the period for completing my TEACH Grant service obligation due to qualifying military service; and

2. I am subject to an extended call or order to active duty status in the Armed Forces of the United States that exceeds the 3-year period for which I have already received a suspension.

To document my extended call or order to active duty status, I have (check one):

Had my commanding or personnel officer complete Section 3B of this form below;

Attached a written statement from my commanding or personnel officer that (1) certifies I am on active duty in the Armed Forces of the United States, and (2) includes the date my service began and the date it is expected to end; or

Attached a copy of my official military orders and a copy of my military identification.

I understand that:

1. I may request a proportional discharge of my 4-year TEACH Grant service obligation only if I have already received the maximum 3 years of suspension of the period for completing my service obligation based on qualifying military service;

2. If I meet the eligibility requirements for a proportional discharge, the U.S. Department of Education will discharge all or a portion of my 4-year service obligation as explained in Section 4B;

3. If I do not qualify for discharge of my entire 4-year TEACH Grant service obligation, I remain responsible for completing the remaining portion of my service obligation in accordance with the terms and conditions specified in my Agreement; and

4. The U.S. Department of Education will not grant my request for a proportional discharge unless I have completed all applicable sections of this form and have provided any required documentation.

I certify that: (1) the information I have provided on this form is true and correct; (2) I have read, understand, and meet the eligibility requirements of the discharge that I have requested, as explained above and in Section 4B; and (3) upon request, I will provide additional documentation to my TEACH Grant servicer, to support my discharge request.

Grant Recipient’s or Representative's Signature __________________________________________________ Date ___ ___ - ___ ___ - 20 ___ ___

Printed Name of Representative (if applicable) & Relationship _____________________________________________________________________

Representative’s Address/Telephone Number ___________________________________________________ ( _______ ) _______ - _____________

SECTION 3B: AUTHORIZED OFFICIAL’S CERTIFICATION OF YOUR EXTENDED CALL OR ORDER TO ACTIVE DUTY (FOR DISCHARGE REQUEST ONLY)

An authorized official who may complete this section is the grant recipient’s commanding or personnel officer.
BE SURE TO SIGN AND DATE THE FORM.

Carefully read Section 4B. Return the form to the TEACH Grant recipient or to the recipient’s representative.

I certify, to the best of my knowledge and belief, that the TEACH Grant recipient identified in Section 1 is on active duty in the Armed Forces of the United States and that the grant recipient’s service began on (mm-dd-yy) ___ ___- ___ ___ - 20 ___ ___ and is expected to end on (mm-dd-yy)
___ ___- ___ ___ - 20 ___ ___.

Name of United States Armed Forces Component ______________________________________________________________________________

Address _________________________________________________________________________________________________________________

City, State, Zip Code _______________________________________________________________________________________________________

Commanding or Personnel Officer’s Name and Title (printed) _____________________________________________________________________

Telephone ( _______ ) _______ - _____________ Email __________________________________________________________________________

Authorized Official’s Signature _____________________________________________________________________ Date ___ ___ - ___ ___ - 20 ___ ___

SECTION 4A: SUSPENSION ELIGIBILITY REQUIREMENTS AND MAXIMUM SUSPENSION PERIOD

Suspension eligibility requirements

You may qualify for a temporary suspension of the period for completing your TEACH Grant service obligation if you are subject to a call or order to federal or state active duty, or active service as a member of a reserve component of the Armed Forces named in 10 U.S.C. 10101 (see below), or service as a member of the National Guard on full-time National Guard duty, as defined in 10 U.S.C. 101(d)(5) (see below).

The reserve components of the Armed Forces are the Army National Guard of the United States; Army Reserve; Navy Reserve; Marine Corps Reserve; Air National Guard of the United States; Air Force Reserve; and Coast Guard Reserve.

Full-time National Guard duty means training or other duty, other than inactive duty, performed by a member of the Army National Guard of the United States or the Air National Guard of the United States in the member’s status as a member of the National Guard of a State or territory, the Commonwealth of Puerto Rico, or the District of Columbia under section 316, 502, 503, 504, or 505 of title 32 for which the member is entitled to pay from the United States or for which the member has waived pay from the United States.

If you qualify for a suspension, your TEACH Grant servicer must receive your suspension request before your TEACH Grants are converted to Direct Unsubsidized Loans. Refer to your Agreement or contact us (see "Who can I contact if I have questions?" on page 1) for more information about the conditions under which your TEACH Grants may be converted to loans.

Maximum suspension period

If you meet the requirements described in this section, you will receive a temporary suspension of the 8-year period for completing your TEACH Grant service obligation for a consecutive 12-month period covering the school year during which you are temporarily unable to teach. If you continue to qualify for a suspension at the end of one suspension period, you may reapply for another 12-month suspension. There is a maximum 3-year limit on the period of time for which you may receive a suspension of the 8-year service obligation period based on qualifying military service. However, if you receive the maximum 3 years of suspension based on military service and are subject to an extended call or order to active duty status that exceeds 3 years, you may be eligible for a discharge of some or all of your 4-year service obligation. See section 4B.

SECTION 4B: MILITARY DISCHARGE ELIGIBILITY REQUIREMENTS AND TERMS AND CONDITIONS

Discharge eligibility requirements

You may qualify for a proportional discharge (see below) of your 4-year TEACH Grant service obligation if:

• You have completed or otherwise ceased to be enrolled in the program of study for which you received a TEACH Grant;

• You have received the maximum 3 years of suspension of the period for completing your TEACH Grant service obligation based on qualifying military service; and

• You are subject to an extended call or order to active duty status in the Armed Forces of the United States (see below).

The Armed Forces of the United States are:

• The Army;

• The Navy;

• The Air Force;

• The Marine Corps;

• The Coast Guard;

• A Reserve component of the Armed Forces named in 10 U.S.C. 10101 (see Section 4A); or

• The National Guard

Proportional discharge

If you meet the eligibility requirements for discharge described above, you may receive a:

• One-year discharge of your service obligation if the call or order to active duty status exceeds 3 years;

• Two-year discharge of your service obligation if the call or order to active duty status exceeds 4 years;

• Three-year discharge of your service obligation if the call or order to active duty status exceeds 5 years; or

• Full discharge of your service obligation if the call or order to active duty status exceeds 6 years.

Requirement to complete any remaining portion of your service obligation

If you qualify for less than a full discharge of your entire 4-year TEACH Grant service obligation, you must still complete the remaining portion of the service obligation in accordance with all of the terms and conditions specified in your Agreement. For example, if you receive a discharge of 3 years of your 4-year service obligation, you would remain responsible for completing one year of qualifying teaching service.

SECTION 5: 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 §420L et seq. and §451 et seq. of the Higher Education Act (HEA) of 1965, as amended (20 U.S.C. 1070g et seq. and 20 U.S.C. 1087a et seq.) and the authorities for collecting and using your social security number (SSN) are §484(a)(4) of the HEA (20 U.S.C. 1091(a)(4)) and §31001(i)(1) of the Debt Collection Improvement Act of 1996 (31 U.S.C. 7701(c)). Participating in the Teacher Education Assistance for College and Higher Education (TEACH) Grant Program and/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 TEACH Grant, and, if a TEACH Grant that you receive is converted to a Direct Unsubsidized Loan, to determine your eligibility to receive a benefit on the loan (such as deferment, forbearance, discharge, or forgiveness), to permit the servicing of your loan(s), and, if it becomes necessary, to locate you and to collect and report on your loan(s) if your loan(s) become delinquent or in 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 case-by-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 the information that we collect about you, if your TEACH Grant has not been converted to a Direct Unsubsidized Loan, include, but are not limited to, its disclosure to federal, state, or local agencies, to institutions of higher education, and to third party servicers to determine your eligibility to receive a TEACH Grant, to investigate possible fraud, and to verify compliance with federal student financial aid program regulations.

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.

If your TEACH Grant has been converted to a Direct Unsubsidized Loan, the routine uses of this information also 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 creditors, to financial and educational institutions, and to guaranty agencies to verify your identity, to determine your program eligibility and benefits, to permit making, servicing, assigning, collecting, adjusting or discharging your loan(s), to enforce the terms of the loan(s), to investigate possible fraud and to verify compliance with federal student financial aid program regulations, to locate you if you become delinquent in your loan payments or if you default, or to verify whether your debt qualifies for discharge or cancellation. To provide default rate calculations, disclosures may be made to guaranty agencies, to financial and educational institutions, or to federal, state or local 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 status, 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.

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 currently valid OMB control number. The valid OMB control number for this information collection is 1845-0158. 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 resources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond to this collection is required to obtain a benefit in accordance with 34 CFR 686.41(b) or 34 CFR 686.42(c).

If you have comments or concerns regarding the status of your individual submission of this form, write to:

U.S. Department of Education
FedLoan Servicing
P.O. Box 69184
Harrisburg, PA 17106-9184

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