Teacher Education Assistance for College and Higher Education Grant Program (TEACH Grant Program) Service Obligation Certification and Suspension Request Forms

TEACH GRANT SERVICE OBLIGATION SUSPENSION REQUEST:
RESIDING OR BEING EMPLOYED IN A FEDERALLY DECLARED MAJOR
DISASTER AREA
DIS

OMB No. 1845-0158
Form Under Review
Exp. Date XX/XX/XXXX

Teacher Education Assistance for College and Higher Education (TEACH) Grant 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.
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. 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 certain qualifying conditions. 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 you are residing in or are employed in a federally declared major disaster
area. See Section 4 of the form for specific eligibility requirements.
How do I complete the form?
•

Before you begin, carefully read the entire form. Print using dark ink.

•

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 us, check the box in Section 1 to indicate this.

•

Complete Section 2. Check the box or boxes to identify the condition that qualifies you for a temporary suspension of the 8-year period for
completing your TEACH Grant service obligation, and for each box that you check enter the location of the federally-declared major disaster
area where you are/were residing or are/were employed.

•

Complete Section 3:

•

o

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 2024 and ends in
June 2025, you would enter “0 8 - 20 2 4” as the beginning date and “0 6 - 20 2 5” as the ending date.

o

Sign and date the form. Enter the date as month-day-year. For example, if you signed the form on August 25, 2024, you would enter
“0 8 - 2 5 - 20 2 4”.

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

Mail the form and any required documentation to the following address:
U.S. Department of Education
MOHELA
633 Spirit Drive
Chesterfield, MO 63005-1243

o

Fax the form to 1-866-222-7060.

o

Upload the form online atmohela.com.

Who can I contact if I have questions?
The U.S. Department of Education uses a servicer 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 suspension request after you have submitted the form, contact your TEACH Grant servicer:
MOHELA
1-888-866-4352
International: 636-532-0600
mohela.com

Page 1 of 4 – 30D DRAFT 09/12/2023

TEACH GRANT SERVICE OBLIGATION SUSPENSION REQUEST:
RESIDING OR BEING EMPLOYED IN A FEDERALLY DECLARED MAJOR DISASTER AREA
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 2: DOCUMENTATION OF YOUR QUALIFYING SUSPENSION REASON
Check the appropriate box or boxes to identify the condition that qualifies you for a temporary suspension of the 8-year period for completing your
TEACH Grant service obligation and for each box that you check enter the location (county or other designated area) of the federally-declared
major disaster area where you are/were residing or are/were employed. You can search for federally declared major disasters at
https://www.fema.gov/disasters/.
I am/was residing in the following federally declared major disaster area:
______________________________________________________________________________________________________________________
I am/was employed in the following federally declared major disaster area:
______________________________________________________________________________________________________________________
SECTION 3: YOUR 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 teach
during this school year for the reason I indicated in Section 2.
I understand that:
1.

If I qualify for a suspension, I will receive a suspension for a consecutive 12-month period. 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 residing in or being employed in a federally declared major disaster area.

2.

My TEACH Grant servicer must receive my suspension request before my TEACH Grants are converted to Direct Unsubsidized Loans. As
explained in my Agreement, my TEACH Grants will be converted to Direct Unsubsidized Loans 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 my 8-year
service obligation period.

3.

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 Sections 2 and 4; and (3) upon request, I will provide additional documentation to my
TEACH Grant servicer to support my suspension request.

Grant Recipient’s Signature __________________________________________________________________ Date ___ ___ - ___ ___ - 20 ___ ___

Page 2 of 4
U.S. Department of Education * MOHELA * 633 Spirit Drive * Chesterfield, MO 63005-1243 * Fax: 1-866-222-7060 * mohela.com
TEL: 1-888-866-4352 *International: 636-532-0600

SECTION 4: SUSPENSION ELIGIBILITY REQUIREMENTS, DEFINITI0NS, AND MAXIMUM SUSPENSION PERIOD
Suspension eligibility requirements
You may qualify for a temporary suspension of the 8-year period for completing your TEACH Grant service obligation if you are/were temporarily
unable to teach because you are/were residing in or are/were employed in a federally declared major disaster area as defined in the Robert T.
Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C. 5122(2)). 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.
Definitions
A federally declared major disaster is any natural catastrophe (including a hurricane, tornado, storm, high water, wind-driven water, tidal wave,
tsunami, earthquake, volcanic eruption, landslide, mudslide, snowstorm, drought, or health emergency), or, regardless of cause, any fire, flood, or
explosion, in any part of the United States, which in the determination of the President causes damage of sufficient severity and magnitude to
warrant major disaster assistance under the Robert T. Stafford Disaster Relief and Emergency Assistance Act to supplement the efforts and
available resources of States, local governments, and disaster relief organizations in alleviating the damage, loss, hardship, or suffering caused by
the natural catastrophe, fire, flood, or explosion. You can search for federally declared major disasters at https://www.fema.gov/disasters/.
United States means the fifty States, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Commonwealth of
the Northern Mariana Islands. State means any State of the United States, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American
Samoa, and the Commonwealth of the Northern Mariana Islands.
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. However, 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 residing in or
being employed in a federally declared major disaster area.
SECTION 5: IMPORTANT NOTICES
PRIVACY ACT NOTICE

The routine uses of the information that we collect about you, if your
TEACH Grant has not been converted to a Direct Unsubsidized Loan,
The Privacy Act of 1974 (5 U.S.C. 552a) requires that the following notice
include, but are not limited to, its disclosure to federal, state, or local
be provided to you:
agencies, to institutions of higher education, and to third party servicers
The authorities for collecting the requested information from and about to determine your eligibility to receive a TEACH Grant, to investigate
you are §420L et seq. and §451 et seq. of the Higher Education Act (HEA) possible fraud, and to verify compliance with federal student financial
of 1965, as amended (20 U.S.C. 1070g et seq. and 20 U.S.C. 1087a et
aid program regulations.
seq.) and the authorities for collecting and using your social security
In the event of litigation, we may send records to the Department of
number (SSN) are §484(a)(4) of the HEA (20 U.S.C. 1091(a)(4)) and
Justice, a court, adjudicative body, counsel, party, or witness if the
§31001(i)(1) of the Debt Collection Improvement Act of 1996 (31 U.S.C.
disclosure is relevant and necessary to the litigation. If this information,
7701(c)). Participating in the Teacher Education Assistance for College
either alone or with other information, indicates a potential violation of
and Higher Education (TEACH) Grant Program and/or the William D.
law, we may send it to the appropriate authority for action. We may
Ford Federal Direct Loan (Direct Loan) Program and giving us your SSN
send information to members of Congress if you ask them to help you
are voluntary, but you must provide the requested information,
with federal student aid questions. In circumstances involving
including your SSN, to participate.
employment complaints, grievances, or disciplinary actions, we may
The principal purposes for collecting the information on this form,
disclose relevant records to adjudicate or investigate the issues. If
including your SSN, are to verify your identity, to determine your
provided for by a collective bargaining agreement, we may disclose
eligibility to receive a TEACH Grant, and, if a TEACH Grant that you
records to a labor organization recognized under 5 U.S.C. Chapter 71.
receive is converted to a Direct Unsubsidized Loan, to determine
Disclosures may be made to our contractors for the purpose of
your eligibility to receive a benefit on the loan (such as deferment,
performing any programmatic function that requires disclosure of
forbearance, discharge, or forgiveness), to permit the servicing of
records. Before making any such disclosure, we will require the
your loan(s), and, if it becomes necessary, to locate you and to
contractor to maintain Privacy Act safeguards. Disclosures may also be
collect and report on your loan(s) if your loan(s) become delinquent
made to qualified researchers under Privacy Act safeguards.
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.
Page 3 of 4
U.S. Department of Education * MOHELA * 633 Spirit Drive * Chesterfield, MO 63005-1243 * Fax: 1-866-222-7060 * mohela.com
TEL: 1-888-866-4352 *International: 636-532-0600

SECTION 5: IMPORTANT NOTICES (CONTINUED)
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).
If you have comments or concerns regarding the status of your
individual submission of this form, write to:
U.S. Department of Education
MOHELA
633 Spirit Drive
Chesterfield, MO 63005-1243

Page 4 of 4
U.S. Department of Education * MOHELA * 633 Spirit Drive * Chesterfield, MO 63005-1243 * Fax: 1-866-222-7060 * mohela.com
TEL: 1-888-866-4352 *International: 636-532-0600