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/DISCHARGE REQUEST:
MILITARY SERVICE

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

Teacher Education Assistance for College and Higher Education (TEACH) Grant Program
MIL

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:

•
•

o

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 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

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, 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/uploadDocument.

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 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 5 30D DRAFT 09/12/2023

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 as indicated below began or will begin on (mm-dd-yy) ___ ___- ___ ___ - 20 ___ ___ and
ended or will end on (mm-dd-yy) ___ ___- ___ ___ - 20 ___ ___
Qualifying military service (check the appropriate box):
Army National Guard of the United States
Army Reserve
Navy Reserve
Marine Corps Reserve
Air Force Reserve
Coast Guard Reserve
Air National Guard of the United States
Full-Time National Guard duty (as defined in Section 4A)
Address (Street, City, State, Zip Code) ________________________________________________________________________________________
Authorized Official’s Name and Title (printed) __________________________________________________________________________________
Telephone ( _______ ) _______ - _____________ Email __________________________________________________________________________
Authorized Official’s Signature _______________________________________________________________ Date ___ ___ - ___ ___ - 20 ___ ___

Page 2 of 5
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

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.
2.
3.
4.

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;
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;
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
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 ___ ___

Page 3 of 5
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 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.

Page 4 of 5
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
PRIVACY ACT NOTICE

associates, to creditors, to financial and educational institutions, and to
The Privacy Act of 1974 (5 U.S.C. 552a) requires that the following notice guaranty agencies to verify your identity, to determine your program
eligibility and benefits, to permit making, servicing, assigning, collecting,
be provided to you:
The authorities for collecting the requested information from and about adjusting or discharging your loan(s), to enforce the terms of the loan(s),
you are §420L et seq. and §451 et seq. of the Higher Education Act (HEA) to investigate possible fraud and to verify compliance with federal
student financial aid program regulations, to locate you if you become
of 1965, as amended (20 U.S.C. 1070g et seq. and 20 U.S.C. 1087a et
delinquent in your loan payments or if you default, or to verify whether
seq.) and the authorities for collecting and using your social security
your debt qualifies for discharge or cancellation. To provide default rate
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. calculations, disclosures may be made to guaranty agencies, to financial
and educational institutions, or to federal, state or local agencies. To
7701(c)). Participating in the Teacher Education Assistance for College
provide financial aid history information, disclosures may be made to
and Higher Education (TEACH) Grant Program and/or the William D.
educational institutions. To assist program administrators with tracking
Ford Federal Direct Loan (Direct Loan) Program and giving us your SSN
refunds and cancellations, disclosures may be made to guaranty
are voluntary, but you must provide the requested information,
agencies, to financial and educational institutions, or to federal or state
including your SSN, to participate.
agencies.
The principal purposes for collecting the information on this form,
To provide a standardized method for educational institutions to
including your SSN, are to verify your identity, to determine your
efficiently submit student enrollment status, disclosures may be made
eligibility to receive a TEACH Grant, and, if a TEACH Grant that you
to guaranty agencies or to financial and educational institutions. To
receive is converted to a Direct Unsubsidized Loan, to determine
counsel you in repayment efforts, disclosures may be made to guaranty
your eligibility to receive a benefit on the loan (such as deferment,
agencies, to financial and educational institutions, or to federal, state, or
forbearance, discharge, or forgiveness), to permit the servicing of
local
agencies.
your loan(s), and, if it becomes necessary, to locate you and to
PAPERWORK REDUCTION NOTICE
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
According to the Paperwork Reduction Act of 1995, no persons are
permit you to access your account information electronically.
required to respond to a collection of information unless it displays a
The information in your file may be disclosed, on a case-by-case basis or currently valid OMB control number. The valid OMB control number for
this information collection is 1845-0158. Public reporting burden for this
under a computer matching program, to third parties as authorized
collection of information is estimated to average 20 minutes (0.33
under routine uses in the appropriate systems of records notices.
hours) per response, including time for reviewing instructions, searching
The routine uses of the information that we collect about you, if your
existing data resources, gathering and maintaining the data needed, and
TEACH Grant has not been converted to a Direct Unsubsidized Loan,
completing and reviewing the collection of information. The obligation
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 respond to this collection is required to obtain a benefit in
accordance with 34 CFR 686.41(b) or 34 CFR 686.42(c).
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 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

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
Page 5 of 5
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