Loan Discharge Applications (DL/FFEL/Perkins)

	LOAN DISCHARGE APPLICATION: SCHOOL CLOSURE William D. Ford Federal Direct Loan (Direct Loan) Program Federal Family Education Loan (FFEL) Program Federal Perkins Loan Program	OMB No. 1845-0058 Form Approved Exp. Date 12/31/2026
	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 the following information.
SSN
Date of Birth
Name
Address
City		State			Zip Code
Telephone
Email

SECTION 2: SCHOOL CLOSURE INFORMATION

1. You are applying for this loan discharge as a:

Student borrower - Skip to Item 4.

Parent PLUS borrower - Continue to Item 2. If a question includes "(or the student)," answer as it applies to the student for whom you borrowed the loan.

2. Student Name (Last, First, MI):

______________________________________________

3. Student SSN: ___________________________________

4. Closed School Name:

______________________________________________

5. Closed School Address (Street, City, State, Zip Code):

______________________________________________

______________________________________________

6. First and last dates that you (or the student) attended the closed school:

   First Date: ____________	or	Don’t Know
   Last Date: ____________	or	Don’t Know

7. Name of the program of study you (or the student) were last enrolled in before the school closed:

______________________________________________

8. Did you (or the student) complete the program before the school closed?

Yes - You are not eligible for this discharge.

No - Continue to Item 9.

9. Were you (or the student) still enrolled in the program when the school closed?

Yes - Skip to Item 13.

No - Continue to Item 10.

10. Were you (or the student) on an approved leave of absence when the school closed?

Yes - Provide the dates of the leave of absence, then skip to Item 13.

First Date: ____________	or	Don’t Know
Last Date: ____________	or	Don’t Know

No - Continue to Item 11.

11. Did you (or the student) withdraw from the school before the school closed?

Yes – Continue to Item 12.

No - Skip to Item 13.

12. On what date did you (or the student) withdraw from the school? See Section 6 for an explanation of how this date can affect eligibility for a closed school discharge.

______________________________________________

13. Select the option that most closely describes your (or the student's) efforts to complete the program of study:

Didn’t accept a teach-out agreement or continue the program of study at a different branch or location of the closed school (see Section 5). - Skip to Item 15.

Enrolled in a teach-out agreement or continued my program of study at a different branch or location of the closed school (see Section 5). - Continue to Item 14.

Borrower Name ____________________________________________________ Borrower SSN _____________________________

SECTION 2: SCHOOL CLOSURE INFORMATION (Continued)

14. Select the option that most closely describes your (or the student's) enrollment status in the program identified in Item 13:

Completed a teach-out agreement or program of study (see Section 5). - You’re ineligible for this discharge.

Withdrew from the teach-out agreement or program of study. - Continue to Item 15.

Still enrolled in the teach-out agreement or program of study (see Section 5). - You’re ineligible for this discharge at this time (see Section 6).

15. Have you (or the student) requested or received a refund or payment from the closed school or any third party (see Section 6) as a result of the school’s closure for any loan that you are requesting be discharged?

Yes - Continue to Item 16.

No - Sign and date the application in Section 3, then send it to the address in Section 7.

Don't Know - Sign and date the application in Section 3, then send it to the address in Section 7.

16. Was the refund or payment in item 15 issued by the closed school?

No - Continue to Items 17–18.

Yes - Skip to Items 19–20.

17. Provide the name, address, and telephone number of the party you (or the student) requested or received a payment from:

Name: _________________________________________

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

______________________________________________

______________________________________________

Telephone Number: _____________________________

18. What is the amount and the status of the claim?

Amount: ______________________________________

Status: ________________________________________

19. What was the amount of any payment received? If none, enter "0."

____________________________________________

20. Explain why the amount in Item 19 was received; if none, enter N/A.

Sign and date the application in Section 3, then send it to the address in Section 7.

SECTION 3: BORROWER CERTIFICATIONS, ASSIGNMENT, AND AUTHORIZATION

I certify that:

• I (or the student) was enrolled at the school when it closed, was on an approved leave of absence when the school closed, withdrew from the school not more than 180 days before it closed, or withdrew more than 180 days before it closed due to exceptional circumstances described in Section 6.

• Due to the school's closure, I (or the student) did not complete the program of study at the closed school.

• I (or the student) did not complete, am not currently completing, and have not made arrangements to complete the program of study at another branch or location of the closed school or at another school through a teach-out agreement.

• I have read and agree to the terms and conditions for loan discharge, as specified in Section 6.

• Under penalty of perjury, all of the information I have provided on this application and in any accompanying documentation is true and accurate to the best of my knowledge and belief.

By signing this application, I assign and transfer to the U.S. Department of Education (the Department) any right I have to a refund on the amount discharged from the school and/or from any owners, affiliates, or assignees of the school, and from any third party that pays claims for a refund because of the actions of the school.

I authorize the organization I submit this request to and its agents to contact me regarding my request or my loans at the cellular telephone number that I provide now or in the future using automated telephone dialing equipment or artificial or prerecorded voice or text messages.

Borrower's Signature ______________________________________________________ Date ________________________

SECTION 4: INSTRUCTIONS FOR COMPLETING THE APPLICATION

When completing this application, type or print using dark ink. Enter dates as month/day/year (mm/dd/yyyy). Use only numbers. Example: March 14, 2024 = 03/14/2024. If you need more space to answer any of the items, continue on separate sheets of paper and attach them to this application. Identify the item number for which you are providing additional information. Include your name and Social Security Number (SSN) at the top of page 2 and on any attached pages. Return the completed application and any documentation to the address shown in Section 7.

SECTION 5: DEFINITIONS

The William D. Ford Federal Direct Loan (Direct Loan) Program includes Federal Direct Stafford/Ford (Direct Subsidized) Loans, Federal Direct Unsubsidized Stafford/Ford (Direct Unsubsidized) Loans, Federal Direct PLUS (Direct PLUS) Loans, and Federal Direct Consolidation (Direct Consolidation) Loans.

The Federal Family Education Loan (FFEL) Program includes Federal Stafford Loans (both subsidized and unsubsidized), Federal Supplemental Loans for Students (SLS), Federal PLUS Loans, and Federal Consolidation Loans.

The Federal Perkins Loan (Perkins Loan) Program includes Federal Perkins Loans, National Direct Student Loans (NDSL), and National Defense Student Loans (Defense Loans).

The date a school closed is the earlier of the date, determined by the Department, that the school ceased to provide educational instruction in programs in which most students at the school were enrolled, or a date, determined by the Department, that reflects when the school ceased to provide educational instruction for all of its students.

A leave of absence from school is considered to be an approved leave of absence only if it meets certain requirements specified in the Department's regulations. A student who is on an approved leave of absence is considered to still be enrolled at the school.

The holder of your Direct Loan Program loans is the Department. The holder of your FFEL Program loans may be a lender, a guaranty agency, or the Department. The holder of your Perkins Loans may be a school 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.

If your loan is discharged, this means that you (and any endorser) are not required to repay the remaining portion of the loan, and you will be reimbursed for any payments on the loan that you made voluntarily or through forced collection (for example, through wage garnishment or Treasury offset). For a consolidation loan, only the portion that represents the original loans you received that are eligible for discharge will be discharged. The loan holder reports the discharge to all consumer reporting agencies to which the holder previously reported the status of the loan and requests the removal of any adverse credit history previously associated with the loan.

The student refers to the borrower or, in the case of a parent PLUS loan, the student the parent borrower obtained a Direct PLUS Loan or Federal PLUS Loan for.

Program of study means the instructional program leading to a degree or certificate you (or the student) were enrolled in.

School means the school's main campus, or any location or branch of the main campus.

A teach-out agreement is a written agreement between schools that is approved by the school’s accrediting agency and, if applicable, the school’s state authorizing agency that provides for the equitable treatment of students and a reasonable opportunity for students to complete their program of study if a school ceases to operate before all students have completed their program of study.

Third party refers to any entity that may provide reimbursement for a refund owed by the school, such as a state or other entity offering a tuition recovery program.

SECTION 6: TERMS AND CONDITIONS FOR LOAN DISCHARGE BASED ON SCHOOL CLOSURE

Only loans made on or after January 1, 1986, are eligible for this type of discharge.

You are eligible for loan discharge based on school closure only if the location or campus that you (or the student) were attending closed. If you (or the student) were taking distance education classes, you are eligible for discharge only if the main campus of the school closed.

To be eligible for this type of discharge, you (or the student) must have (1) been enrolled at the school or on an approved leave of absence on the date that the school closed or (2) withdrawn from the school not more than 180 days before it closed, or (3) If you accepted, but did not complete, a teach-out agreement or the continuation of your program of study at a different location or branch of the closed school.

SECTION 6: TERMS AND CONDITIONS FOR LOAN DISCHARGE BASED ON SCHOOL CLOSURE (Continued)

You may automatically be eligible for this type of discharge without the need for an application one year after the date of the school’s closure if the Department determines you are eligible for this discharge based on information available.

If you accepted, but did not complete, a teach-out agreement or the continuation of your program of study at a different location or branch of the closed school, this discharge may be granted without application one year after your last date of enrollment in the teach-out agreement or continuation of your program of study.

If you are denied a closed school discharge for all or some of your loans from your school because your school reported that you completed a program of study with a credential level less than the credential level you were pursuing. You may become eligible for this type of discharge if you provide evidence that the program reported by the school was for a credential level that is lesser than the credential level you were enrolled in.

If you (or the student) withdrew more than 180 days before the school closed, you may be eligible for discharge if the Department determines that exceptional circumstances related to the school's closing justify an extension of this 180-day period.

Examples of exceptional circumstances include, but are not limited to, the following:

• The revocation or withdrawal by an accrediting agency of the school's institutional accreditation

• The school being or having been placed on probation or issued a show-cause order, or placed on an equivalent accreditation status, by its accrediting agency for failing to meet one or more of the agency's standards

• The revocation or withdrawal by the state authorization or licensing authority to operate or to award academic credentials in the state

• The termination by the Department of the school's participation in a Title IV, HEA program

• A finding by a state or federal government agency that the school violated state or federal law related to education or services to students

• A state or federal court judgment that a school violated state or federal law related to education or services to students

• The teach-out of the student’s educational program exceeding the 180-day look-back period for a closed school discharge

• The school responsible for the teach-out of the student’s educational program failing to perform the material terms of the teach-out plan or agreement, such that the student does not have a reasonable opportunity to complete his or her program of study

• The school’s discontinuation of a significant share of its academic programs

• The permanent closure of all or most of the school’s in-person locations while maintaining online programs

• The school’s placement on the heightened cash monitoring payment method as defined in § 668.162(d)(2)

By signing this application, you are agreeing to provide, upon request, testimony, a sworn statement, or other documentation reasonably available to you that demonstrates to the satisfaction of the Department or its designee that you meet the qualifications for loan discharge, or that supports any statement you made on this application or in any accompanying documents.

By signing this application, you are agreeing to cooperate with the Department or the Department's designee in any enforcement action related to this application.

Your application may be denied or your discharge may be revoked if you fail to provide testimony, a sworn statement, or documentation upon request, or if you provide testimony, a sworn statement, or documentation that does not support the material representations you made on this application or in any accompanying documents.

SECTION 7: WHERE TO SEND THE COMPLETED APPLICATION

Return the completed application and any documentation to: (If no address is shown, return to your loan holder.)

If you need help completing this application, call: (If no telephone number is shown, call your loan holder.)

SECTION 8: IMPORTANT NOTICES

Privacy Act Statement

Authority: The authorities for collecting the requested information from and about you are §421 et seq. and §451 et seq. of the Higher Education Act of 1965, as amended (20 U.S.C. 1071 et seq. and 20 U.S.C. 1087a et seq.), and the authorities for collecting and using your Social Security Number (SSN) are §§428B(f) and 484(a)(4) of the HEA (20 U.S.C. 1078-2(f) and 1091(a)(4)) and 31 U.S.C. 7701(b).

Purpose: The principal purposes for collecting the information on the Loan Discharge Application: School Closure 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 William D. Ford Federal Direct Loan (Direct Loan), Federal Family Education Loan (FFEL) and/or Federal Perkins Loan (Perkins Loan) programs, to permit the servicing of your loans, to enforce the conditions or terms of a title IV, HEA obligation, to originate, disburse, service, collect, assign, adjust, transfer, refer, furnish credit information for, and discharge a title IV, HEA obligation, to verify whether a title IV, HEA obligation qualifies for discharge, to determine credit balances to be refunded by the U.S. Department of the Treasury (Treasury) to the individual or loan holder, 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.

Disclosures: The information provided on the Loan Discharge Application: School Closure form will only be disclosed outside of the U.S. Department of Education (Department) with prior written consent or as otherwise allowed by the Privacy Act of 1974, as amended (Privacy Act) (5 U.S.C. 552a). One of the exceptions to the Privacy Act’s prior written consent requirement that allows for disclosure, without consent, is for “routine uses” that the Department publishes in our System of Records Notices (SORNs). The Department may disclose, without consent, the information provided on a Loan Discharge Application: School Closure form, on a case-by-case basis or under a computer matching program, to third parties pursuant to the routine uses identified in the “Common Services for Borrowers (CSB) System” (18-11-16) SORN. This notice is available on the Department’s “Privacy Act System of Record Notice Issuances (SORN)” webpage located at https://www2.ed.gov/notices/ed-pia.html.

These routine uses included, but are not limited to:

• To verify the identity of the individual whom records indicate has applied for or received title IV, HEA program funds, disclosures may be made to guaranty agencies, educational and financial institutions, and their authorized representatives; to Federal, State, Tribal, or local agencies, and their authorized representatives; to private parties, such as relatives, business and personal associates, and present and former employers; to creditors; to consumer reporting agencies; to adjudicative bodies; and to the individual whom the records identify as the party obligated to repay the title IV, HEA obligation;

• To determine program eligibility and benefits, disclosures may be made to guaranty agencies, educational and financial institutions, and their authorized representatives; to Federal, State, or local agencies, and their authorized representatives; to private parties, such as relatives, business and personal associates, and present and former employers; to creditors; to consumer reporting agencies; and to adjudicative bodies;

• To enforce the conditions or terms of a title IV, HEA obligation, disclosures may be made to guaranty agencies, educational and financial institutions, and their authorized representatives; to Federal, State, or local agencies, and their authorized representatives; to private parties, such as relatives, business and personal associates, and present and former employers; to creditors; to consumer reporting agencies; to adjudicative bodies; and to the individual whom the records identify as the party obligated to repay the title IV, HEA obligation;

• To permit originating, disbursing, servicing, collecting, assigning, adjusting, transferring, referring, furnishing of credit information, or discharging title IV, HEA obligations, disclosures may be made to guaranty agencies, educational institutions, or financial institutions that originated, held, serviced, or have been assigned the title IV, HEA obligation, and their authorized representatives; to a party identified by the debtor as willing to advance funds to repay the title IV, HEA obligation; to Federal, State, or local agencies, and their authorized representatives; to private parties, such as relatives, business and personal associates, and present and former employers; to creditors; to consumer reporting agencies; and to adjudicative bodies;

• To investigate possible fraud or abuse or to verify compliance with contractual requirements or Federal, State, local, or Tribal statutory, regulatory, or program requirements, disclosures may be made to guaranty agencies, educational and financial institutions, third-party servicers, and their authorized representatives; to Federal, State, Tribal, or local agencies, and their authorized representatives; to private parties, such as relatives, present and former employers, and business

SECTION 8: IMPORTANT NOTICES (Continued)

and personal associates; to creditors; to consumer reporting agencies; and to adjudicative bodies;

• To locate a delinquent or defaulted borrower, or an individual who owes a title IV, HEA obligation, disclosures may be made to guaranty agencies;

• To verify whether a title IV, HEA obligation qualifies for discharge, disclosures may be made to guaranty agencies, educational and financial institutions, and their authorized representatives; to Federal, State, or local agencies, and their authorized representatives; to private parties, such as relatives, present and former employers, and business and personal associates; to creditors; to consumer reporting agencies; and to adjudicative bodies;

• To prepare a title IV, HEA obligation for litigation, to provide support services for litigation on a title IV, HEA obligation, to litigate a title IV, HEA obligation, or to audit the results of litigation on a title IV, HEA obligation, disclosures may be made to FFEL loan holders or servicers; Department contractors including but not limited to, Federal Loan Servicers, NFP Federal Loan Servicers, the Federal Perkins Servicer, PCAs and to guaranty agencies and their authorized representatives; Federal, State, Tribal, or local agencies, and their authorized representatives; and to adjudicative bodies.

For additional routine uses, view the “Common Services for Borrowers (CSB) System” (18-11-16) SORN. This notice is available on the Department’s “Privacy Act System of Record Notice Issuances (SORN)” webpage located at https://www2.ed.gov/notices/ed-pia.html.

Consequences of Failure to Provide Information: Participating in the Direct Loan Program, the FFEL Program, or the Perkins Loan Program is voluntary, but providing the Department your SSN and requested information is mandatory to participate.

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 0MB control number. The valid 0MB control number for this information collection is 1845-0058. Public reporting burden for this collection of information is estimated to average 30 minutes 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 or retain a benefit (34 CFR 674.33(g)(4), 682.402(d)(3), or 685.214(c)).

If you have comments or concerns regarding the status of your individual submission of this form, contact your loan holder directly.

Page 3 of 10