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 Approved
Exp. Date: 11/30/2026

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.

Section 1: 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 7A and 7B 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 2. 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 2. If any of your information has changed since the last
time you reported it to your TEACH Grant servicer, check the box in Section 2 to indicate this.

•

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

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•

•

If you are requesting a suspension of your 8-year service obligation period based on
military service, complete Section 3A of the form and have an authorized official
complete Section 3B, or attach documentation as described in Section 3A. 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 “08/2024” as the beginning date
and “06/2025” 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 4A of the form and have
an authorized official complete Section 4B, or attach other documentation of your
extended call or order to active duty as described in Section 4A.

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
“08/25/2024”).

Section 2: Grant Recipient Information
See the instructions on page 1.
Social Security Number (SSN):
Name:
Address:
City:

State:

Zip Code:

Telephone – Primary:
Telephone – Alternate:
Email (optional):
Check this box if you are changing any preprinted information.

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Grant Recipient’s Name:

Grant Recipient’s SSN:

Section 3A: 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 (mm/yyyy)
and ending (mm/yyyy)
.
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 7A. I have had an authorized official complete
Section 3B, or I have attached documentation from the official that includes all of the information
requested in Section 3B and a certification that I meet the qualifying military service conditions
described in Section 7A.
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 7A; 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 (mm/dd/yyyy)
Printed Name of Representative (if applicable)
Relationship:
Representative’s Address:
City:

State:

Zip Code:

Telephone Number:

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Grant Recipient’s Name:

Grant Recipient’s SSN:

Section 3B: Authorized Official’s Certification of Your Qualifying Military Service
(For Suspension Request Only)
4B

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 7A. 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 2 meets all conditions described in Section 7A; 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/yyyy)
and ended or will end on (mm/dd/yyyy)
Qualifying military service (check the appropriate box):
Army National Guard of the United States
Marine Corps Reserve
Coast Guard Reserve

Army Reserve

Navy Reserve

Air Force Reserve
Air National Guard of the United States

Full-Time National Guard duty (as defined in Section 7A)
Address:
City:

State:

Zip Code:

Authorized Official’s Name and Title (printed)
Telephone
Authorized Official’s Signature:

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Email
Date (mm/dd/yyyy):

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Grant Recipient’s Name:

Grant Recipient’s SSN:

Section 4A: 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 7B, 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 4B 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 7B;
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.

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Grant Recipient’s Name:

Grant Recipient’s SSN:

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 7B; 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(mm/dd/yyyy)
Printed Name of Representative (if applicable) & Relationship:
Representative’s Address:
City:

State:

Zip Code:

Telephone Number:

Section 4B: Military Service Discharge Request, Documentation, Understandings,
and Certifications
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 7B. 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/yyyy)
and is expected to end on (mm/dd/yyyy)
.
Name of United States Armed Forces Component (check the appropriate box):
Army National Guard of the United States
Marine Corps Reserve

Air Force Reserve

Army Reserve

Navy Reserve

Coast Guard Reserve

Air National Guard of the United States
Full-Time National Guard duty (as defined in Section 7A)

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Grant Recipient’s Name:

Grant Recipient’s SSN:

Address:
City:

State:

Zip Code:

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

Email

Authorized Official’s Signature

Date (mm/dd/yyyy)

Please omit pages 8–12 when mailing or faxing back.

Section 5: 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:
Federal Student Aid Programs - TEACH
P.O. Box 300010
Greenville, TX 75403

•

Fax the form to 540-212-2415.

Section 6: Who can I contact if I have questions?
If you need help completing this form, contact 1-800-4-FED-AID.

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Section 7A: 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 2) 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 7B.

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Section 7B: 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 7A); 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

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•

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 8: 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.
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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).

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If you have comments or concerns regarding the status of your individual submission of this form,
write to:
Federal Student Aid Programs - TEACH
P.O. Box 300010
Greenville, TX 75403

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