University of Central Missouri
Office of Student Financial Services
P.O. Box 800
Warrensburg, MO 64093-5178
Phone 660-543-8266
FAX 660-543-8080
Webpage: www.ucmo.edu/sfs
for the
Federal Student Loan
Programs
TPDIS
I acknowledge that 1) I have previously borrowed Federal Stafford Loan, Perkins Loan,
and/or Consolidation Loan funds; 2) I have allowed one or more of these loans to go into
default; and 3) my obligation to repay this loan(s) was cancelled on ____________, due to
my total and permanent disability.
I wish
to again borrow loan funds to help me pay the educational and living expenses I will
incur to attend University of Central Missouri. Therefore, I acknowledge that any Stafford
and/or PLUS Loan funds I receive cannot be cancelled or discharged at any time in the
future based on any disability present at the time each new loan is applied for, unless this
disability subsequently deteriorates to the status of a total and permanent disability, which
must then be re-certified by a physician.
I also understand that I
must submit to the UCM Office of Student Financial Services (if I
have not done so already) a statement from a physician, certifying that I am able to be
gainfully employed and to pursue normal academic activities at the University of Central
Missouri.
____________________________________________ __________________________
Borrower’s Signature Date
___
_________________________________________ 700_______________________
Borrower’s Full Name (please print) UCM ID Number
The federal Total and Permanent Disability Discharge website
(www.disabilitydischarge.com) will provide you additional detailed information.
Complete and submit this document in person (1100 Ward Edwards Bldg.),
by fax (660-543-8080), or by mail to:
University of Central Missouri
Office of Student Financial Services
P.O. Box 800
Warrensburg MO 64093-5178
Borrower Acknowledgment Loan Disability_18.pdf NOV 3, 2017
