MIDLANDSTECH.EDU | PO BOX 2408 | COLUMBIA SC 29202 | 803.738.7792
PHYSICIAN SECTION
Note: Physician, please complete Section A or Section B as applicable and mail to:
Midlands Technical College
Attn: Cheryl Lindsey
PO Box 2408
Columbia, SC 29202
SECTION A
I certify that, in my best professional judgment, the condition of (name of
borrower) has improved enough to allow him or her to either engage in substantial gainful activity or
to attend school. I further certify that this improvement of condition could not have been reasonably
foreseen on (date of original certification of total and permanent disability).
Warning: Previous student loan debts have been cancelled due to Total and Permanent Disability.
Certification of this form enables the borrower to obtain additional financial aid. Any person who
knowingly makes false statements or misrepresentation on this form shall be subject to penalties
which may include fines or imprisonment under the United States Criminal Code 20 USC 1097.
Signature of Physician (M.D. or D.O.) Date
Print or Type Physician’s Name Physician Phone Number
Physician’s Address (include suite #) City State Zip Code
STUDENT FINANCIAL SERVICES
CERTIFICATION OF
BORROWER’S CONDITION
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MIDLANDSTECH.EDU | PO BOX 2408 | COLUMBIA SC 29202 | 803.738.7792
SECTION B
I certify, in my best professional judgment, the condition of (name of
borrower) has not improved enough to allow him or her to either engage in substantial gainful activity
or to attend school.
Signature of Physician (M.D. or D.O.) Date
Print or Type Physician’s Name Physician Phone Number
Physician’s Address (include suite #) City State Zip Code
STUDENT SECTION
Please read the statement below and sign.
I understand that any new student loans awarded by Midlands Technical College may not be discharged due to
the same or any disability existing at the time the new loan is made, unless the disabling condition substantially
deteriorates to the extent that the condition of total and permanent disability is met.
Signature of Student Date
Print Name of Student MTC ID Number
SD-18-4168A-01-18
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signature
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