Records Code: DLPAP
Version Date: 01/01/14
Provide contact information for two adults with different U.S. addresses who do not live with you and who have known you
for at least three years. References who live outside the United States are not acceptable. If a reference does not have a
telephone number or e-mail address, or does not wish to provide an e-mail address, enter N/A.
If you provide an e-mail address for a reference, we may use it to communicate with the reference.
I certify that the details listed above are true and correct, and understand the terms and conditions above.
Federal Direct Consolidation Loan Program Request to Update Reference Details
Borrower Name
Account Number
Name
Address
City Zip Code
Phone Email
Name
Relationship
Relationship
Address
City Zip Code
Phone Email
Date
Send completed form to: FedLoan Servicing
P.O. Box 69184
Harrisburg, PA 17106-9184
Or fax to: 717-720-1628
Borrower Signature
State
State
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