XXCLNDIS 1/14/2020
Student Last Name _________________________ First Name _______________________ MI _________
HCC ID __________________________________
A review of your account shows you have prior loans that were discharged.
If you are not interested in receiving additional student loans, please check here:
OR
If you are interested in receiving additional student loans, please complete the following:
1. Attach a physician’s certification specifically stating that “Student name (your name) has
the ability to engage in substantial gainful activity.” (If you are a veteran and you have been
determined by the Department of Veterans Affairs to be unemployable due to a service-connected
disability. Attach documentation from the VA verifying your TPD (total and permanent disability)
determination.)
2. Attach a typed statement explaining how circumstances have changed since the loans were
discharged and how you intend to pay back all student loans, including all discharged loans.
3. Write the following statement on a separate piece of paper:
I am aware that neither any conditionally discharged nor any new Federal Student
Loans that I am applying for can later be discharged for any present impairment unless
it deteriorates so that I am again totally and permanently disabled. Also, I acknowledge
that collection will resume on any of my conditionally discharged loans and agree to
provide documentation of the resumption of collection.
Your appeal will not be reviewed and will be considered incomplete unless all 3 items are submitted.
• I have read the above statement and understand: these loans will now go into repayment.
• It is my responsibility to contact my lender.
Signature: ______________________________________________ Date: _______________
A borrower whose prior loan was discharged due to a total and permanent disability (TPD) who wishes to take out
another Federal Student Loan, must:
• obtain a physician’s certification that she/he has the ability to engage in substantial gainful activity, and
• She/he must sign a statement that he is aware the new FSA loan can’t later be discharged for any present
impairment unless it deteriorates so that she/he is again TPD.
If the borrower is in the post-discharge monitoring period, she/he must resume payment on the previously
discharged loan before receipt of the new loan. A borrower who received a TPD discharge based on a
determination from the VA is not required to resume payment on the discharged loan.
If a defaulted loan was conditionally discharged and then reinstated, the student must make satisfactory repayment
arrangements before receiving the new loan.
Student Financial Aid Office
11400 Robinwood Drive
Hagerstown, MD 21742
finaid@hagerstowncc.edu
FAX: 301-791-9165
Loan Discharge Appeal
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, be sentenced to jail, or both.
