Financial Aid Office, 1620 Edward P Smith Dr, Aberdeen, WA 98520
www.ghc.edu/finaid (360) 538-4081 Fax: (360) 538-4293 finaid@ghc.edu Revised: 08/30/2017
Loan Request After Discharge – Physician Statement
Borrower Information
Last Name First Name SSN
Date of Birth GHC SID
Space holder
Request to re-establish Federal Student Loan Eligibility
after discharge of prior educational loan(s)
due to total and permanent disability
According to NSLDS records (www.studentloans.gov access with U.S. Department of Education PIN), one or more of this
borrower’s prior federal educational loans has been discharged due to total and permanent disability. This discharge
means that the borrower may not be considered for further federal student loans unless eligibility is re-established by
submitting a statement from a legally licensed physician stating that the borrower is no longer totally and permanently
disabled and a form acknowledging that the borrower will repay future loans.
PHYSICIAN STATEMENT
The above referenced borrower was previously classified as totally and permanently disabled and received a discharge
of their student loans as a result of the classification. The borrower is now requesting more student loan funds from the
federal government. Please respond to the following question as required by the U.S. Department of Education.
Is the borrower totally and permanently disabled and, therefore, unable to work and earn money*? Yes No
*Totally and Permanently Disabled means that a borrower must be unable to work and earn money because of an injury
or illness that is expected to continue indefinitely or result in death. NOTE: This standard may be different from
standards used under other private and public programs in connection with occupational disability or eligibility for social
services.
Comments:
Physician Name Phone Professional License # (Subject to verification)
Address City State
Physician’s Signature Date