Fillable Loan Request After Discharge Borrower Request (Grays Harbor College)

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Loan Request After Discharge Borrower Request (Grays Harbor College)

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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 – Borrower Request
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 your NSLDS record (www.studentloans.gov access with your U.S. Department of Education PIN), one or
more of your prior federal educational loans has been discharged due to total and permanent disability. This discharge
means that you may not be considered for further federal student loans unless you re-establish eligibility by submitting
this form signed by you, and a statement from a legally licensed physician stating that you are no longer totally and
permanently disabled.
STUDENT CERTIFICATION
I certify that I am aware that any new federal educational loans that I borrow cannot be discharged in the future on the
basis of any impairment present at the time the new loan is accepted unless my impairment substantially deteriorates.
In addition, acceptance of a new federal educational loan may prevent final discharge of prior educational loans which
were conditionally discharged due to total and permanent disability after July 1, 2010. I understand that I must sign this
statement for each new loan that I apply for.
I am aware that collection activity will resume on any loans still in a total and permanent disability conditional discharge
period and that I am responsible for repayment of these loans.
I understand that I must cancel all of my pending requests for loan discharge based on disability.
I understand that I must submit a statement from my physician stating that I am no longer totally and permanently
disabled.
Signature Date
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
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Loan Request After Discharge Borrower Request (Grays Harbor College)

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Completed 27 July 2020

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