LOAN DISCHARGE APPLICATION: SCHOOL CLOSURE
William D. Ford Federal Direct Loan (Direct Loan) Program
Federal Family Education Loan (FFEL) Program
Federal Perkins Loan Program
OMB No. 1845-0058
Form Approved
Exp. Date 9/30/2020
WARNING: Any person who knowingly makes a false statement or misrepresentation on this form or on
any accompanying document is subject to penalties that may include fines, imprisonment, or both, under
the U.S. Criminal Code and 20 U.S.C. 1097.
SECTION 1: BORROWER IDENTIFICATION
Please enter or correct the following information.
Check this box if any of your information has changed.
SSN
Name
Address
City
State
Zip Code
Telephone - Primary
Telephone - Alternate
Email (Optional)
SECTION 2: SCHOOL CLOSURE INFORMATION
1. You are applying for this loan discharge as a:
Student borrower - Skip to Item 4.
Parent PLUS borrower - Continue to Item 2. If a
question includes "(or the student)", answer as it
applies to the student you borrowed the loan for.
2.
Student Name (Last, First, MI):
3.
Student SSN:
4.
Closed School Name:
5.
Closed School Address (Street, City, State, Zip Code):
6. First and last dates that you (or the student) attended
the closed school:
7.
Name the program you (or the student) were last
enrolled in before the school closed:
8. Did you (or the student) complete the program before
the school closed?
Yes - You are not eligible for this discharge.
No - Continue to Item 9.
9. Were you (or the student) on an approved leave of
absence when the school closed?
Yes - Provide the dates of the leave of absence, then
skip to Item 13:
No - Continue to Item 10.
10. Were you (or the student) still enrolled in the program
when the school closed?
Yes - Skip to Item 13.
No - Continue to Item 11.
11. Did you (or the student) withdraw from the school
before the school closed?
Yes - Continue to Item 12.
No - Skip to Item 13.
12.
On what date did you (or the student) withdraw from
the school? See Section 6 for an explanation of how
this date can affect eligibility for a closed school
discharge.
Page 1 of 5
Don't Know
OR
Last Date:
First Date:
Don't Know
OR
Last Date:
First Date:
Carefully read the entire application before completing it. Complete Section 2 in its entirety.
LS850-XSPC
Borrower Name Borrower SSN
SECTION 2: SCHOOL CLOSURE INFORMATION (CONTINUED)
13. Select the option that most closely describes your (or
the student's) efforts to complete the program of study
after the school closed:
Haven't enrolled in any program at another school
since the school closed - Skip to Item 16.
Enrolled in a program that was not comparable to
the program I attended at the closed school - Skip
to Item 16.
Enrolled in a teach-out plan (see Section 5) at
another school - Continue to Item 14.
Enrolled in the same or a comparable program at
another school - Continue to Item 14.
14. Select the option that most closely describes your (or
the student's) enrollment status in the program
identified in Item 13:
Completed a teach-out plan (see Section 5) - You
are not eligible for this discharge.
Completed the same or comparable program -
Continue to Item 15.
Withdrew from the program - Skip to Item 16.
Still enrolled in the teach-out plan (see Section 5) -
You are not eligible for this discharge.
Still enrolled in the same or comparable program -
Continue to Item 15.
15. Select the option that most closely describes how the
new school gave you (or the student) credit for the
training received at the closed school:
New school accepted transfer credits from the
closed school - You are not eligible for discharge.
New school did not require me (or the student) to
complete core credits for the program after
evaluating my (or the student's) competency
through testing or interviews, or by other
comparable means - You are not eligible for this
discharge.
New school did not accept any transfer credit from
the closed school or give me (or the student) credit
by any other means - Continue to Item 16.
16. Did the closed school refund any money on your
behalf?
Yes - Continue to Items 17-19.
No - Skip to Item 19.
Don't Know - Skip to Item 19.
17.
What was the amount of the refund?
18.
Explain why the money was refunded:
19. Have you (or the student) requested or received a
refund or payment from the closed school or any third
party (see Section 6) for any loan that you are
requesting be discharged?
Yes - Continue to Items 20-22.
No - Sign and date the application in Section 3, then
send it to the address in Section 7.
Don't Know - Sign and date the application in
Section 3, then send it to the address in Section 7.
20. Provide the name, address, and telephone number of
the party you (or the student) requested or received a
payment from:
Name:
Address (Street, City, State, Zip Code):
Telephone Number:
21. What is the amount and the status of the claim?
Amount:
Status:
22.
What was the amount of any payment received? If
none, enter "0".
Sign and date the application in Section 3, then send it to
address in Section 7.
Page 2 of 5
LS850-XSPC
Borrower Name Borrower SSN
SECTION 3: BORROWER CERTIFICATIONS, ASSIGNMENT, AND AUTHORIZATION
I certify that:
I (or the student) was enrolled at the school when it closed, was on an approved leave of absence when the school
closed, withdrew from the school not more than 120 days before it closed, or withdrew more than 120 days before it
closed due to exceptional circumstances described in Section 6.
Due to the school's closure, I (or the student) did not complete the program of study at the closed school.
I (or the student) did not complete, am not currently completing, and have not made arrangements to complete the
same or a comparable program of study at another school through a teach-out plan, by transferring credits or hours
earned at the closed school to another school, or by any other comparable means.
I have read and agree to the terms and conditions for loan discharge, as specified in Section 6.
Under penalty of perjury, all of the information I have provided on this application and in any accompanying
documentation is true and accurate to the best of my knowledge and belief.
By signing this application I assign and transfer to the U.S. Department of Education (the Department) any right I have to a
refund on the amount discharged from the school and/or from any owners, affiliates, or assignees of the school, and from any
third party that pays claims for a refund because of the actions of the school.
I authorize the organization I submit this request to and its agents to contact me regarding my request or my loans at the
cellular telephone number that I provide now or in the future using automated telephone dialing equipment or artificial or
prerecorded voice or text messages.
Borrower's Signature
Date
SECTION 4: INSTRUCTIONS FOR COMPLETING THE APPLICATION
When completing this application, type or print using dark ink. Enter dates as month-day-year (mm-dd-yyyy). Use only
numbers. Example: March 14, 2018 = 03-14-2018. If you need more space to answer any of the items, continue on separate
sheets of paper and attach them to this application. Indicate the number of the Items you are answering. Include your name
and Social Security Number (SSN) at the top of pages 2 and 3 and on any attached pages. Return the completed application
and documentation to the address shown in Section 7.
SECTION 5: DEFINITIONS
The William D. Ford Federal Direct Loan (Direct Loan)
Program includes Federal Direct Stafford/Ford (Direct
Subsidized) Loans, Federal Direct Unsubsidized Stafford/
Ford (Direct Unsubsidized) Loans, Federal Direct PLUS
(Direct PLUS) Loans, and Federal Direct Consolidation
(Direct Consolidation) Loans.
The Federal Family Education Loan (FFEL) Program
includes Federal Stafford Loans (both subsidized and
unsubsidized), Federal Supplemental Loans for Students
(SLS), Federal PLUS Loans, and Federal Consolidation Loans.
The Federal Perkins Loan (Perkins Loan) Program
includes Federal Perkins Loans, National Direct Student
Loans (NDSL), and National Defense Student Loans (Defense
Loans).
The date a school closed is the date that the school
stopped providing educational instruction in all programs
as determined by the the Department.
A leave of absence from school is considered to be an
approved leave of absence only if it meets certain
requirements specified in the Department's regulations. A
student who is on an approved leave of absence is
considered to still be enrolled at the school.
The holder of your Direct Loan Program loans is the
Department. The holder of your FFEL Program loans may be
a lender, a guaranty agency, or the Department. The holder
of your Perkins Loans may be a school or the Department.
Your loan holder may use a servicer to handle billing and
other communications related to your loans. References to
“your loan holder” on this form mean either your loan holder
or your servicer.
Page 3 of 5
LS850-XSPC
SECTION 5: DEFINITIONS (CONTINUED)
If your loan is discharged, this means that you (and any
endorser) are not required to repay the remaining portion
of the loan, and you will be reimbursed for any payments
on the loan that you made voluntarily through forced
collection (for example, through wage garnishment or
Treasury offset). For a consolidation loan, only the portion
that represents the original loans you received and that are
eligible for discharge will be discharged. The loan holder
reports the discharge to all consumer reporting agencies to
which the holder previously reported the status of the loan
and requests the removal of any adverse credit history
previously associated with the loan.
The student refers to the student the parent borrower
obtained a Direct PLUS Loan or Federal PLUS Loan for.
Program of study means the instructional program
leading to a degree or certificate you (or the student) were
enrolled in.
School means the school's main campus, or any location
or branch of the main campus.
A teach-out plan is a written agreement between
schools that provides for the equitable treatment of
students and a reasonable opportunity for students to
complete their program of study if a school ceases to
operate before all students have completed their program
of study.
Third party refers to any entity that may provide
reimbursement for a refund owed by the school, such as a
State or other entity offering a tuition recovery program.
SECTION 6: TERMS AND CONDITIONS FOR LOAN DISCHARGE BASED ON SCHOOL CLOSURE
Only loans made on or after January 1, 1986 are eligible
for this type of discharge.
You are eligible for loan discharge based on school
closure only if the location or campus that you (or the
student) were attending closed. If you (or the student) were
taking distance education classes, you are eligible for
discharge only if the main campus of the school closed.
You (or the student) must have been enrolled at the
school or on an approved leave of absence on the date that
the school closed, or must have withdrawn from the school
not more than 120 days before it closed to be eligible for this
type of discharge.
If you or the student withdrew more than 120 days
before the school closed, you may be eligible for discharge if
the Department determines that exceptional circumstances
related to the school's closing justify an extension of this
120-day period.
Examples of exceptional circumstances include, but are
not limited to:
By signing this application, you are agreeing to provide,
upon request, testimony, a sworn statement, or other
documentation reasonably available to you that
demonstrates to the satisfaction of the Department or its
designee that you meet the qualifications for loan discharge,
or that supports any statement you made on this application
or in any accompanying documents.
By signing this application, you are agreeing to cooperate
with the Department or the Department's designee in any
enforcement action related to this application.
Your application may be denied or your discharge may
be revoked if you fail to provide testimony, a sworn
statement, or documentation upon request, or if you
provide testimony, a sworn statement, or documentation
that does not support the material representations you
made on this application or in any accompanying
documents.
Page 4 of 5
The closed school's loss of accreditation;
The closed school's discontinuation of the majority
of its academic programs;
Action by the State to revoke the closed school's
license to operate or award academic credentials in
the State; or
A finding by a State or Federal government agency
that the closed school violated State or Federal law
while you (or the student) were enrolled at the
school.
LS850-XSPC
SECTION 7: WHERE TO SEND THE COMPLETED APPLICATION
Return the completed application and any documentation to:
(If no address is shown, return to your loan holder.)
If you need help completing this application, call:
(If no telephone number is shown, call your loan holder.)
SECTION 8: IMPORTANT NOTICES
Privacy Act Notice. The Privacy Act of 1974 (5 U.S.C.
552a) requires that the following notice be provided to you:
The authorities for collecting the requested information
from and about you are §421 et seq., §451 et seq., and §461
et seq. of the Higher Education Act of 1965, as amended (20
U.S.C. 1071 et seq., 20 U.S.C. 1087a et seq., and 20 U.S.C.
1087aa et seq.), and the authorities for collecting and using
your Social Security Number (SSN) are §§428B(f) and 484(a)
(4) of the HEA (20 U.S.C. 1078-2(f) and 1091(a)(4)) and 31
U.S.C. 7701(b). Participating in the Federal Family Education
Loan (FFEL) Program, the William D. Ford Federal Direct
Loan (Direct Loan) Program, or the Federal Perkins Loan
(Perkins Loan) Program and giving us your SSN are
voluntary, but you must provide the requested information,
including your SSN, to participate.
The principal purposes for collecting the information on
this form, including your SSN, are to verify your identity, to
determine your eligibility to receive a loan or a benefit on a
loan (such as a deferment, forbearance, discharge, or
forgiveness) under the FFEL, Direct Loan Programs, and/or
Perkins Loans to permit the servicing of your loans, and, if it
becomes necessary, to locate you and to collect and report
on your loans if your loans become delinquent or default.
We also use your SSN as an account identifier and to permit
you to access your account information electronically.
The information in your file may be disclosed, on a case-
by-case basis or under a computer matching program, to
third parties as authorized under routine uses in the
appropriate systems of records notices. The routine uses of
this information include, but are not limited to, its disclosure
to federal, state, or local agencies, to private parties such as
relatives, present and former employers, business and
personal associates, to consumer reporting agencies, to
financial and educational institutions, and to guaranty
agencies in order to verify your identity, to determine your
eligibility to receive a loan or a benefit on a loan, to permit
the servicing or collection of your loans, to enforce the
terms of the loans, to investigate possible fraud and to verify
compliance with federal student financial aid program
regulations, or to locate you if you become delinquent in
your loan payments or if you default. To provide default rate
calculations, disclosures may be made to guaranty agencies,
to financial and educational institutions, or to state
agencies. To provide financial aid history information,
disclosures may be made to educational institutions.
To assist program administrators with tracking refunds
and cancellations, disclosures may be made to guaranty
agencies, to financial and educational institutions, or to
federal or state agencies. To provide a standardized method
for educational institutions to efficiently submit student
enrollment statuses, disclosures may be made to guaranty
agencies or to financial and educational institutions. To
counsel you in repayment efforts, disclosures may be made
to guaranty agencies, to financial and educational
institutions, or to federal, state, or local agencies.
In the event of litigation, we may send records to the
Department of Justice, a court, adjudicative body, counsel,
party, or witness if the disclosure is relevant and necessary
to the litigation. If this information, either alone or with
other information, indicates a potential violation of law, we
may send it to the appropriate authority for action. We may
send information to members of Congress if you ask them
to help you with federal student aid questions. In
circumstances involving employment complaints,
grievances, or disciplinary actions, we may disclose relevant
records to adjudicate or investigate the issues. If provided
for by a collective bargaining agreement, we may disclose
records to a labor organization recognized under 5 U.S.C.
Chapter 71. Disclosures may be made to our contractors for
the purpose of performing any programmatic function that
requires disclosure of records. Before making any such
disclosure, we will require the contractor to maintain Privacy
Act safeguards. Disclosures may also be made to qualified
researchers under Privacy Act safeguards.
Paperwork Reduction Notice. According to the
Paperwork Reduction Act of 1995, no persons are required
to respond to a collection of information unless it displays a
valid OMB control number. The valid OMB control number
for this information collection is 1845-0058. Public reporting
burden for this collection of information is estimated to
average 30 minutes per response, including time for
reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and
completing and reviewing the information collection. The
obligation to respond to this collection is required to obtain
or retain a benefit (34 CFR 674.33(g)(4), 682.402(d)(3), or
685.214(c)). If you have comments or concerns regarding
the status of your individual submission of this form,
contact your loan holder directly.
Page 5 of 5
LS850-XSPC
U.S. Department of Education / FedLoan Servicing
P.O. Box 69184
Harrisburg, PA 17106-9184
800-699-2908
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome