Fillable Forgiveness Eligibility Confirmation Form printable pdf download

Texas Higher Education Coordinating Board

P O Box 12788, Austin, TX 78711

Toll-free 1(800) 242-3062 or (512) 427-6345 Austin Area

B-ON-TIME LOAN

FORGIVENESS ELIGIBILITY CONFIRMATION FORM

SECTION ONE - TO BE COMPLETED BY LOAN RECIPIENT

Borrower Name

Home Phone

Borrower Address

Daytime Phone

City

State

Zip Code

Social Security No.

I certify that I have met the forgiveness eligibility requirements to have my B-ON-TIME loans forgiven and have enclosed an official college

transcript for each school attended. I authorize my school to provide any additional documentation required to complete the forgiveness

process. I understand that any forgiveness I receive will be considered taxable income within the year forgiveness occurs. Additional tax

information will be provided to me at the end of the year.

Borrower Signature

Date

SECTION TWO - TO BE COMPLETED BY THE REGISTRAR'S OFFICE OR DESIGNATED AGENT

The individual named above is seeking forgiveness of his/her B-On-Time loan(s) obtained through the Texas Higher Education Coordinating

Board. Please assist us by completing the required information below. See administrative rule §21.129 Forgiveness of Loans on the reverse

of this form.

____ The individual named above does NOT meet the loan forgiveness requirements for the Texas B-On-Time Loan Program.

Reason:

Forgiveness Eligibility Criteria (select one)

____ The borrower graduated with a cumulative GPA of at least 3.0 on a four-point scale, and within 4 calendar years after the date he/she

was initially enrolled in an eligible institution; 5 calendar years after the date he/she was initially enrolled in an eligible institution, if the degree

is in architecture, engineering, or any other program determined by the board to require more than 4 years to complete; 2 calendar years after

the date he/she was initially enrolled in a public or private two-year institution; or 1 calendar year after the date he/she was initially enrolled in

a one-year certification program.

____Graduated with a cumulative GPA of at least 3.0 on a four-point scale, and with a total number of credit hours attempted (including transfer

hours earned exclusively by examination) that is no more than 6 hours beyond what is required to complete the degree or certificate.

Name of Institution _______________________________________________

Borrower Initial Enrollment Date

Degree Title _________________________

Graduation Date

Cumulative GPA upon Graduation

Number of Credit Hours Required for Degree

Number of Credit Hours Attempted

Number of Years Required for Degree

High School Graduation Date