Student Loan Repayment Program Service Agreement Form

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ATTACHMENT 1
SAMPLE
STUDENT LOAN REPAYMENT PROGRAM SERVICE AGREEMENT
NAME (Print or Type –
First
Middle
Last)
SOCIAL SECURITY NUMBER
[AGENCY
COMPONENT]
In consideration of the student loan repayment benefit for which I qualify under 5 U.S.C. 5379 as
implemented by the regulations of the U.S. Office of Personnel Management (5 CFR, Part 537), the
policies of the [AGENCY], and the __________________________________, I hereby agree:
To serve in __________________________________________ ____ for 3 years (initial contract) or
1.
1 year (extensions).
(AGENCY COMPONENT)
2.
The amount of the student loan repayment benefit is $___________ (up to $10,000). I understand that
the commitment to repay my loan is for one year, subject to yearly extensions.
nd
rd
3.
If student loan repayment benefits are made in the 2
or 3
year, my service agreement will not be
extended.
4.
If student loan repayment benefits are made beyond 3 years, my service agreement will be extended by
rd
one year for each payment made beyond the 3
year.
5.
The service agreement is effective ____________________ through
.
(Month/Day/Year)
(Month/Day/Year)
6.
That ___________________ is authorized to verify the status and outstanding balance of each loan and
to discuss the terms with the lender or note holder.
7.
This service agreement in no way constitutes a right, promise, or entitlement for continued
employment or noncompetitive conversion to the competitive service. That acceptance of this
agreement does not alter the conditions or terms of my employment; accordingly, this agreement will
not preclude nor limit the Agency from effecting personnel actions as may be appropriate.
8.
That in the event I voluntarily leave [AGENCY], or in the event I am involuntarily separated for
misconduct or performance before completing the agreed upon period of service, I will be indebted to
the Federal Government and must reimburse [AGENCY] for the full amount of any student loan
repayment benefits received under this service agreement.
9.
I am responsible for making loan payments on the portion of the loan that continues to be my
responsibility.
10. The student loan repayment benefits made do not exempt me from my responsibility and/or liability
for the loan.
11. I am responsible for any income tax obligation resulting from the student loan repayment benefit.
12. [AGENCY]/___________ is not responsible for any late fees assessed by the lender if the student loan
repayment benefit is not received on time.
13. The student loan repayment benefits made on my behalf by [AGENCY] have/will not exceed the
maximum amount of $60,000.

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