Loans Discharged Due To Disability Form - U.s. Department Of Education Page 2

Download a blank fillable Loans Discharged Due To Disability Form - U.s. Department Of Education in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Loans Discharged Due To Disability Form - U.s. Department Of Education with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

354 Richards Hall

fax: 617.373.8735

360 Huntington Ave

email: sfs@neu.edu

Boston, MA 02115

northeastern.edu/financialaid

Student Name: ________________________________

NU ID: ___________________________

BORROWER STATEMENT

• I acknowledge in writing by signing this form that the new loan cannot be discharged on the basis of any

present impairment unless it deteriorates so that I am again totally and permanently disabled.

• If any prior loan and/or TEACH grant was conditionally discharged on or after July 1, 2011 and the

three-year period has not yet elapsed, or discharged after July 1, 2011 and I am in a post discharge

monitoring period and the three year period has not yet elapsed, I understand that collection must resume

on the old loan and/or TEACH grant prior to my receiving the new loan.

• If a defaulted loan was discharged and then reaffirmed or was conditionally discharged and payment

resumed on it, I understand that I must make satisfactory repayment arrangements before I receive a new

loan and/or grant funds.

• I authorize the release of pertinent information to my schools, lenders, guarantor, subsequent holder, the

U.S. Department of Education, and their agents.

Student’s Signature: ___________________________________ Date: __________________________________

PHYSICIAN STATEMENT

The above referenced borrower was previously classified as totally and permanently disabled and

received a discharge of their student loans and/or TEACH grant as a result of this classification. The

borrower is requesting additional financial aid from the Federal Direct Stafford Loan Program. Please

respond to the following question as required by the U.S. Department of Education. The signed

Borrower Statement authorizes you to release this information.

Is the borrower *totally and permanently disabled and therefore, unable to engage in substantial gainful

employment?

□ Yes

□ No

Please explain:

_____________________________________________________________________________________

Physician’s Name: _______________________________________________License #: ______________

(please print)

Office Address: ________________________________________________________________________

City: ________________________State: _________ Zip: ___________ Phone: _____________________

Physician Signature (M.D. or D.O.) ________________________________________ Date: _________________

*Totally and Permanently Disabled is the condition of an individual who:

• is unable to engage in substantial gainful activity by reason of a medically determinable physical or mental impairment that can be expected to result in death; has

lasted for a continuous period of at least 60 months; or can be expected to last for a continuous period of at least 60 months OR

• has been determined by the Department of Veterans Affairs (VA) to be unemployable due to a service-connected disability.

*The phrase “substantial gainful activity” generally describes a situation in which a borrower is sufficiently physically recovered to be capable of attending school,

successfully completing a program of study, and securing employment in order to repay the new loan the borrower is seeking.

Please return this form to: Northeastern University, Student Financial Services, 360 Huntington Avenue, 354 Richards Hall, Boston, MA 02115