Loan Discharge Application: School Closure
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5LOAN DISCHARGE APPLICATION: SCHOOL CLOSURE
OMB No. 1845-0058
Form Approved
William D. Ford Federal Direct Loan (Direct Loan) Program, Federal Family
Exp. Date 08/31/2017
Education Loan (FFEL) Program, and Federal Perkins Loan Program
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
( _______ ) _______ - _____________
E-mail (optional)
____________________________________
SECTION 2: SCHOOL CLOSURE INFORMATION
1. You are applying for this loan discharge as a:
10. Were you (or, for a parent PLUS borrower, the
student) still enrolled in the program of study
Student borrower – Skip to Item 4.
when the school closed?
Parent borrower – Continue to Item 2.
Yes – Skip to Item 13.
2. Student Name (Last, First, MI):
_________________________________________
No – Continue to Item 11.
3. Student SSN:
11. Did you (or, for a parent PLUS borrower, the
___ ___ ___ - ___ ___ - ___ ___ ___ ___
student) withdraw from the school before the
4. Closed School Name:
school closed?
_________________________________________
Yes – Continue to Item 12.
5. Closed School Address (street, city, state, zip):
_________________________________________
No – Skip to Item 13.
_________________________________________
12. On what date did you withdraw from the school?
6. Dates of attendance at the closed school:
___ ___ - ___ ___ - ___ ___ ___ ___
___ ___ - ___ ___ - ___ ___ ___ ___ to
13. Did you (or, for a parent PLUS borrower, the
___ ___ - ___ ___ - ___ ___ ___ ___
student) complete or are you in the process of
7. Name of the program you (or, for a parent PLUS
completing the same or a comparable program of
borrower, the student) were enrolled in at the
study at another school?
time the school closed:
Yes – Continue to Item 14.
_________________________________________
No – Skip to Item 16.
8. Did you (or, for a parent PLUS borrower, the
student) complete the program of study at the
14. Are you (or, for a parent PLUS borrower, the
closed school?
student) completing the new program through a
teach-out agreement (see Section 5)?
Yes – You are not eligible for this discharge.
Yes – You are not eligible for this discharge.
No – Continue to Item 9.
No – Continue to Item 15.
9. Were you (or for a parent PLUS borrower, the
student) on an approved leave of absence when
15. Did the other school give you (or, for a parent
the school closed?
PLUS borrower, the student) credit for training
Yes – Provide the dates of the leave of
received at the closed school by allowing transfer
absence, then skip to Item 13:
credits or hours earned at the closed school, or by
___ ___ - ___ ___ - ___ ___ ___ ___ to
any other comparable means?
___ ___ - ___ ___ - ___ ___ ___ ___
Yes – You are not eligible for this discharge.
No – Continue to Item 10.
No – Continue to Item 16.
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