Dd Form 2475 - Dod Educational Loan Repayment Program (Lrp) Annual Application Page 2
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24.
b. CANCELLED AMOUNT
c. DISBURSED AMOUNT
d. DATE OF DISBURSEMENT
a. ORIGINAL LOAN AMOUNT
(YYYYMMDD)
5. REMARKS
NSLDS # _____________
DD FORM 2475, "DOD EDUCATIONAL LOAN REPAYMENT PROGRAM (LRP) ANNUAL APPLICATION"
INSTRUCTIONS
SECTION 1. PERSONNEL OFFICE VERIFICATION
3.n. Type of Loan. Select from list below: The loan must qualify under the
(To be completed by the designated personnel officer.)
Higher Education Act of 1965, Title 4, Parts B, D, and E; the Health
Education Assistance Loan under Part C, Title VII, Public Health Service Act;
1.a. - b. Self-explanatory.
under Part B, Title VIII; Health Professional Loans that the SECDEF
determines to be critical to meet wartime medical skill shortages; William D.
Ford Federal Direct Loan; or any loan incurred for educational purposes
SECTION 2. SERVICEMEMBER DATA
made by a lender that is: (1) an agency or instrumentality of a State; (2) a
(To be completed by Servicemember or Borrower.)
financial or credit institution (including an insurance company) that is subject
to examination and supervision by an agency or the United States or any
2.a. - g. Servicemember or Borrower must complete. If the
State; or (3) from a pension fund or a non-profit private entity (subject to
Borrower is the parent and has a Parent Loan for
case-by-case review/approval by the
Undergraduate Students incurred for the Servicemember's
Office of the Undersecretary of Defense for Personnel and Readiness
education, please ensure the Servicemember's full name
(Military Personnel Policy) (Accession Policy) through each Service's
and last 4 digits of their SSN are provided in Section 5,
Education Representatives).
Remarks.
NOTE: For eligible LRP participants - Parent Loans for Undergraduate
Students (PLUS) and Consolidated Loans are also eligible for repayment
SECTION 3. LOAN DATA
under the LRP, as long as the loans were incurred for the Servicemember's
(To be completed by loan servicing agency.)
education. Since the loans may be in someone else's name and could
include loans incurred for individual's education other than the
3.a. Name as it appears on the promissory note.
Servicemember (such as a sibling or loans incurred for their own education),
3.b. - c. Self-explanatory.
it would be necessary to have the borrower complete Section 2 and include
3.d. Loan ___ of ___ Loans. A separate DD Form 2475
information regarding the education for which the loans were incurred.
must be completed for each loan if Borrower has more
3.o. Self-explanatory.
than one (1) loan. For example, loan 1 of 3 loans, loan 2
3.p. Complete this block only if different than the one listed in 3.f. and 3.g.
of 3 loans, and loan 3 of 3 loans.
3.q. Lender may not use a routing number as the payment address.
3.e. Loan Account Number to be used to ensure payments
3.r. Self-explanatory.
are applied to the correct amount.
3.f. - h. Identify the name, address, and telephone number
SECTION 4. LOAN DATA (To be completed by loan servicing agency.)
of the institution that currently services the loan. Please
4.a. Self-explanatory.
list any additional contact information in Section 5,
4.b. Amount cancelled after Origination Date of Loan.
Remarks.
4.c. Self-explanatory.
3.i. Mark X in the appropriate box.
4.d. Date of each individual disbursement.
3.j. Self-explanatory.
3.k. Self-explanatory.
SECTION 5. REMARKS.
3.l. If multiple loans have been consolidated, mark (X)
Use this section to enter additional information that will assist in processing
"Yes"
this application.
or "No" indicating consolidating action.
3.m. Provide Federal tax identification number for tax
After completion and signature, please return form to the address listed in
withholding.
Section 1.a.
DD FORM 2475 (BACK), JAN 2014
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