Dedicasion

TEACHER LOAN FORGIVENESS APPLICATION
Federal Family Education Loan Program / William D. Ford Federal Direct Loan Program
You may qualify for loan forgiveness only if you had no outstanding balance on a Federal Family Education Loan (FFEL) Program loan or a William D. Ford Federal Direct Loan (Direct Loan) Program loan on October 1, 1998, or had no outstanding balance on a FFEL or Direct Loanprogram loan on the date you obtained a loan after October 1, 1998. WARNING: Any person who knowingly makes a false statement or misrepresentation on this form or on any accompanying documents is subject to penalties that may include fines, imprisonment or both, under the U.S. Criminal Code and 20 U.S.C. 1097.

OMB No. 1845-0059 Form Approved Exp. Date 03/31/2011

TLFA

SECTION 1: BORROWERIDENTIFICATION
Please enter or correct the following information. SSN Name Address City, State, Zip Code Telephone - Home ( Telephone - Other ( E-mail (optional)

) )

SECTION 2: BORROWER’S LOAN FORGIVENESS REQUEST, PREVIOUS LOAN FORGIVENESS INFORMATION, UNDERSTANDINGS, AND CERTIFICATION

The borrower must complete this section.

Before completing this section, carefully read the entireform, including the general information and instructions, terms and conditions, definitions, and eligibility requirements in Sections 4, 5, 6, 7, and 8 on this form. Loan Forgiveness Request I request forgiveness on my FFEL and/or Direct Loan Program loan(s) based on my employment as a full-time teacher in an elementary or secondary school for at least five consecutive, complete academic years. (Note:School librarians, guidance counselors, and other administrative staff are not considered teachers for the purposes of this loan forgiveness program.) During the period that qualifies me for loan forgiveness, I taught (check only one box): Full time in an elementary school as a highly qualified special education teacher for children with disabilities. The children’s disabilities corresponded tomy special education training, and I demonstrated knowledge and teaching skills in the content areas of the elementary or secondary school curriculum (loan forgiveness of up to $17,500). Full time in a secondary school as a highly qualified special education teacher for children with disabilities. The children’s disabilities corresponded to my special education training, and I demonstratedknowledge and teaching skills in the content areas of the elementary or secondary school curriculum (loan forgiveness of up to $17,500). Full time in a secondary school as a highly qualified mathematics teacher (loan forgiveness of up to $17,500). Full time in a secondary school as a highly qualified science teacher (loan forgiveness of up to $17,500). Full time in a secondary school (i) in a subject arearelevant to my academic major, or (ii) as a highly qualified secondary school teacher (loan forgiveness of up to $5,000). Full time in an elementary school (i) where I demonstrated knowledge and teaching skills in reading, writing, mathematics, and other areas of the elementary school curriculum, or (ii) as a highly qualified elementary school teacher (loan forgiveness of up to $5,000). PreviousLoan Forgiveness Information Check one of the boxes below: I have not previously applied for or received forgiveness on my FFEL and/or Direct Loan program loan(s) under this Teacher Loan Forgiveness Program. I have applied for or received forgiveness on my FFEL and/or Direct Loan program loan(s) under this Teacher Loan Forgiveness Program with the loan holder listed below. (If you check this box,provide the loan holder and forgiveness amount information requested below. If you have applied for but have not yet received forgiveness, leave “Forgiveness Amount” blank.) Loan Holder Name Loan Holder Telephone/Web Site Forgiveness Amount $ Understandings and Certification I understand that a forbearance of principal and accrued interest will be applied on the qualifying loan(s) from the date...