Teacher Loan Forgiveness Form

Teacher Loan Forgiveness Form
Teacher Information
Name
First NameLast Name
Employee ID/Teacher Certification Number
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Loan Details
Loan Servicer
Loan Account Number
Outstanding Loan Amount
Employment Verification
I certify that I have been employed as a full-time teacher for at least five consecutive years in a qualifying low-income school.
School Name
School Location
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Loan Forgiveness Amount Requested
I am requesting loan forgiveness in the amount of $ Amount in accordance with the Teacher Loan Forgiveness Program.
Certification
I certify that the information provided in this form is true and accurate to the best of my knowledge. I understand that any intentional misrepresentation of information may result in penalties.
Supporting Documents
Please attach the following documents:
Employment certification from the school or district.
Cancelof
Documentation proving qualifying low-income school status.
Cancelof
Any additional supporting documentation.
Cancelof
Authorization:
I authorize the release of any necessary information to verify my eligibility for the Teacher Loan Forgiveness Program.
Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Clear
Should be Empty:

Teacher Information