Student Loan Borrower Defense Group Discharge Application Form

Student Loan Borrower Defense Group Discharge Application Form
Use this form to apply for a borrower defense group discharge by providing your contact details, school and loan information, the basis for your claim, and supporting documents. The exact title must remain unchanged throughout the form.
Applicant Information
Full legal name
First NameMiddle NameLast Name
Email address
example@example.com
Phone number
Please enter a valid phone number.Format: (000) 000-0000.
Current mailing address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Preferred contact method
Loan and School Details
School Name
School Location (if known)
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Program or Degree
Approximate Attendance Dates
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Loan Servicer or Lender Name (if known)
Brief Description of School-Related Misconduct
Group Application and Supporting Information
Are you applying as part of a group or cohort?
Group or cohort name
Names or contact information of other affected borrowers
Supporting documents
Cancelof
Declaration
Should be Empty: