Federal Direct Consolidation Loan Application and Promissory Note

Federal Direct Consolidation Loan Application and Promissory Note

William D. Ford Federal Direct Loan Program

OMB No. 1845-0053 | Form Approved | Exp. Date 04/30/2016

WARNING:

Any person who knowingly makes a false statement or misrepresentation on this form or any accompanying documentation is subject to penalties that may include fines, imprisonment, or both, under the U.S. Criminal Code and 20 U.S.C. 1097.

BEFORE YOU BEGIN

Read the Instructions for Completing the Federal Direct Consolidation Loan Application and Promissory Note (“Instructions”).

NOTE: PAGES 1 THROUGH 5 MUST BE SUBMITTED FOR YOUR LOAN REQUEST TO BE PROCESSED.

BORROWER INFORMATION

1. Last Name:   First Name:   Middle Initial:

2. Former Name(s):

3. Social Security Number:

4. Date of Birth:

5. Permanent Address (Street, City, State, Zip Code):

6. Area Code/Telephone Number:

7. E-Mail Address (Optional):

8. Driver’s License State and Number:

9. Employer’s Name and Address:

10. Work Area Code/Telephone Number:

REFERENCE INFORMATION

List 2 persons with different U.S. addresses who do not live with you and who have known you for at least 3 years.

11. Reference 1

Last Name:   First Name:   Middle Initial:

Permanent Address:

Relationship to You:   Area Code/Telephone Number:

E-Mail Address (optional):

12. Reference 2

Last Name:   First Name:   Middle Initial:

Permanent Address:

Relationship to You:   Area Code/Telephone Number:

E-Mail Address (optional):

LOANS YOU WANT TO CONSOLIDATE

Read the Instructions before completing this section. List each federal education loan that you want to consolidate. If you need more space, use the Additional Loan Listing Sheet included with this Note.

17. Expected Grace Period End Date (month/year):

Loan Listing Table

LOANS YOU DO NOT WANT TO CONSOLIDATE

List all education loans that you are not consolidating, but want us to consider when we calculate the maximum repayment period for your Direct Consolidation Loan.

18. Loan Code:   19. Loan Holder/Servicer Name, Address, and Area Code/Telephone Number:

20. Loan Account Number:   21. Current Balance:

REPAYMENT PLAN SELECTION

To understand your repayment plan options, carefully read the repayment plan information in Item 11 of the Borrower’s Rights and Responsibilities Statement.

Standard Repayment Plan

Graduated Repayment Plan

Extended Repayment Plan

Income-Contingent Repayment Plan (ICR)

Income-Based Repayment Plan (IBR)

Pay As You Earn Repayment Plan

BORROWER UNDERSTANDINGS, CERTIFICATIONS, AND AUTHORIZATIONS

22. I understand that I may receive notices, disclosures, and loan servicing information electronically and that the Department of Education may verify information reported on this Note with other federal agencies.

23. Under penalty of perjury, I certify that:

The information I have provided is true, complete, and correct.

All loans selected for consolidation were used to finance my education or the education of one or more of my children.

All selected loans are in a grace period or in repayment.

If I owe an overpayment, I have made satisfactory arrangements to repay the amount owed.

If I am in default, I have made a satisfactory repayment arrangement or will repay under an income-driven plan, if required.

If I was convicted of or pled no contest/guilty to fraud, I have fully repaid the funds.

24. I make the following authorizations:

Authorize ED to contact loan holders and obtain payoff information.

Authorize ED to issue proceeds to loan holders to pay off selected loans.

Authorize ED to investigate my credit record and report loan status as permitted by law.

Authorize schools, ED, and agents to release loan information to references and immediate family members.

Authorize schools, ED, and agents to share information about my loan with each other.

Authorize contact with me by phone, autodialing equipment, prerecorded voice, or text messages.

PROMISE TO PAY

25. I promise to pay ED all sums disbursed under the terms of this Note.

26. If I do not make a payment when due, I will pay reasonable collection costs, including attorney fees and court costs.

27. My signature on this Note serves as my authorization to pay off the balances of the loans I have selected for consolidation.

28. I will not sign this Note before reading the entire Note.

29. My signature certifies that I have read, understand, and agree to the terms and conditions of this Note.

I UNDERSTAND THAT THIS IS A LOAN THAT I MUST REPAY.

NOTE TERMS AND CONDITIONS

GOVERNING LAW

The terms of this Federal Direct Consolidation Loan Application and Promissory Note will be interpreted in accordance with the Higher Education Act of 1965, as amended, and applicable federal laws and regulations.

DISCLOSURE OF LOAN TERMS

This Note applies to a Federal Direct Consolidation Loan. The principal amount owed will be equal to all sums disbursed to pay off prior loan obligations, plus any unpaid interest that is capitalized and added to the principal balance.

INTEREST

Unless ED notifies you in writing that a different rate will apply, the interest rate is a fixed rate calculated in accordance with the Act.

REPAYMENT

You must repay the full amount of the Direct Consolidation Loan plus accrued interest. You must select a repayment plan. If you do not select one, ED will choose a plan for you in accordance with the Act.

ACCELERATION AND DEFAULT

At ED’s option, the entire unpaid balance of the loan may become immediately due and payable if you make a false representation or default on the loan.

IMPORTANT NOTICES

This form includes privacy notices, federal disclosure notices, and paperwork reduction information required by law.