Teacher Loan Forgiveness Application Form
TLFA
TEACHER LOAN FORGIVENESS APPLICATION
William D. Ford Federal Direct Loan (Direct Loan) Program
Federal Family Education Loan (FFEL) Program
OMB No. 1845-0059
Form Approved
Exp. Date 07/31/2017
WARNING: Any person who knowingly makes a false statement or misrepresentation on this form or on any
accompanying document is subject to penalties that may include fines, imprisonment, or both, under the U.S. Criminal
Code and 20 U.S.C. 1097.
SECTION 1: BORROWER IDENTIFICATION
SECTION 2: LOAN FORGIVENESS REQUEST (TO BE COMPLETED BY THE BORROWER)
READ SECTIONS 7-10 BEFORE COMPLETING THE FORM. The information you provide is subject to verification.
I request forgiveness on my Direct Loan and/or FFEL program loan(s) based on my employment as a full-time teacher for
at least five consecutive, complete academic years. During the period that qualifies me for loan forgiveness, I taught
(check all that apply):
at an eligible elementary school at an eligible secondary school for an eligible educational service agency
AND I was (check all that apply):
A highly qualified full-time special education teacher for elementary school children with disabilities. The children’s
disabilities corresponded to my special education training, and I demonstrated knowledge and teaching skills in the
content areas of the elementary school curriculum (forgiveness of up to $17,500).
A highly qualified full-time special education teacher for secondary school children with disabilities. The children’s
disabilities corresponded to my special education training, and I demonstrated knowledge and teaching skills in the
content areas of the secondary school curriculum (forgiveness of up to $17,500).
A highly qualified full-time mathematics teacher for secondary school students (forgiveness of up to $17,500).
A highly qualified full-time science teacher for secondary school students (forgiveness of up to $17,500).
A full-time secondary education teacher in a subject area relevant to my academic major (only if my teaching service
began before 10/30/2004), or a highly qualified full-time secondary education teacher (forgiveness of up to $5,000).
A full-time elementary education teacher and I demonstrated knowledge and teaching skills in reading, writing,
mathematics, and other areas of the elementary school curriculum (only if my teaching service began before
10/30/2004), or a highly qualified full-time elementary education teacher (forgiveness of up to $5,000).
Continued on the next page.
Page 1 of 8
Please enter or correct the following information.
Check this box if any of your information has changed.
SSN - -
Name
Address
City, State, Zip Code
Telephone – Primary
Telephone – Alternate
E-mail (optional)
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