BORROWER DEFENSE TO REPAYMENT APPLICATION

SECTION 1: APPLICANT INFORMATION

Full Legal Name: _______________________________________________

Date of Birth: _______________________________________________

Social Security Number (Last 4 Digits): XXX-XX-____________

Current Mailing Address:
_______________________________________________
_______________________________________________
City: _________________ State: _______ ZIP: ___________

Phone Number: _______________________________________________

Email Address: _______________________________________________

Federal Student Aid ID (FSA ID): _______________________________________________

SECTION 2: LOAN INFORMATION

Loan Servicer Name: _______________________________________________

Account Number(s): _______________________________________________

Total Outstanding Balance (Approximate): $_______________

Loan Types (Check all that apply):

☐ Direct Subsidized Loans
☐ Direct Unsubsidized Loans
☐ Direct PLUS Loans (Graduate/Professional)
☐ Direct PLUS Loans (Parent)
☐ Direct Consolidation Loans
☐ FFEL Program Loans (Consolidation may be required)
☐ Federal Perkins Loans (Consolidation may be required)

SECTION 3: SCHOOL INFORMATION

Name of School: _______________________________________________

Campus Location (City/State): _______________________________________________

Program of Study: _______________________________________________

Dates of Enrollment:
- Start Date: _______________________________________________
- End Date/Withdrawal Date: _______________________________________________

Did you complete the program?
☐ Yes
☐ No - Date of Withdrawal: _______________________________________________

Credential Received (if applicable):
☐ Certificate
☐ Associate's Degree
☐ Bachelor's Degree
☐ Master's Degree
☐ Doctorate/Professional Degree
☐ Did not receive credential

SECTION 4: BASIS FOR BORROWER DEFENSE CLAIM

Select the category that best describes your claim (Check all that apply):

A. Misrepresentation by the School

☐ Job Placement Rates - The school misrepresented graduate employment statistics
☐ Salary Expectations - The school misrepresented expected salaries after graduation
☐ Accreditation Status - The school misrepresented its accreditation status
☐ Transferability of Credits - The school misrepresented credit transfer options
☐ Program Quality/Content - The school misrepresented the nature or quality of instruction
☐ Cost of Attendance - The school misrepresented total costs or financial aid terms
☐ Licensing/Certification - The school misrepresented licensure or certification outcomes
☐ Affiliation with Employers - The school falsely claimed employer partnerships

B. Breach of Contract

☐ The school failed to provide services, programs, or equipment promised in enrollment agreements
☐ The school significantly changed the program without notice
☐ The school failed to provide qualified instructors as promised

C. Other Misconduct

☐ Unfair or deceptive practices
☐ Violation of state consumer protection laws
☐ Other: _______________________________________________

SECTION 5: DETAILED STATEMENT OF CLAIM

Describe in detail what the school told you or did that you believe was false, misleading, or illegal. Include:
- What specific statements were made
- Who made the statements (recruiter, admissions officer, instructor, etc.)
- When the statements were made (approximate dates)
- How the statements were communicated (in person, writing, website, advertising)
- How the statements influenced your decision to enroll or borrow

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(Attach additional pages if necessary)

SECTION 6: EVIDENCE AND DOCUMENTATION

Check all documentation you are providing with this application:

☐ Enrollment agreement/contract
☐ School catalog or brochure
☐ Promotional materials or advertisements
☐ Website screenshots (with dates if possible)
☐ Emails or written communications from school officials
☐ Notes from conversations with school representatives
☐ Witness statements from other students
☐ Academic transcripts
☐ Loan documents
☐ News articles about the school
☐ Government enforcement actions against the school
☐ State attorney general complaints or actions
☐ Accreditation notices or warnings
☐ Other: _______________________________________________

SECTION 7: FINANCIAL HARM

Describe the financial harm you suffered as a result of the school's conduct:

Total Amount Borrowed for This School: $_______________

Payments Already Made: $_______________

Current Outstanding Balance: $_______________

Did you complete your education at another institution?
☐ Yes - Institution: _______________________________________________ Cost: $_______________
☐ No

Employment Impact:
☐ Unable to find employment in field of study
☐ Employed but at significantly lower salary than represented
☐ Had to obtain additional education/training at personal expense
☐ Other: _______________________________________________

SECTION 8: PRIOR APPLICATIONS AND LEGAL ACTIONS

Have you previously submitted a borrower defense claim?
☐ Yes - Date: _______________ Claim Number (if known): _______________
☐ No

Have you participated in any lawsuit or legal action against this school?
☐ Yes - Please describe: _______________________________________________
☐ No

Are you aware of any government enforcement action against this school?
☐ Yes - Please describe: _______________________________________________
☐ No

SECTION 9: RELIEF REQUESTED

Check all forms of relief you are requesting:

☐ Full discharge of all loans related to this school
☐ Partial discharge of loans (specify amount or percentage): _______________________________________________
☐ Refund of payments already made on these loans
☐ Removal of negative credit reporting related to these loans
☐ Discharge of any amounts in collections
☐ Credit for payments toward income-driven repayment forgiveness

SECTION 10: CURRENT REPAYMENT STATUS

What is your current loan status?
☐ In Repayment
☐ In Forbearance
☐ In Deferment
☐ In Default
☐ Wage Garnishment Active
☐ Treasury Offset (Tax Refund Seizure) Active

Do you wish to request forbearance while your claim is pending?
☐ Yes - I request that my loans be placed in forbearance during the review of this application
☐ No - I will continue making payments

STATE-SPECIFIC NOTES

California (CA)

• California residents may have additional protections under the California Student Borrower Bill of Rights (Education Code Section 69800)
• File complaints with the California Department of Financial Protection and Innovation (DFPI)
• California Student Aid Commission may provide additional assistance
• Statute of limitations considerations under California Civil Code

Texas (TX)

• Texas residents should be aware that Career Colleges and Schools of Texas (CCST) litigation may affect processing timelines
• File complaints with the Texas Higher Education Coordinating Board (THECB)
• Texas Workforce Commission oversees career schools
• Texas Deceptive Trade Practices Act may provide additional remedies

Florida (FL)

• Florida residents may file complaints with the Florida Department of Education Commission for Independent Education
• Florida Consumer Protection laws may provide additional grounds
• Florida Attorney General's Office handles education-related consumer complaints

New York (NY)

• New York residents have additional protections under New York Education Law
• File complaints with the New York State Education Department
• New York Attorney General maintains active student loan protection efforts
• New York Student Loan Servicer Act provides additional rights

CERTIFICATION AND SIGNATURE

I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that providing false information may result in criminal prosecution and/or civil penalties. I authorize the U.S. Department of Education to verify any information provided and to share information with the school for purposes of investigation.

I understand that:
- The Department of Education will review my application and make a determination
- Processing times may vary significantly based on the complexity of my claim and pending litigation
- I may be contacted for additional information during the review process
- If my claim is approved, I may receive full or partial discharge of my loans
- If denied, I have the right to request reconsideration

Applicant Signature: _______________________________________________

Date: _______________________________________________

Print Name: _______________________________________________

SUBMISSION INSTRUCTIONS

Online Submission (Preferred):

1. Log in to StudentAid.gov
2. Navigate to the Borrower Defense Application portal
3. Complete the online form and upload supporting documents

Mail Submission:

U.S. Department of Education
Borrower Defense to Repayment
P.O. Box 1854
Monticello, KY 42633

Fax Submission:

(606) 330-2027

IMPORTANT LEGAL NOTICES

Regulatory Status: As of January 2025, borrower defense regulations are subject to ongoing litigation. The 2022 regulations have been enjoined by the 5th Circuit Court of Appeals, and the case is pending review by the U.S. Supreme Court. The 2019 regulations remain in effect until further notice. Additionally, the One Big Beautiful Bill Act (July 2025) delays implementation of the 2022 regulations until July 1, 2035.

Statutes of Limitation: Under current regulations, there is no statute of limitations for filing a borrower defense claim. However, this may be subject to change based on pending litigation and regulatory revisions.

Consolidation Note: If you have FFEL or Perkins Loans, you may need to consolidate them into a Direct Consolidation Loan before filing a borrower defense claim.

CHECKLIST BEFORE SUBMISSION

☐ Completed all required sections of this application
☐ Signed and dated the certification
☐ Attached all supporting documentation
☐ Made copies of everything for your records
☐ Confirmed correct mailing address or online submission method
☐ Noted any response deadlines or follow-up requirements

This template was last updated on 2026-01-25 and reflects current federal regulations and pending legal developments. Regulations and requirements may change. For the most current information, visit StudentAid.gov or consult with a qualified attorney.