FALSE CERTIFICATION DISCHARGE APPLICATION

OVERVIEW

False certification discharge is available when a school falsely certified your eligibility for federal student loans. There are three main categories of false certification:

1. Ability to Benefit (ATB) - The school enrolled you without a high school diploma/GED and without properly testing your ability to benefit from the education
2. Disqualifying Status - The school enrolled you in a program leading to employment that you could not legally obtain due to a physical or mental condition, age, criminal record, or other status
3. Unauthorized Signature/Payment - Someone forged your signature or you did not authorize the loan disbursement

SECTION 1: APPLICANT INFORMATION

Full Legal Name: _______________________________________________

Former Names (if any): _______________________________________________

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

Current Loan Servicer: _______________________________________________

Account Number: _______________________________________________

Total Outstanding Balance: $_______________

Loan Types (Check all that apply):

☐ Direct Subsidized Loans
☐ Direct Unsubsidized Loans
☐ Direct PLUS Loans
☐ Direct Consolidation Loans
☐ FFEL Stafford Loans
☐ FFEL PLUS Loans
☐ FFEL Consolidation Loans
☐ Federal Perkins Loans

Loan Disbursement Period:
- First Disbursement Date: _______________________________________________
- Last Disbursement Date: _______________________________________________

SECTION 3: SCHOOL INFORMATION

Name of School: _______________________________________________

Campus Location: _______________________________________________

School Address:
_______________________________________________
_______________________________________________

School OPE ID (if known): _______________________________________________

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

Program of Study: _______________________________________________

Credential Sought:
☐ Certificate/Diploma
☐ Associate's Degree
☐ Bachelor's Degree
☐ Master's Degree
☐ Other: _______________________________________________

SECTION 4: TYPE OF FALSE CERTIFICATION

Select the type of false certification that applies to your situation:

☐ OPTION A: ABILITY TO BENEFIT (ATB)

This applies if you did not have a high school diploma or GED when you enrolled and the school did not properly test your ability to benefit from the education.

Continue to Section 5A

☐ OPTION B: DISQUALIFYING STATUS

This applies if, at the time of enrollment, you had a physical or mental condition, age, criminal record, or other status that would disqualify you from employment in the field for which you were being trained.

Continue to Section 5B

☐ OPTION C: UNAUTHORIZED SIGNATURE/PAYMENT

This applies if your signature on the loan documents was forged, or if the loan was disbursed without your knowledge or authorization.

Continue to Section 5C

SECTION 5A: ABILITY TO BENEFIT (ATB) DETAILS

Complete this section only if you selected Option A

Educational Status at Enrollment

At the time you enrolled at this school:

☐ I did NOT have a high school diploma
☐ I did NOT have a GED (General Education Development certificate)
☐ I did NOT have an equivalent credential recognized by my state

Date of enrollment: _______________________________________________

ATB Testing

Did the school administer an ability-to-benefit test before you enrolled?

☐ No - I was not given any test before enrollment
☐ Yes - A test was administered

If a test was administered:

Name of test (if known): _______________________________________________

Date of test: _______________________________________________

Did you pass the test on your first attempt?
☐ Yes
☐ No

If you did not pass on your first attempt:
☐ I was allowed to immediately retake the test until I passed
☐ I was given answers during the test
☐ The test administrator completed parts of the test for me
☐ The test was not proctored properly
☐ Other irregularities: _______________________________________________

Was the test administered by an independent test administrator (not a school employee)?
☐ Yes
☐ No
☐ Unknown

Did you complete at least six credit hours or 225 clock hours before receiving federal aid?
☐ Yes
☐ No

ATB Eligibility Summary

I believe I qualify for false certification discharge because:

☐ No ATB test was administered before I received federal student aid
☐ The ATB test was improperly administered
☐ I was allowed to retake the test until I passed
☐ The school certified my eligibility without proper documentation
☐ Other: _______________________________________________

Explain in detail what happened regarding ATB testing at your school:
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________

SECTION 5B: DISQUALIFYING STATUS DETAILS

Complete this section only if you selected Option B

The Disqualifying Condition

What condition or status existed at the time of enrollment that would disqualify you from employment in your field of study?

☐ Physical condition or disability
☐ Mental condition or disability
☐ Age (too young or too old for licensing/employment requirements)
☐ Criminal record
☐ Immigration status
☐ Lack of required prerequisite credentials
☐ Other: _______________________________________________

Describe the condition or status in detail:
_______________________________________________
_______________________________________________
_______________________________________________

When did this condition or status exist?
☐ Before I enrolled at the school
☐ At the time I enrolled at the school
☐ Developed during my enrollment

Field of Study and Employment Requirements

What was your program of study? _______________________________________________

What job or occupation was the program designed to lead to? _______________________________________________

What are the legal requirements for employment in this field?
(Examples: licensure requirements, age requirements, background check requirements, physical requirements)
_______________________________________________
_______________________________________________
_______________________________________________

School's Knowledge

Did the school know about your disqualifying condition?
☐ Yes - I disclosed it during enrollment
☐ Yes - The school should have known based on visible evidence
☐ Yes - The school conducted background checks or screening
☐ No - I did not disclose it and the school had no way to know
☐ Unknown

If yes, explain how the school knew:
_______________________________________________
_______________________________________________

Impact on Employment

Has your condition or status actually prevented you from working in the field?
☐ Yes
☐ No - but it legally disqualifies me from licensure/employment

Describe how this condition affects your ability to work in the field:
_______________________________________________
_______________________________________________
_______________________________________________

SECTION 5C: UNAUTHORIZED SIGNATURE/PAYMENT DETAILS

Complete this section only if you selected Option C

Type of Unauthorized Action

What type of unauthorized action occurred?

☐ Forged Signature - Someone signed loan documents using my name without my permission
☐ Identity Theft - Someone obtained loans in my name without my knowledge
☐ Unauthorized Endorsement - Someone endorsed my loan check without my permission
☐ Unauthorized Disbursement - The school received loan funds I never authorized

Details of Unauthorized Activity

Who do you believe was responsible for the unauthorized signature or payment?

☐ School official or employee
☐ Family member (Name: _______________________________________________)
☐ Unknown person
☐ Other: _______________________________________________

Did you ever:
☐ Sign the loan application - Yes / No
☐ Sign the promissory note - Yes / No
☐ Endorse the loan check - Yes / No
☐ Authorize the school to apply funds to your account - Yes / No

When did you first learn about the loan(s)?

Date: _______________________________________________

How did you learn about it?
_______________________________________________
_______________________________________________

Documentation of Unauthorized Activity

Have you reported the unauthorized activity to:

☐ Local police - Report Number: _______________________________________________
☐ Federal Trade Commission (FTC)
☐ Your loan servicer
☐ The school
☐ State Attorney General
☐ None of the above

Do you have documentation of the unauthorized signatures?
☐ Yes - I have copies of documents with forged signatures
☐ No - but I can obtain them
☐ No - I do not have access to the documents

SECTION 6: DOCUMENTATION CHECKLIST

For All False Certification Claims:

☐ Government-issued photo identification
☐ Loan account statements
☐ Enrollment documents (if available)

For Ability to Benefit (ATB):

☐ Documentation showing you did not have a high school diploma/GED at enrollment
☐ Any ATB test results or documentation
☐ School catalog from your enrollment period
☐ Evidence of improper testing (if available)

For Disqualifying Status:

☐ Medical records or documentation of condition (if applicable)
☐ Court records showing criminal history (if applicable)
☐ Licensing requirements for the field of study
☐ Evidence that school knew of disqualifying status
☐ Documentation of denial of employment or licensure based on status

For Unauthorized Signature/Payment:

☐ Police report
☐ FTC identity theft report
☐ Copies of documents with allegedly forged signatures
☐ Your genuine signature samples for comparison
☐ Evidence that you did not authorize the loan

SECTION 7: FORBEARANCE REQUEST

Do you want your loans placed in forbearance while your application is processed?

☐ Yes, I request forbearance during the review process
☐ No, I will continue making payments

Note: Interest may continue to accrue during forbearance. If your application is denied, accrued interest may capitalize.

SECTION 8: REFUND REQUEST

If your false certification discharge is approved:

☐ I request a refund of all payments I made on the discharged loans

☐ I request a refund of amounts collected through wage garnishment

☐ I request a refund of tax refunds seized through Treasury offset

☐ I request removal of adverse credit history related to these loans

Total estimated payments made: $_______________

STATE-SPECIFIC NOTES

California (CA)

• Bureau for Private Postsecondary Education (BPPE) maintains school records
• California has specific ATB testing requirements that may differ from federal requirements
• DFPI oversees student loan servicer conduct
• California Consumer Privacy Act may provide additional access to records

Texas (TX)

• Texas Higher Education Coordinating Board handles complaints
• Texas Workforce Commission oversees career schools
• Texas may have different ATB testing requirements for state-licensed schools
• Contact Attorney General's Consumer Protection Division

Florida (FL)

• Commission for Independent Education handles school licensing
• Florida Office of Financial Regulation oversees servicers
• Florida law may provide additional consumer protections
• Keep copies of all school records as Florida schools close frequently

New York (NY)

• NY State Education Department maintains school records
• HESC may provide assistance for NY residents
• NY Student Loan Servicer Act provides additional protections
• Attorney General's Office has active education fraud division

SECTION 9: CERTIFICATION AND SIGNATURE

I certify under penalty of perjury that:

☐ I believe I am entitled to a false certification discharge based on the type selected in this application

☐ All information provided in this application is true, complete, and accurate to the best of my knowledge

☐ I understand that the U.S. Department of Education will investigate my claim

☐ I understand that providing false information may result in criminal penalties under 18 U.S.C. 1001 and/or civil liability

☐ I authorize the release of any relevant records to the Department of Education for investigation

☐ I understand that if my application is approved, I will receive a refund of amounts paid on the discharged loans

☐ I understand that the discharged amount may have tax implications

For Unauthorized Signature Claims:

☐ I did not sign the promissory note, or the school signed my name on the promissory note without my authorization

☐ I did not endorse the loan check, or the school endorsed my name on the loan check without my authorization

☐ The school certified my eligibility for a loan without my knowledge

Applicant Signature: _______________________________________________

Date: _______________________________________________

Print Name: _______________________________________________

SUBMISSION INSTRUCTIONS

Online Submission:

1. Visit StudentAid.gov
2. Log in with your FSA ID
3. Navigate to Loan Discharge applications
4. Select "False Certification Discharge"
5. Complete the online form and upload documents

Mail Submission:

Download the appropriate form from StudentAid.gov and mail to your loan servicer:

Servicer Address: _______________________________________________

Fax Submission:

Contact your servicer for fax number

Phone Assistance:

Federal Student Aid Information Center: 1-800-433-3243

PROCESSING TIMELINE

Note: Complex cases, especially unauthorized signature claims, may take longer due to investigation requirements.

WHAT HAPPENS AFTER APPROVAL

1. Loan Discharge: Your remaining loan balance will be discharged

2. Refund: You will receive a refund of:
   - All payments made voluntarily
   - All amounts collected through garnishment or offset
   - Any amounts paid to collection agencies

3. Credit Report Correction: The loan holder will:
   - Report the discharge to all credit bureaus
   - Request deletion of any adverse credit history

4. No Future Liability: You (and any endorser) will have no further obligation on the loan

5. Consolidation Loans: Only the portion representing the falsely certified loans will be discharged

IF YOUR APPLICATION IS DENIED

If your false certification discharge is denied, you may:

1. Request Reconsideration

• Submit additional documentation
• Clarify any misunderstandings
• Provide new evidence

2. Appeal

• Follow the formal appeal process in your denial letter
• Submit within the timeframe specified

3. Seek Legal Assistance

• Contact a student loan attorney
• Contact National Consumer Law Center
• Contact your state's legal aid organization

4. Consider Alternative Relief

• Borrower Defense to Repayment
• Income-Driven Repayment plans
• Other discharge programs

FREQUENTLY ASKED QUESTIONS

Q: What if I got my GED after enrolling but before completing the program?
A: You may still be eligible if the school did not properly test you at the time of enrollment.

Q: What if I can't prove I didn't have a high school diploma?
A: The Department of Education has access to records and can investigate. Explain your situation thoroughly.

Q: What if my criminal record has been expunged?
A: You may still be eligible if the record existed at the time of enrollment and would have disqualified you.

Q: What if a family member signed my name with my verbal permission?
A: This is still considered an unauthorized signature under federal regulations.

RESOURCES

• StudentAid.gov - Official false certification discharge information
• StudentLoanBorrowerAssistance.org - National Consumer Law Center
• CFPB.gov - Consumer Financial Protection Bureau
• FTC.gov/idtheft - Identity theft reporting
• Your State Attorney General - Consumer protection resources

This template was last updated on 2026-01-25 and reflects current federal regulations. For the most current information, visit StudentAid.gov or consult with a qualified attorney or student loan counselor.