Attestation for Certain Heald College Students 

UNITED STATES DEPARTMENT OF EDUCATION 

ATTESTATION FOR CERTAIN HEALD COLLEGE STUDENTS 

APPLICATION FOR BORROWER DEFENSE TO REPAYMENT LOAN DISCHARGE 

FORM APPROVED OMB NO: 1845-0132 Exp. 12/31/2015 

The Department of Education has found that at various times between 2010 and 2014, Heald College

published misleading job placement rates for many of its programs of study. This form is designed to

expedite the process of obtaining loan forgiveness based on borrower defense to repayment for loans taken

out by Heald College students to enroll in these programs. This form covers federal Direct Loans received on

or after July 1, 2010. A list of covered programs and dates of enrollment is available at

https://studentaid.ed.gov/sa/sites/default/files/heald-findings.pdf. Please fill out this attestation ONLY IF your

program and dates of enrollment are included on this list. 

Heald College students who did not attend programs where the Department of Education found misleading

job placement rates, or whose decision to enroll was not influenced by those job placement rates, may still be

eligible for loan forgiveness based on borrower defense to repayment. Additional instructions to file a claim

for loan forgiveness can be found at studentaid.ed.gov. 

Instructions: Please complete this form. To sign the form, insert a digital image of your signature in the

appropriate field below or print a hard copy of the form and sign. Submit your form and all supplementary

documents referenced in question #4 via email to FSAOperations@ed.gov or mail to Department of

Education, PO Box 194407, San Francisco, CA 94119. 

SECTION I: BORROWER INFORMATION 

First Name ______________________________ 

Middle Name ______________________________ 

Last Name ______________________________ 

Date of Birth ______________________________ 

Social Security Number (last 4 digits) ______________________________ 

Telephone Number ______________________________ 

Email Address ______________________________ 

Home Address ______________________________ 

City ______________________________ 

State ______________________________ 

Zipcode ______________________________ 
I,__________________ , attest to the following: 

I am submitting this attestation and additional materials in support of my application for a borrower defense

to repayment discharge of my Direct Loans under 34 C.F.R. § 685.206 (c). 

SECTION II: PROGRAM INFORMATION 

If you enrolled in more than one covered Heald program, you will need to complete the following for each

covered program you attended. For example, if you were a criminal justice student in 2011 and returned in

2012 for an accounting program, you should complete the first Campus Program section based on your

enrollment in criminal justice and the second Campus Program section based on your enrollment in

accounting. 

If you have more than one program, click the Add Campus Program button that appears at the bottom of the

Campus Program section. 

Note: This form applies to students who enrolled in a program after misleading placement rates were

published for the program. A list of covered programs and dates of enrollment is available at

https://studentaid.ed.gov/sa/sites/default/files/heald-findings.pdf. The earliest enrollment date covered is July

1, 2010. 

CAMPUS PROGRAM 

Campus ______________________________ 

Enrollment Start Date* (MM/YYYY) ______________________________ 

Enrollment End Date* (MM/YYYY) ______________________________ 

Program Name ______________________________ 

Credential______________________________ 

1. Prior to my enrollment in this Heald College program, I received information about job placement rates

related to my program of study through one or more of the following ways (check each that applies) 

__Brochures advertising Heald College's academic programs or other printed materials, including those

provided by Heald College representatives or recruiters; 

__Emails, online materials, or online disclosures from or by Heald College. 

2. I believed that the job placement rates related to my program of study indicated the level of quality a Heald

education offered to students. I chose to enroll at Heald based, in substantial part, on the information I

received about job placement rates related to my program of study and the quality of education I believed

those placement rates represented. 

3. I applied for and received a federal Direct Loan to cover the cost of attendance of the Heald program in

which I enrolled. 
__________________________________________________________________________ 

__________________________________________________________________________ 

__________________________________________________________________________ 

__________________________________________________________________________ 

__________________________________________________________________________ 

__________________________________________________________________________ 

__________________________________________________________________________ 

4. As an attachment to this attestation, I have included documents(s) with additional information to confirm

that I was enrolled in the program of study at Heald College that I identified above, and was enrolled for the

dates I provided above. (Suggested documents include transcripts and registration documents indicating your

specific program of study at Heald College and dates of enrollment.) The document(s) I have attached are: 

__ *Select the check box if you had multiple periods of enrollment in a program, that is, if you enrolled in a

program but subsequently discontinued enrollment, and then reenrolled in the same program at a later date,

please provide all start and end dates applicable to this program. (Selecting the box provides user ability to

add multiple periods of enrollment. Deselect the check box to remove any enrollment dates added in error.) 

ADD CAMPUS PROGRAM BUTTON [Allows to add an additional campus program by repeating questions

1-4 above] 

REMOVE CAMPUS PROGRAM BUTTON [Removes additional campus program section prevoiusly added

by clicking the ADD CAMPUS BUTTON] 

SECTION III: OTHER INFORMATION 

Please provide or attach any other information about your experience at Heald College that you believe is

relevant: (2,000 characters max) 

SECTION IV: DIRECT LOAN FORBEARANCE 

By completing this form, you are eligible to have all of your federal loans placed into forbearance and for

collections on any federal loans in default to stop while your claim is reviewed by the Department of

Education. Please read the following information carefully before making your selection below.

During any period that your loans are in forbearance, you do not have to make payments on those loans, and

the loans will not go into default. If your loans are already in default, collections will stop. This will continue

until the loan discharge review process is completed. Your servicer will notify you when your loan has been

placed into forbearance or stopped collections. Until you receive that notice, you should continue to make

payments. 

The forbearance or stopped collections will affect all of a borrower's federal loans, including loans that are

not eligible for discharge through this form, such as Federal Family Education Loans (FFEL), loans taken out 
to attend a Heald College program not on the enclosed list of covered programs, or loans taken out to attend

another institution. 

Note that interest will continue to accrue on all of these federal loans, including subsidized loans, during the

forbearance or stopped collections period. 

If you want the forbearance or stopped collections to apply only to those loans that may be eligible for a

discharge using this form (federal Direct Loans received on or after July 1, 2010 to attend Heald College

programs covered by the enclosed list), you must notify your loan servicer. At any time during the

forbearance or stopped collections period, you may voluntarily make payments on your loans, including

payments for accrued interest, or end the forbearance or stopped collections by contacting your servicer. 

If your claim made using this form is successful, your federal Direct Loans borrowed to attend a covered

Heald College program will be discharged. Also at that time, the forbearance or stopped collections period

for your other federal loans will end. You will be responsible for repaying these other remaining loans,

including interest that accrued during the forbearance or stopped collections period, under the terms of your

promissory note. 

If your claim is denied, you will not receive a discharge of any of your loans and the forbearance or stopped

collections period will end for all of your loans. You will be responsible for repaying these loans, including

interest that accrued during the forbearance or stopped collections period, under the terms of your promissory

note. 

__ Yes, I want my federal loans to be placed in forbearance and for collections to stop on any loans in default

while my loan discharge claim is reviewed. 

__ No, I do not want my federal loans to be placed in forbearance and for collections to stop on any loans in

default while my loan discharge claim is reviewed. 

SECTION V: CERTIFICATION 

By signing this attestation I certify that: 

I agree to provide, upon request, testimony, a sworn statement, or other documentation reasonably available

to me that demonstrates to the satisfaction of the Department of Education or its designee that I meet the

qualifications for borrower defense to repayment loan discharge. 

All of the information I provided is true and complete to the best of my knowledge and I agree, if asked, to

provide information reasonably available to me to the Department of Education that will verify the accuracy

of my completed attestation. 

I understand that the Department of Education has the authority to verify information reported on this

application with other federal or state agencies or other entities. I authorize the Department of Education,

along with its agents and contractors, to contact me regarding this request at the phone number above using

automated dialing equipment or artificial or prerecorded voice or text messages. 

I understand that if I purposely provided false or misleading information on this application, I may be subject

to the penalties specified in 18 U.S. Code § 1001. 

Signature______________________________ 
Date______________________________ 

Privacy Act Notice 

The Privacy Act of 1974 (5 U.S.C. 552a) requires that the following notice be provided to you: The

authorities for collecting the requested information from and about you are §421 et seq., §451 et seq. and

§461 et seq. of the Higher Education Act of 1965, as amended (20 U.S.C. 1071 et seq., 20 U.S.C. 1087(a) et

seq., and 20 U.S.C. 1087(a) et seq., and the authorities for collecting and using your Social Security Number

(SSN) are §428B(f) and §484(a)(4) of the HEA (20 U.S.C. 1078-2(f) and 20 U.S.C. 1091(a)(4) and 31 U.S.C.

7701(b). Participating in the William D. Ford Federal Direct Loan (Direct Loan) Program, the Federal Family

Education Loan (FFEL) Program, or the Federal Perkins Loan (Perkins Loan) Program, and giving us your

SSN are voluntary, but you must provide the requested information, including your SSN, to participate. The

principal purposes for collecting the information on this form, including your SSN, are to verify your identity,

to determine your eligibility to receive a loan or a benefit on a loan (such as a deferment, forbearance,

discharge, or forgiveness) under the Direct Loan Program, FFEL, or Perkins Loan Programs, to permit the

servicing of your loan(s), and, if it becomes necessary, to locate you and to collect and report on your loan(s)

if your loan(s) becomes delinquent or defaults. We also use your SSN as an account identifier and to permit

you to access your account information electronically. The information in your file may be disclosed, on a

case-by-case basis or under a computer matching program, to third parties as authorized under routine uses in

the appropriate systems of records notices. The routine uses of this information include, but are not limited to,

its disclosure to federal, state, or local agencies, to private parties such as relatives, present and former

employers, business and personal associates, to consumer reporting agencies, to financial and educational

institutions, and to guaranty agencies in order to verify your identity, to determine your eligibility to receive a

loan or a benefit on a loan, to permit the servicing or collection of your loan(s), to enforce the terms of the

loan(s), to investigate possible fraud and to verify compliance with federal student financial aid program

regulations, or to locate you if you become delinquent in your loan payments or if you default. To provide

default rate calculations, disclosures may be made to guaranty agencies, to financial and educational

institutions, or to state agencies. To provide financial aid history information, disclosures may be made to

educational institutions. To assist program administrators with tracking refunds and cancellations, disclosures

may be made to guaranty agencies, to financial and educational institutions, or to federal or state agencies. To

provide a standardized method for educational institutions to efficiently submit student enrollment statuses,

disclosures may be made to guaranty agencies or to financial and educational institutions. To counsel you in

repayment efforts, disclosures may be made to guaranty agencies, to financial and educational institutions, or

to federal, state, or local agencies. In the event of litigation, we may send records to the Department of

Justice, a court, adjudicative body, counsel, party, or witness if the disclosure is relevant and necessary to the

litigation. If this information, either alone or with other information, indicates a potential violation of law, we

may send it to the appropriate authority for action. We may send information to members of Congress if you

ask them to help you with federal student aid questions. In circumstances involving employment complaints,

grievances, or disciplinary actions, we may disclose relevant records to adjudicate or investigate the issues. If

provided for by a collective bargaining agreement, we may disclose records to a labor organization

recognized under 5 U.S.C. Chapter 71. Disclosures may be made to our contractors for the purpose of

performing any programmatic function that requires disclosure of records. Before making any such

disclosure, we will require the contractor to maintain Privacy Act safeguards. Disclosures may also be made

to qualified researchers under Privacy Act safeguards. 

Paperwork Reduction Act Notice 

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of 
information unless such collection displays a valid OMB control number. The valid OMB control number for

this information collection is 1845-0132. Public reporting burden for this collection of information is

estimated to average 1 hour per response, including time for reviewing instructions, searching existing data

sources, gathering and maintaining the data needed, and completing and reviewing the collection of

information. The obligation to respond to this collection is required to obtain or retain a benefit (20 U.S.C.

1087e(h)). If you have comments or concerns regarding the status of your individual submission of this

application, please contact FSAOperations@ed.gov.