Federal Direct Consolidation Loan Additional Loan Listing Sheet

William D. Ford Federal Direct Loan Program

OMB No. 1845-0053

Form Approved

Exp. Date xx/xx/xxxx

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. [60-DAY CLEARANCE DRAFT 12/19/2013

BEFORE YOU BEGIN

Read the Instructions for Completing the Federal Direct Consolidation Loan Application and Promissory Note (“Instructions”). Use this form only if you need additional 

space to list loans in the Loans You Want to Consolidate section or the Loans You Do Not Want to Consolidate section of your Note.

BORROWER INFORMATION

Last Name: ______________________________________________ First Name: ___________________________________________ Middle Initial: __________

Social Security Number: ___ ___ ___ - ___ ___ - ___ ___ ___ ___

LOANS YOU WANT TO CONSOLIDATE

List each federal education loan that you want to consolidate, including any Direct Loan Program loans that you want to include in your Direct Consolidation Loan. List 

each loan separately. We will send you a notice before we consolidate your loans. This notice will (1) provide you with information about the loans and payoff 

amounts that we have verified, and (2) tell you the deadline by which you must notify us if you want to cancel the Direct Consolidation Loan, or if you do not want to 

consolidate one or more of the loans listed in the notice. The notice will include information about loans that you listed in this section. If you have additional loans 

with a holder of a loan that you listed in this section, the notice will also include information about those additional loans. See the Instructions for more information 

about the notice we will send. IN THIS SECTION, LIST ONLY LOANS THAT YOU WANT TO CONSOLIDATE

13. Loan Code

(see Instructions)

14. Loan Holder/Servicer Name, Address, and 

Area Code/Telephone Number (see Instructions)

15. Loan Account 

Number

16. Estimated Payoff 

Amount

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 

(see Item 11 of the Borrower’s Rights and Responsibilities Statement that accompanies your Note). Remember to include any Direct Loan Program loans that you do 

not want to consolidate. List each loan separately. We will send you a notice before we consolidate your loans. This notice will (1) provide you with information about 

the loans and payoff amounts that we have verified, and (2) tell you the deadline by which you must notify us if you want to cancel the Direct Consolidation Loan, or 

if you do not want to consolidate one or more of the loans listed in the notice. The notice may also include information about any loans you listed in this section, but 

these loans listed will not be consolidated. See the Instructions for more information about the notice we will send. IN THIS SECTION, LIST ONLY LOANS THAT YOU 

DO NOT WANT TO CONSOLIDATE

18. Loan Code

(see Instructions)

19. Loan Holder/Servicer Name, Address, and 

Area Code/Telephone Number (see Instructions)

20. Loan Account 

Number

21. Current Balance