## 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. **[3 0** 
**- DAY CLEARANCE DRAFT**  **0 2** **/26 /2** **01 4**  **BEFORE YOU BEGIN**
R ead 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
am ounts 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 informat ion 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 may 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 peri od for your Direct Consolidation Loan (see Item 11 of the Borrower’s Rights and Responsibilities Statement that accompanies your No te). 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 in formation 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