## Attestation for Certain Heald College Students

UNITED STATES DEPARTMENT OF EDUCATION ATTESTATION FOR CERTAIN HEALD COLLEGE STUDENTS APPLICATION FOR BORROWER DEFENSE TO REPAYMENT LOAN DI SCHARGE 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 man y of its programs of study. This form is designed to expedite the process of obtaining loan forgiveness based o n borrower defense to repay ment 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://s tudentaid.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 foun d 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 repay ment. Additional instructions to file a claim for loan forgiveness c an be found at studentaid.ed.gov. Instructions: Please complete this form. To sign the form, insert a digital image of y our signature in the appropriate field below or print a hard cop y of the form and sign. Submit your form and all supplementary

document s 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 additio nal materials in support of my application for a borrower defense to repay ment discharge of m y 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, y ou should complete the first Campus Program section based on your enrollment in criminal justi ce and the second Campus Program section based on y our 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 enr olled 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 ______________________________ Credentia l______________________________

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 way s (check each that applies)__Brochures adve rtising 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. Ibelieved that the job placeme nt 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. Iapplied 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, Ihave included documents(s) with additional information to confirm that I was enrolled in the program of study at Heald College that Iidentified above, and was enrolled for the dates I provided above. (Suggested documents include transcripts and registration documents i ndicating your specific program of stud y at Heald College and dates of enrollment.) The document(s) I have attached are:

__________________________________________________________________________

___________________________________________________________ _______________

__________________________________________________________________________ __ *Select the check box if y ou 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 a dded in error.) ADD CAMPUS PROGRAM BUTTON [Allows to add an additional campus program b y repeating questions 1

- 4 above] REMOVE CAMPUS PROGRAM BUTTON [Removes additional campus program section prevoiusly

added by clicking the ADD CAMPUS BUTTON] **SECTION I II: OTHER INFORMATION**  Please provide or attach any other information about y our experience at Heald College that y ou believe is relevant: (2,000 characters max)

__________________________________________________________________________

_________________

_________________________________________________________

__________________________________________________________________________

__________________________________________________________________________ **SECTION IV: DIRECT LOAN FORBEARANCE**By

complet ing this form, y ou are eligible to have all of your federal loans placed into forbearance and for collections on any federal loans in default to stop while y our claim is reviewed b y the Department of Education. Please read the following information careful ly before making your selection below. During an y 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 y our loans are alread y in default, collections will stop. This will co ntinue until the loan discharge review process is completed. Your servicer will notify

y ou when y our loan has been placed into forbearance or stopped collections. Until yo u receive that notice, you should continue to make pay ments. The forbearance or stop ped 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 onl y 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 b y the enclosed list), you must notify y our loan serv icer. At any time during the forbearance or stopped collections period, you may voluntarily

make pay ments on y our loans, including pay ments for accrued interest, or end the forbearance or stopped collections by

contacting y our 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 yo ur 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 an y of your loans and th e forbearance or stopped collections period will end for all of yo ur 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 m y federal loans to be placed in forbearance and for collections to stop on any loans in default while m y loan discharge claim is reviewed. __ No, I do not want m y 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 Icertify that:
I agree to provide, upon request, testimony , a sworn statement, or other documentation reasonabl y available to me that demo nstrates 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 m y knowledge and I agree, i f asked, to provide information reasonabl y 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 app lication 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_______

_______________________ 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 L oan (FFEL) Program, or the Federal Perkins L oan (Perkins Loan) Program, and giving us y our SSN are voluntary , but y ou mus t provide the requested information, including y our SSN, to participate. The principal purposes for collecting the information on this form, including your SSN, are to verify y our identit y, 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 L oan Programs, to permit the servicing of y our loan(s), and, if it becomes necessary , to locate you and to collect and report on your loan(s) if y our loan(s) becomes delinquent or defaults. We also use yo ur SSN as an account identifier and to permit y ou to access your account information electronically. The information in y our file may be disclosed, on a case

- by

- case basis or under a computer m atching program, to third parties as authorized under routine uses in the appropriate sy stems 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 employ ers, business and personal associates, to consumer reporting agencies, to financial and educational institutions, and to guarant y agencies in order to verify yo ur identit y, to determine your eligibility to receiv e a loan or a benefit on a loan, to permit the servicing or collection of y our loan(s), to enforce the terms of the loan(s), to investigate possiblefraud and to verify compliance with federal student financial aid program regulations, or to locate you if you become delinquent in y our loan pay ments or if y ou 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 pr ovide a standardized method for educational institutions to efficiently

submit student enrollment statuses, disclosures may be made to guarant y agencies or to financial and educational institutions. To counsel y ou in repay ment efforts, disclosures may

be m ade to guarant y 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, part y, or witness if the disclo sure 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 authorit y for action. We may

send information to members of Congress if you ask them to help y ou with federal student aid questions. In circumstances involving employ ment complaints, grievances, or disciplinary

actions, we may

disclose relevant records to adjudicate or investigate the issues. If provided for b y a collective b argaining 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 an y programmatic function that requires disclosure of records. Before making an y such disclosure, we will require the contractor to maintain Privacy Act safeguards. Disclosures may also be made to qualified researchers under Privacy Act safeguards. According to the Paperwork Reduction Act of 1995, no persons are required to resp ond to a collection of information unless such collection display s 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 h our 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.