Do not print the form and fill it out by hand.  

Enter all the required information online, use the "Print and Sign" button at the bottom of the form to generate the official PDF copy.
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  The official copy will have a barcode in the lower left corner and a signature line at the end of the form.

  After you print and sign the form, submit it to the Financial Aid Office using one of the following options:

21-22 Federal Loan Discharge Acknowledgement – Financial Aid
 Student Name     Last:      First:      M.I.: 
 ctcLink ID Number:    --   Birthdate:  //   MM/DD/YYYY
   Social Security Number: --
  You have requested a Federal Direct Loan and according to the National Student Loan Data System (NSLDS) you have had prior Federal student loans discharged due to total and permanent disability (TPD). To review your current federal student loans, go to
  You must complete this form each time you request a Federal Direct Loan, however completion of this form does not guarantee that you will qualify for any Federal loans we offer. The information collected on this form will be used to determine your eligibility for the Federal Direct Loan Program. If you are unable to provide a certification from your physician then you will not be eligible for loans.
Student Section - Must complete each time a new loan is requested
I acknowledge that I have previously received a total and permanent disability discharge either through the Federal Family Education Loan Program, William D. Ford Direct Loan Program, or Federal Perkins Loan Program. By my signature below, I clearly understand that any additional student loans I receive must be repaid in full and cannot be discharged in the future on the basis of any impairment present when the new loan is made unless that impairment substantially deteriorates as determined by a physician. I also understand that if I have not successfully completed the post-discharge period for my previously discharged loans, I may be required to begin repayment of those loans.
I authorize any physician, hospital, or other institution having records pertaining to the physician’s certification I have submitted, to make information from such records available to Edmonds College, U.S. Department of Education, or the holder of my loan(s).
 Student Signature (required)                 Date                
    Yes    No        I already have a physician certification on file with the Financial Aid Office at Edmonds CC.
 This button will generate a pdf form.
 Please print the PDF and sign
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