Please answer all questions below and click “Send.” Your Name * Your Address | City | State and Zip Code * What is your Date of Birth? * What is your SSN? * Your Email * Your Phone Number * Number in household that is dependent upon you? (including yourself) * Who is your employer? * How many hours a week do you work for your employer? * Are you a military veteran? * Is your employer a public service entity, non profit and/or 501(c)(3) organization * What is the status of your Federal Student Loan(s)? (Examples: Are you currently in Repayment, Forbearance, Deferment, Economic Hardship Forbearance, Delinquent in Payment, Loan in Default or Co-Signer) * What Payment Plan are you currently paying Federal Student Loans? What is your monthly payment on all Federal Student Loans? Do you have any Private Student Loans? (Examples: Student Loans that are not funded by the Federal Government? Such as loans funded by banks, credit unions or other lenders) * Do you have an impairments or disabilities that keep you from working? If you answer "yes" please briefly describe your disability. * Is your College/University closed? * Did your school falsely certify your eligibility to enter career? If answer "yes" please briefly explain. *
