DD Form 2475: DoW Educational Loan Repayment Program (LRP) Annual Application

Control No. and Loan Program (X one): Selected Reserve LRP, Health Professionals LRP or Active Duty LRP.

Section 1, Personnel Office Verification, is to be completed by the designated personnel officer; 1.a. - b. are self-explanatory.

In 1.a, enter the address to forward the completed form to (Include ZIP Code).

In 1.b, VERIFYING OFFICIAL: "I certify that this servicemember has performed satisfactorily."

The verifying official enters the Name (Last, First, Middle Initial), the Signature and the Date Signed (YYYYMMDD).

Section 2, Servicemember Data, is to be completed by the Servicemember or Borrower.

Enter the Name (Last, First, Middle Initial), Address (Street, City, State, and ZIP Code), Social Security No., Telephone No. (Include Area Code) and E-mail Address.

Sign under "I authorize the release of my financial data by lender/holder to complete entries in Section 3." and enter the Date Signed (YYYYMMDD).

Section 3, Loan Data, is to be completed by loan servicing agency.

3.a. Enter the Name on the loan as it appears on the promissory note.

3.b. - c. Enter the Original Date of Promissory Note (YYYYMMDD) and the Original Loan Amount.

Enter Loan ___ of ___ Loans, for example, loan 1 of 3 loans, loan 2 of 3 loans, and loan 3 of 3 loans.

3.e. Enter the Loan Account Number, to be used to ensure payments are applied to the correct amount.

3.f. - h. Identify the Loan Holder Name, Loan Holder Address and Telephone Number: the name, address, and telephone number of the institution that currently services the loan.

List any additional contact information in Section 5, Remarks.

3.i. For LOAN IN DEFAULT (X one), mark X in the appropriate box.

3.j. UNPAID PRINCIPAL BALANCE and 3.k. OUTSTANDING BALANCE are self-explanatory.

3.l. If multiple loans have been consolidated, mark (X) "Yes" or "No" indicating consolidating action.

3.m. Provide Federal tax identification number for tax withholding.

For TYPE OF LOAN, select from the list: The loan must qualify under the Higher Education Act of 1965, Title 4, Parts B, D, and E; the Health Education Assistance Loan under Part C, Title VII, Public Health Service Act; under Part B, Title VIII; Health Professional Loans that the SECDEF determines to be critical to meet wartime medical skill shortages; William D. Ford Federal Direct Loan; or any loan incurred for educational purposes made by a lender that is: (1) an agency or instrumentality of a State; (2) a financial or credit institution (including an insurance company) that is subject to examination and supervision by an agency or the United States or any State; or (3) from a pension fund or a non-profit private entity (subject to case-by-case review/approval by the Office of the Under Secretary of War for Personnel and Readiness (Military Personnel Policy) (Accession Policy) through each Service's Education Representatives).

3.o. Self-explanatory.

Complete the name and address of the institution where payment is to be sent only if different than the one listed in 3.f. and 3.g.

3.q. Lender may not use a routing number as the payment address.

3.r. CERTIFYING OFFICER. As an official of the holding institution, "I verify that this information is correct and current." Enter the Name (Last, First, Middle Initial), Title, Signature and Date Signed (YYYYMMDD).

Section 4, Loan Data, is to be completed by loan servicing agency.

4.a. and 4.c. are self-explanatory.

4.b. Cancelled Amount: amount cancelled after Origination Date of Loan.

4.d. Date of Disbursement (YYYYMMDD): date of each individual disbursement.

Use Remarks to enter additional information that will assist in processing this application.

A separate DD Form 2475 must be completed for each loan if Borrower has more than one (1) loan.

If the Borrower is the parent and has a Parent Loan for Undergraduate Students incurred for the Servicemember's education, ensure the Servicemember's full name and last 4 digits of their SSN are provided in Section 5, Remarks.

For eligible LRP participants, Parent Loans for Undergraduate Students (PLUS) and Consolidated Loans are also eligible for repayment under the LRP, as long as the loans were incurred for the Servicemember's education.

Since the loans may be in someone else's name and could include loans incurred for individual's education other than the Servicemember (such as a sibling or loans incurred for their own education), it would be necessary to have the borrower complete Section 2 and include information regarding the education for which the loans were incurred.