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Information Required when Referring

Student Overpayments due to Withdrawal

to Borrower Services - Collections
Student Information

Name (Last, First, MI): Address:

Telephone Number:

Social Security Number: Date of Birth:

If the student received an Academic Competitiveness or National Smart Grant, enter the appropriate identifier.

ACG Award ID: National Smart Grant Award ID:

Parent/Spouse Information

Name (Last, First, MI): Address:

Telephone Number:

School Information
If your Pell Reporting ID is different than your Pell Attended ID, please report both. Otherwise, just report the Attended ID.

Reporting School’s Pell ID Number: Attending School’s Pell ID Number:

Name of Contact: Telephone Number:

Disbursements and Repayments

Academic National
Pell Grant Competitiveness Smart FSEOG
Grant Grant
Award year in which overpayment was disbursed:

Total grant disbursed:

Dates of disbursement:
(must match NSLDS overpayment record)

Adjusted amount for student to return:

(From Step 10 of the Return calculation)

Total grant repaid by student to school, if any:

Date of last payment to school, if any:

Total being referred for collection:

If using individual or aggregate matching, report federal share only. Otherwise report total FSEOG. *

SEND INFORMATION TO ➾ Student Loan Processing Center-Overpayments

P.O. Box 4157

(903) 408-4595 FAX Greenville, Texas 75403