State of Wisconsin                                                                 Scott McCallum
                        Higher Educational Aids Board                                                             Governor

                        P.O. Box 7885                        Telephone: (608) 267-2206                Jane M. Hojan-Clark
                        Madison, WI 53707-7885                     Fax: (608) 267-2808
                                                                                                       Executive Secretary
                        E-Mail:    Web Page:

                               MINORITY TEACHER LOAN PROGRAM
                                 SAMPLE RECIPIENT AGREEMENT
1.   I, «FIRSTNAME» «LASTNAME», undersigned recipient of a State of Wisconsin Minority Teacher Loan, MTL, agree
     that in return for an award of «TOTAL_AWARD» for the 2002-2003 academic year, I shall:

         (a) Work as a teacher in an eligible Wisconsin school district. For every academic year that I am so employed,
             25% of my total account shall be forgiven. I shall have a total of 6 consecutive years in which to have my
             account forgiven through eligible teaching employment. Unless otherwise extended by the Higher Educational
             Aids Board under the provisions of the Board’s administrative procedures, any amounts not forgiven at the end
             of 6 years shall be repaid to the State of Wisconsin.
         (b) Provide the Higher Educational Aids Board with proof of employment at the time I am initially hired and every
             12 months thereafter until my account is fully forgiven.
         (c) Repay my account should I not graduate or become employed as a teacher under the requirements of (a), and I
             also agree to notify the board if neither graduation nor employment occurs so that my repayment may begin
         (d) Promptly notify the Board of all changes in my name, permanent address, telephone number, educational
             institutions attended, places of employment, and my status as to being licensed to teach in Wisconsin.

2.   Should repayment become necessary, the interest rate shall be 5% beginning on the initial date of repayment as
     determined by the Board; the minimum monthly payment of the principal and interest shall be $50.00; and no more than
     10 years shall be allowed for repayment depending on the amount received and any deferments from repayment
     authorized by the Board. Recipients may prepay at any time without penalty. Recipients in repayment shall receive an
     annual statement of their account at the end of January each year. All obligations to repay the account shall cease upon
     proof of the permanent disability or death of the recipient.

3.   The Board shall grant deferments from repayment for up to 3 years for military service, Peace Corps, or VISTA; up to 6
     months for temporary unemployment or pregnancy; and forbearance deferments of varying length. Recipients returning
     to school will be deferred from repayment as long as they maintain full time status. All deferments from repayment must
     be requested by the recipient and are defined in the Board’s administrative procedures.

I accept the loan under these conditions, responsibilities, and rights, and so signify my acceptance with my signature.
I have also retained a signed copy of this agreement form for my records.

Signature of Recipient:_____________________________________ Date____________

Name of Recipient (Print): «FIRSTNAME» «LASTNAME»
Social Security Number: «SSN»
Permanent Address: «ADDRESS» «CITY», «STATE» «ZIP»
School You Are Attending: «School_Name»

This award for the «School_Year» academic year is valid only if this signed agreement form is
returned to Mary Lou Kuzdas at HEAB by «EXPIRATION_DATE».

                                       Send to:       HIGHER EDUCATIONAL AIDS BOARD
                                                      (Minority Teachers Program)
                                                      P.O. BOX 7885
                                                      MADISON, WI 53707-7885

                           State of Wisconsin                                                                               Scott McCallum
                           Higher Educational Aids Board                                                                           Governor

                           P.O. Box 7885                               Telephone: (608) 267-2206                      Jane M. Hojan-Clark
                           Madison, WI 53707-7885                            Fax: (608) 267-2808
                                                                                                                       Executive Secretary
                           E-Mail:           Web Page:


SS#: «SSN»

Sunday, September 16, 2012


You have been nominated by «School_Name» to be a recipient of the Minority Teacher Forgivable Loan for the 2002-2003 academic year.
It is essential that you review the enclosed information and return the signed agreement form within 10 days of the date of this letter to
the address above.:

No funds will be requested or disbursed until a signed agreement form and an information sheet is received at HEAB.

I have enclosed a brochure, which will explain many aspects of the program to you. For forgiveness you must be a licensed teacher and
teaching full time in a school district that satisfies the statutory requirements. Please be aware that if, you do not meet the criteria for
forgiveness, this loan must be paid back by you.

This is a student loan. You, the student are responsible to keep the HEAB informed of your new street address, marital status, teaching
position and e-mail address. If the loan is not forgiven it goes into repayment and the loan can be reported to national credit bureaus. After
the loan goes into repayment if payments are not received on a timely basis we will proceed with due diligence procedures and possibly
default the loan. If you have questions about the Minority Teacher Loan Program, please call me at 608-267-2212 or talk to the Financial
Aid Administrator at «School_Name».

As long as the account is active, not paid in full, forgiven in full or defaulted you will be sent a statement once a year listing the principal
balance outstanding and your current status. A forgiveness form will be included in this mailing for your convenience..

If you decide to not accept this award, please return the agreement form, marked cancelled, along with the date and your initials. Thank
you in advance for your consideration. If you do accept this award please return both the signed agreement form and the information
sheet to HEAB prior to the expiration date. Beginning and end dates of employment as a licensed teacher must be filled out on the form so
forgiveness can be applied.

It is important to note that since many of the recipients attend UW System schools that this loan is separate from any other loan you receive
from a UW System school. This loan must be repaid to HEAB, Forgiveness forms must be sent to HEAB


Mary Lou Kuzdas
Program Coordinator
Minority Teacher Forgivable Loan Program

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