Layoff Loan Application - Federal Employee Education & Assistance Fund

Personal Information

First Name*

Middle Name

Last Name*

Date of Birth*

Social Security Number*

Gender*

Race/Ethnicity*

Do you have a disability?*

Home Address*

Apartment No.

City*

State*

Zip*

Personal Email*

Home Phone

Cell Phone*

Association Memberships

Membership in a union or association is not required for this program.

Other Association Membership Name

Are You a Veteran?

Total Number of Members of Household (including self)*

Household Members Detail (tell us who lives in your home, their ages, and their relationship to you)*

Where did you learn about this program?*

Other way you learned about this program

Federal Employment Information

Please provide information for your most recent federal employment

Federal Agency*

Position/Title*

Agency Address*

Agency City*

Agency State*

Agency Zip*

GS Grade

Annual Salary*

Emergency Information

What is the Reason for Your Loan Request?

What expenses are you seeking payment for?*

Rent or mortgage payments
Home utilities
Medical expenses (not covered by insurance)

Are there any additional circumstances impacting your ability to pay for basic needs right now? eg. 2-fed family both laid off, serious illness of self or immediate family member, recent LWOP*

Payee 1

If your loan is approved, please indicate which bill(s) you would like paid with these loan funds. Please note there is a maximum of two creditors and the maximum total loan amount is $2,000. Checks cannot be made out directly to you. Allowable expenses include rent or mortgage payment, utilities (gas, electric, water), and medical expenses not covered by insurance. See instructions for additional information.

Loan Amount to be paid by FEEA to Payee 1*

Payee 1 Name*

Payee 1 Address*

Payee 1 City*

Payee 1 State*

Payee 1 Zip*

Payee 1 Phone Number*

Payee 1 Account Number (if any)

Payee 2

Loan Amount to be paid by FEEA to Payee 2

Payee 2 Name

Payee 2 Address

Payee 2 City

Payee 2 State

Payee 2 Zip

Payee 2 Phone Number

Payee 2 Account Number (if any)

Required Attachments

Only Adobe Acrobat (.pdf) or image (.jpg or .png) files allowed. Please attach only the document(s) requested on each line. Do not attach the same document more than once or on more than one line.

Most Recent SF-50 (Notification of Personnel Action)*

Add File...

Most Recent Employee Leave and Earnings Statements*

Add File...

Most Recent Spouse's Leave and Earnings Statements

Add File...

Layoff/Furlough Notice*

Add File...

Copy of bill(s) you are seeking assistance for*

Add File...

Copy of state-issued driver or non-driver ID*

Add File...

Credit Release Authorization (included in Layoff Loan Application Instructions available at www.feea.org/layoff)*

Add File...

Terms, Signatures and Verification

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I understand that loan approval is not guaranteed and is at FEEA’s discretion.

Full Name *

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If I am granted a no-interest loan, I agree to repay FEEA the full loan amount in the time period specified in my loan agreement, via one of the approved repayment methods, whether or not I return to federal service. I understand FEEA reserves the right to seek repayment for defaulted loans through any legal means available.

Full Name *

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I further agree to complete any required paperwork and follow the proper procedures to establish a repayment mechanism in advance of receiving my loan.

Full Name *

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I certify that all of the information included in my loan application is true and accurate to the best of my knowledge. I understand my information will be handled in accordance with FEEA's privacy policy available at www.feea.org/about/privacy.

Full Name *

Date *

Full Name *

Date *

Captcha*

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Mailing Address

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Layoff Loan Application - Federal Employee Education & Assistance Fund

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