Teacher Education Assistance for College and Higher Education Grant Program (TEACH Grant Program) Service Obligation Certification and Suspension Request Forms

TEACH Grant Certification of Qualifying
Teaching

OMB No. 1845-0158
Form Approved
Exp. Date: 11/30/2026

Teacher Education Assistance for College and
Higher Education (TEACH) Grant Program
WARNING: Any person who knowingly makes a false statement or misrepresentation on this form or
on any accompanying document is subject to penalties that may include fines, imprisonment, or both,
under the U.S. Criminal Code and 20 U.S.C. 1097.

Section 1: General Information and Instructions
1

NOTE: Throughout this form, the words “we,” “us,” and “our” refer to the U.S. Department of
Education or to your TEACH Grant servicer. The word “Agreement” refers to the Agreement to Serve
or Repay that you signed before you received each of your TEACH Grants.
How do I use this form?
As explained in your Agreement, you must complete at least 4 elementary or secondary school years
of qualifying teaching service for each program of study for which you received a TEACH Grant. You
must provide us with documentation of each completed year of teaching by submitting this form.
As further explained in your Agreement, if you do not begin or do not maintain qualifying teaching
service within a timeframe that would allow you to complete your required 4 years of teaching within
the 8-year period described in your Agreement, the TEACH Grants you received will be converted to
Direct Unsubsidized Loans that you must repay in full. Upon our request, you must document that you
have begun qualifying teaching service by submitting this form.
How do I complete the form?
•

Before you begin, carefully read the entire form. Print using dark ink.

•

Your name, address, and other information may be preprinted in Section 2. If any of this
information is not shown, or if any preprinted information is incorrect, enter or correct the
information on the right side of Section 2. If any of your information has changed since the
last time you reported it to us, check the box in Section 2 to indicate this.

•

Complete Section 3. Be sure to answer all questions.

•

Sign and date the form in Section 4. Enter the date as month-day-year (for example, if
you signed the form on August 25, 2024, you would enter “08/25/2024”).

•

Enter your name and Social Security Number (SSN) at the top of page 3, then have
the chief administrative officer (CAO) of your school or educational service agency
complete Section 5. If you are certifying a completed year of teaching and you met the
requirements for a full school year of teaching by teaching at different schools or for

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different educational service agencies during the same school year, the CAO for each
school or educational service agency must complete Section 5. If you need a certification
from more than one CAO, an additional copy of Section 5 is included on page 13 of this
form. Be sure to enter your name and SSN at the top of each certification page that you
submit. If the same CAO is authorized to certify your teaching during the same academic
year at different schools or for different educational service agencies (for example, if you
taught at different schools within the same school district), the CAO must provide the
information requested in Section 5 for each school or educational service agency.

Section 2: Grant Recipient Information
See the instructions on page 1.
Social Security Number (SSN):
Name:
Address:
City:

State:

Zip Code:

Telephone:
Telephone (Alternate):
Email (optional):
Check this box if you are changing any preprinted information.

Section 3: Information About Your Teaching Service (to be completed by the
TEACH Grant recipient)
Read the definitions in Section 9 before you complete this section.
1. Did you complete a full school year of teaching or have you begun teaching?
Yes – Continue to Question 2.
No – Do not complete this form; you must have completed a full school year of
teaching or must have begun teaching.
2. Were you a full-time teacher or have you begun full-time teaching.
Yes – Continue to Question 3.
No – Do not complete this form; you must teach full-time.

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Grant Recipient’s Name:

Grant Recipient’s SSN:

3. Did you teach or have you begun teaching at a low-income school, as defined in Section 9
of this form?
Yes – Continue to Question 4.
No – Do not complete this form; you must teach at a low-income school as defined in
Section 9.
4. Did you teach or have you begun teaching at a low-income school, as defined in Section 9
of this form?
Yes – Continue to Question 4.
No – Do not complete this form; you must teach the majority of your classes in a highneed field as defined in Section 9.
5. Where did you teach or where have you begun teaching? Check all that apply.
at a low-income elementary school
at a low-income secondary school
for a low-income educational service agency (ESA)
6. In what high-need field or fields did you teach or have you begun teaching? Check all that
apply.
Bilingual education or English language acquisition
Reading specialist

Foreign language

Science (includes computer science)

Math

Special education

Other high-need field not listed above (this may include a geographic region or grade level
with teacher shortages; see the definition of “high-need field” in Section 9). If you check this
box, continue to Question 7. Otherwise, go to Section 4.
7. If you checked “other high-need field not listed above” in Question 6, in what other highneed field did you teach or have you begun teaching?

IMPORTANT: You must identify the other high-need field using the same name under which the
field is listed in the Nationwide List (see the definition of “high-need field” in Section 9).

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Grant Recipient’s Name:

Grant Recipient’s SSN:

Section 4: Your Certifications and Understandings (to be completed by the
TEACH Grant recipient)
I certify that (1) the information I have provided on this form is true and correct; (2) I have read and
understand the terms and conditions and definitions in Sections 8 and 9; and (3) upon request, I will
provide additional documentation to my TEACH Grant servicer to document my qualifying teaching
service.
IMPORTANT: I understand that (1) under the terms and conditions of my Agreement, any TEACH
Grant I received for a program of study will be converted to a Direct Unsubsidized Loan if I do not
begin qualifying teaching or continue to perform qualifying teaching service within a timeframe that
would allow me to complete my required 4 years of teaching within the 8-year period required by my
Agreement; and (2) if any TEACH Grant that I received is converted to a Direct Unsubsidized Loan, I
must repay that loan in full, with interest charged from the date of each TEACH Grant disbursement.
Grant Recipient’s Signature:

Date (mm/dd/yyyy):

Section 5: Chief Administrative Officer’s (CAO’s) Certification
Read the definitions in Section 9 before completing this section. Be sure to sign and date the form at
the end of this section. Return the form to the grant recipient.
1. What is the name of the school or educational service agency (ESA) where the grant
recipient taught or is currently teaching? Enter the name and other information requested
below, then continue to Question 2.
NOTE: If the grant recipient met the requirements for a full school year of teaching by teaching at
different schools or for different ESAs and you are authorized to certify the recipient’s teaching
service at each school or ESA (for example, if the recipient taught at different schools within the
same school district), provide all information requested below for each school or ESA. Attach
additional pages if necessary; include all information requested in this section.
School (not school district) or ESA Name:

Check here if this is a school or ESA operated by the Bureau of Indian Education (BIE) or
operated on an Indian reservation by an Indian tribal group under contract with the BIE.

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Grant Recipient’s Name:

Grant Recipient’s SSN:

School or ESA Address:
City:

State:

Zip Code:

School or ESA Website:
School District:

County:

2. Was the grant recipient a full-time teacher who met all state certification requirements for
teaching (which may include meeting the requirements through certification obtained
through alternate routes to teaching) during the school year(s) of teaching that you are
being asked to certify?
Yes – Continue to Question 3.
No – Do not complete this form. The teaching does not satisfy the terms and
conditions of the TEACH Grant service obligation.
3. Were more than half of the classes that the grant recipient taught/teaches in the high-need
field(s) indicated by the grant recipient in Section 3 (this may include a geographic region
or grade level with teacher shortages; see the definition of “high-need field” in Section 9)?
Yes – Continue to Question 4.
No – Do not complete this form. The teaching does not satisfy the terms and
conditions of the TEACH Grant service obligation.
4. Has the grant recipient met their contractual requirements (for purposes of salary
increases, tenure, and retirement) for a full school year of teaching, and has that school
year ended?
Yes – Continue to Question 5.
No – Skip to Question 8.
5. Check the box below that describes how the grant recipient completed a full school year of
teaching, then follow the instructions for the box that you check. Check only one box.
The grant recipient completed a full school year of teaching during one school year at the
same school or for the same ESA. Continue to Question 6 and identify the school year.
The grant recipient completed a full school year of teaching by teaching for two complete and
consecutive half years within the same school year at different schools or for different ESAs.
Continue to Question 6 and identify the school year.
The grant recipient completed a full school year of teaching by teaching for two complete and
consecutive half years of teaching during different school years at either the same school or
for the same ESA or at different schools or for different ESAs. Skip to Question 7 and
identify the school year.

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Grant Recipient’s Name:

6. The grant recipient taught for the full 20

Grant Recipient’s SSN:

- 20

7. The grant recipient taught for the second half of the 20
for first half of the 20
- 20
school year.
8. The grant recipient has begun teaching for the 20
completed a full school year of teaching.

school year.
- 20

school year and

school year, but has not yet

I certify that the information I have provided above about the TEACH Grant recipient’s teaching
service is true and correct.
CAO’s Name:
CAO’S Title (printed):
Telephone:

Email:

CAO’s Signature:

Date (mm/dd/yyyy):

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Please omit pages 7–14 when mailing or faxing back.

Section 6: Make sure that all sections are complete
•

then send us the completed form (including any additional CAO certifications if required) by
one of the following means:

•

Mail the form and any required documentation to the following address:
Federal Student Aid Programs - TEACH
P.O. Box 300010
Greenville, TX 75403
Fax the form to 540-212-2415

•

Section 7: Who can I contact if I have questions?
If you need help completing this form, contact 1-800-4-FED-AID.

Section 8: Terms and Conditions of Your Teach Grant Service Obligation
For each program of study for which you received a TEACH Grant, you must complete a service
obligation by teaching full-time for a total of at least 4 elementary or secondary school years (1) at a
school or educational service agency serving low-income students; and (2) in a high-need field. In
addition, you must meet all state certification requirements for teaching in the state where you teach
(which may include meeting the requirements through certification obtained through alternate routes
to teaching).
You must complete the 4 years of teaching within 8 years after you cease to be enrolled at the
postsecondary institution where you received your TEACH Grants. You must provide us with
documentation of each completed school year of teaching. When requested, you must provide us
with other documentation showing that you are meeting the terms and conditions of your service
obligation.

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If you do not begin qualifying teaching or continue to perform qualifying teaching service within a
timeframe that would allow you to complete the required 4-year service obligation for a program of
study within the 8-year period required by your Agreement, any TEACH Grant you received for that
program of study will be converted to a Direct Unsubsidized Loan that you must repay in full, with
interest charged from the date of each TEACH Grant disbursement you received. Any TEACH Grant
you received will also be converted to a Direct Unsubsidized Loan if you ask us to convert your
TEACH Grant to a loan because you have decided not to teach in an eligible school or field, or for
any other reason. For the complete terms and conditions of your TEACH Grant service obligation,
refer to your Agreement.

Section 9: Definitions
Chief administrative officer
The chief administrative officer (CAO) who may complete Section 5 is the official who has access to
employment records that establish that your teaching service meets the terms and conditions of your
TEACH Grant Agreement, as described in Section 8, and who is authorized to verify your qualifying
teaching service. Depending on your employer, the chief administrative officer may be a
superintendent, a human resources official or other school district or educational service agency
official, or a principal or assistant principal.
Educational service agency
An educational service agency (ESA) is a regional, public multiservice agency (not a private
organization) authorized by state statute to develop, manage, and provide services or programs to
local educational agencies (such as public school districts), as defined in section 9101 of the
Elementary and Secondary Education Act of 1965, as amended (ESEA).
Elementary school
An elementary school is a public or nonprofit private school, including a public elementary charter
school, that provides elementary education, as determined under state law.
Full-time
You are considered to be a full-time teacher if you meet the standard used by the state where you
teach in defining full-time employment as a teacher. If you are teaching in more than one school, the
determination of full-time is based on the combination of all of your qualifying employment.
High-need fields
High-need fields are—
•

Bilingual education and English language acquisition;

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•

Foreign language;

•

Mathematics;

•

Reading specialist;

•

Science (including, but not limited to, computer science);

•

Special education; or

•

Any other high-need field listed in the Teacher Shortage Area Nationwide Listing
(Nationwide List) at https://tsa.ed.gov/#/home/ that we issue annually and periodically
update, including a geographic region of a state or a specific grade level designated as
having a shortage of teachers.

To satisfy your TEACH Grant service obligation by teaching in a high-need field that is listed in the
Nationwide List, the field must be listed for the state where you are teaching at the time you begin
teaching in that field (even if the field later loses its high-need designation), or it must have been
listed for the state where you are teaching at time you signed your Agreement or received a TEACH
Grant (even if the field loses its high-need designation before you begin teaching in that field).
Low-income school
A low-income school is an elementary school, secondary school, or educational service agency
(ESA) that is listed in the U.S. Department of Education’s Teacher Cancellation Low-Income Directory
(TCLI Directory) at https://studentloans.gov/myDirectLoan/tcli.action. All elementary and
secondary schools or educational service agencies operated by the U.S. Department of the Interior’s
Bureau of Indian Education (BIE) or operated on Indian reservations by Indian tribal groups under
contract or grant with the BIE qualify as low-income schools, even if they are not listed in the TCLI
Directory.
If a school or ESA where you teach meets the requirements for inclusion in the TCLI Directory for all
or a part of a school year of your required 4 school years of teaching, but does not meet those
requirements in subsequent school years, those subsequent years of teaching at that same school or
ESA will still qualify for purposes of satisfying your TEACH Grant service obligation.
School year
A school year is—
•

One complete school year at the same school or for the same ESA; or

•

Two complete and consecutive half school years at different schools or for different ESAs;
or

•

Two complete and consecutive half school years from different school years at either the
same school or for the same ESA or at different schools or for different ESAs.

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Half years do not include summer sessions. Two half school years generally fall within a 12-month
period. For schools or ESAs that have a year-round program of instruction, a minimum of nine
months is considered to be a school year.
Under limited conditions, less than a full school year of teaching may still be counted as one of your
required 4 years. If you completed at least one-half of a school year of qualifying teaching, but
were unable to teach for the remainder of the school year, that partial year may still be counted
toward one of your required 4 years of teaching if—
•

Your employer considers you to have fulfilled your contract requirements for the school
year for the purposes of salary increases, tenure, and retirement; and

•

You were unable to complete the full school year due to (1) a condition that is a qualifying
reason for leave under the Family and Medical Leave Act of 1993 (FMLA), (2) a call or
order to Federal or State active duty, or Active Service as a member of a Reserve
Component of the Armed Forces named in 10 U.S.C. 10101, or service as a member of the
National Guard on full-time National Guard duty, as defined in 10 U.S.C. 101(d)(5); or (3)
residing in or being employed in a federally declared major disaster area as defined in the
Robert T. Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C. 5122(2).

Secondary school
A secondary school is a public or nonprofit private school, including a public secondary charter
school, that provides secondary education, as determined under state law. However, a secondary
school does not include any education beyond grade 12.
Teacher
A teacher is a person who provides direct classroom teaching or classroom-type teaching in a nonclassroom setting, including special education teachers and reading specialists.
TEACH Grant servicer
Your TEACH Grant servicer (identified in Section 7) monitors your progress toward completing your
TEACH Grant service obligation on behalf of the U.S. Department of Education.

Section 10: Privacy Act Notice
The Privacy Act of 1974 (5 U.S.C. 552a) requires that the following notice be provided to you:
The authorities for collecting the requested information from and about you are §420L et seq. and
§451 et seq. of the Higher Education Act (HEA) of 1965, as amended (20 U.S.C. 1070g et seq. and
20 U.S.C. 1087a et seq.) and the authorities for collecting and using your social security number
(SSN) are §484(a)(4) of the HEA (20 U.S.C. 1091(a)(4)) and §31001(i)(1) of the Debt Collection
Improvement Act of 1996 (31 U.S.C. 7701(c)). Participating in the Teacher Education Assistance for
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College and Higher Education (TEACH) Grant Program and/or the William D. Ford Federal Direct
Loan (Direct Loan) Program and giving us your SSN are voluntary, but you must provide the
requested information, including your SSN, to participate.
The principal purposes for collecting the information on this form, including your SSN, are to verify
your identity, to determine your eligibility to receive a TEACH Grant, and, if a TEACH Grant that you
receive is converted to a Direct Unsubsidized Loan, to determine your eligibility to receive a benefit
on the loan (such as deferment, forbearance, discharge, or forgiveness), to permit the servicing of
your loan(s), and, if it becomes necessary, to locate you and to collect and report on your loan(s) if
your loan(s) become delinquent or in default. We also use your SSN as an account identifier and to
permit you to access your account information electronically.
The information in your file may be disclosed, on a case-by-case basis or under a computer matching
program, to third parties as authorized under routine uses in the appropriate systems of records
notices.
The routine uses of the information that we collect about you, if your TEACH Grant has not been
converted to a Direct Unsubsidized Loan, include, but are not limited to, its disclosure to federal,
state, or local agencies, to institutions of higher education, and to third party servicers to determine
your eligibility to receive a TEACH Grant, to investigate possible fraud, and to verify compliance with
federal student financial aid program regulations.
In the event of litigation, we may send records to the Department of Justice, a court, adjudicative
body, counsel, party, or witness if the disclosure is relevant and necessary to the litigation. If this
information, either alone or with other information, indicates a potential violation of law, we may send
it to the appropriate authority for action. We may send information to members of Congress if you ask
them to help you with federal student aid questions. In circumstances involving employment
complaints, grievances, or disciplinary actions, we may disclose relevant records to adjudicate or
investigate the issues. If provided for by a collective bargaining agreement, we may disclose records
to a labor organization recognized under 5 U.S.C. Chapter 71. Disclosures may be made to our
contractors for the purpose of performing any programmatic function that requires disclosure of
records. Before making any such disclosure, we will require the contractor to maintain Privacy Act
safeguards. Disclosures may also be made to qualified researchers under Privacy Act safeguards.
If your TEACH Grant has been converted to a Direct Unsubsidized Loan, the routine uses of this
information also include, but are not limited to, its disclosure to federal, state, or local agencies, to
private parties such as relatives, present and former employers, business and personal associates, to
creditors, to financial and educational institutions, and to guaranty agencies to verify your identity, to
determine your program eligibility and benefits, to permit making, servicing, assigning, collecting,
adjusting or discharging your loan(s), to enforce the terms of the loan(s), to investigate possible fraud
and to verify compliance with federal student financial aid program regulations, to locate you if you
become delinquent in your loan payments or if you default, or to verify whether your debt qualifies for
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discharge or cancellation. To provide default rate calculations, disclosures may be made to guaranty
agencies, to financial and educational institutions, or to federal, state or local agencies. To provide
financial aid history information, disclosures may be made to educational institutions. To assist
program administrators with tracking refunds and cancellations, disclosures may be made to guaranty
agencies, to financial and educational institutions, or to federal or state agencies.
To provide a standardized method for educational institutions to efficiently submit student enrollment
status, disclosures may be made to guaranty agencies or to financial and educational institutions. To
counsel you in repayment efforts, disclosures may be made to guaranty agencies, to financial and
educational institutions, or to federal, state, or local agencies.
Paperwork Reduction Notice
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection
of information unless it displays a currently valid OMB control number. The valid OMB control number
for this information collection is 1845-0158. Public reporting burden for this collection of information is
estimated to average 20 minutes (0.33 hours) per response, including time for reviewing instructions,
searching existing data resources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. The obligation to respond to this collection is required to obtain
a benefit in accordance with 34 CFR 686.40(a).

If you have comments or concerns regarding the status of your individual submission of this form,
write to:
Federal Student Aid Programs - TEACH
P.O. Box 300010
Greenville, TX 75403

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Grant Recipient’s Name:

Grant Recipient’s SSN:

Additional Chief Administrative Officer’s Certification
(to be used if a certification from more than one chief administrative officer is required)

Section 5: Chief Administrative Officer’s (CAO’s) Certification
Read the definitions in Section 9 before completing this section. Be sure to sign and date the form at
the bottom of this page. Return the form to the grant recipient.
1. What is the name of the school or educational service agency (ESA) where the grant
recipient taught or is currently teaching? Enter the name and other information requested
below, then continue to Question 2.
NOTE: If the grant recipient met the requirements for a full school year of teaching by teaching at
different schools or for different ESAs and you are authorized to certify the recipient’s teaching
service at each school or ESA (for example, if the recipient taught at different schools within the
same school district), provide all information requested below for each school or ESA. Attach
additional pages if necessary; include all information requested in this section.
School (not school district) or ESA Name:
Check here if this is a school or ESA operated by the Bureau of Indian Education (BIE) or
operated on an Indian reservation by an Indian tribal group under contract with the BIE.
School or ESA Address:
City:

State:

Zip Code:

School or ESA Website:
School District:

County:

2. Was the grant recipient a full-time teacher who met all state certification requirements for
teaching (which may include meeting the requirements through certification obtained
through alternate routes to teaching) during the school year(s) of teaching that you are
being asked to certify?
Yes – Continue to Question 3.
No – Do not complete this form. The teaching does not satisfy the terms and
conditions of the TEACH Grant service obligation.

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Grant Recipient’s Name:

Grant Recipient’s SSN:

3. Were more than half of the classes that the grant recipient taught/teaches in the high-need
field(s) indicated by the grant recipient in Section 3 (this may include a geographic region
or grade level with teacher shortages; see the definition of “high-need field” in Section 9)?
Yes – Continue to Question 4.
No – Do not complete this form. The teaching does not satisfy the terms and
conditions of the TEACH Grant service obligation.
4. Has the grant recipient met their contractual requirements (for purposes of salary
increases, tenure, and retirement) for a full school year of teaching, and has that school
year ended?
Yes – Continue to Question 5.
No – Do not complete this form. You can only certify teaching for a full school year of
teaching that has ended.
5. Check the box below that describes how the grant recipient completed a full school year of
teaching, then follow the instructions for the box that you check. Check only one box.
The grant recipient completed a full school year of teaching during one school year at the
same school or for the same ESA. Continue to Question 6 and identify the school year.
The grant recipient completed a full school year of teaching by teaching for two complete and
consecutive half years within the same school year at different schools or for different ESAs.
Continue to Question 6 and identify the school year.
The grant recipient completed a full school year of teaching by teaching for two complete and
consecutive half years of teaching during different school years at either the same school or
for the same ESA or at different schools or for different ESAs. Skip to Question 7 and
identify the school year.
6. The grant recipient taught for the full 20______ - 20______ school year.
7. The grant recipient taught for the second half of the 20______ - 20______ school year and
for first half of the 20______ - 20______ school year.
I certify that the information I have provided above about the TEACH Grant recipient’s teaching
service is true and correct.
CAO’s Name:
CAO’S Title (printed):
Telephone:
CAO’s Signature:

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Email:
Date (mm/dd/yyyy):

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