Student Loan Discharge Intake Form (Brunner Test Screening)
This intake form is designed to help screen for eligibility under the Brunner test for undue hardship in student loan discharge cases. Please answer all questions to the best of your ability. Your responses will remain confidential.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
In total, how much do you owe in student loans?
How much of your total student loan debt are private student loans?
How much of your total student loan debt are federal student loans?
Have you received a bankruptcy discharge before?
Yes
No
If you have filed for bankruptcy before, when was the discharge date?
-
Month
-
Day
Year
Date
Can you currently afford to make monthly payments on your student loans over a 10-year period (120 months)?
*
Yes
No
What is your current monthly income (after taxes)? Please enter the amount in US dollars
*
What are your total monthly expenses (housing, food, transportation, medical, etc? Please enter the amount in US dollars.
*
Have you ever enrolled in an Income-Driven Repayment (IDR) plan?
*
Yes
No
Have you requested forbearance or deferment on your student loans?
*
Yes
No
Have you contacted your loan servicer to discuss repayment options?
*
Yes
No
Have you made any payments on your student loans since they became due?
*
Yes
No
When did your student loan originally enter repayment status?
-
Month
-
Day
Year
Date
Did you complete any of the degrees or programs for which the loan was taken?
*
Vocational
Associates
Bachelors
Masters
PHD
No
Are you currently experiencing a physical or mental disability that affects your ability to work or earn income?
*
Yes, and I have medical documentation
Yes, and I do not have medical documentation
No
Have you been unemployed for at least 5 of the last 10 years?
*
Yes
No
Have you failed to acquire employment using the obtained degree?
*
Yes
No
Submit
Should be Empty: