Public Service Loan Forgiveness (PSLF) & TEPSLF Certification & Application Completed Form Examples and Samples

Explore practical examples and samples of the Public Service Loan Forgiveness (PSLF) & TEPSLF Certification & Application form. Learn how to accurately fill out your PSLF application with our step-by-step guides and real-world templates.
Public Service Loan Forgiveness (PSLF) & TEPSLF Certification & Application has a moderate Form Complexity Index of 46/100 — Instafill’s AI completes it in under a minute.
Fill out form with AI
Download PDF Example
Completed Public Service Loan Forgiveness form based on HR employment email

Public Service Loan Forgiveness (PSLF) & TEPSLF Certification & Application Sample

How this form was filled:

This example demonstrates how an AI can parse an unstructured HR email regarding employment verification and automatically populate the official Public Service Loan Forgiveness (PSLF) & TEPSLF Certification & Application form. By identifying key entities such as employer tax IDs, employment dates, and applicant contact details, the AI eliminates the manual data entry burden for student loan borrowers.

Source document used: Employment Verification Email from HR

Subject: Employment Verification Request - Marcus A. Thorne

Dear Marcus,

It was a pleasure speaking with you earlier regarding your student loan forgiveness paperwork. Per your request, I have pulled the necessary employment details from our records at the St. Jude Community Health Center. For your PSLF application, our Federal Employer Identification Number (EIN) is 44-9876543. Our main office is located at 1200 Medical Plaza Dr, Memphis, TN 38104. Our website is www.stjudechc.org if the Department of Education requires further verification.

Regarding your employment history, your official start date with us was 06/15/2016 and you are still currently employed here in a full-time capacity. You have consistently maintained an average of 40 hours per week during your tenure. I have also included your personal file details we have on record: DOB is 11/04/1988, SSN ending in 9901 (please verify the full number on your document), and your current contact address is 4522 Oak Street, Apartment 4B, Memphis, TN 38112. Your primary phone number on file is (901) 555-0129 and your email is [email protected].

I am authorized to sign your form as the HR Director. Please send the document over, and I will be happy to sign it electronically or via ink as required. If you need any further information regarding your status or benefits, please reach out to our department directly.

Best regards,
Sarah Jenkins
HR Director, St. Jude Community Health Center
(901) 555-9988 | [email protected]

Information used to fill out the document:

  • Applicant: Marcus A. Thorne (DOB: 11/04/1988)
  • Employer: St. Jude Community Health Center (EIN: 44-9876543)
  • Employment Details: Full-time, 40 hrs/week, Active since 06/15/2016
  • Contact Info: 4522 Oak Street, Apt 4B, Memphis, TN 38112, (901) 555-0129
  • Certification Official: Sarah Jenkins, HR Director, (901) 555-9988

What this filled form sample shows:

  • Intelligent entity extraction from unstructured email threads
  • Normalization of employment dates and weekly hour averages
  • Automatic mapping of HR contact details to form-specific fields
  • Identification of 'Still Employed' status to handle open-ended date fields

Form specifications and details:

Form: Public Service Loan Forgiveness (PSLF) & TEPSLF Certification & Application
FormNumber: OMB No. 1845-0110
Industry: Higher Education Finance / Public Service
TargetUser: Federal Direct Loan Borrowers
Categories: education application forms, federal loan forms, federal student aid forms, loan application forms, student aid forms, student application forms, student loan forgiveness forms, student loan forms
Created: July 06, 2026 02:11 PM
Completed Public Service Loan Forgiveness form based on HR employment email