Student Loan Evaluation - Please tell us more: - Ohio & Michigan Student Loan Attorney Scott Ciolek

Full Legal Name:*

Previous Names

E-mail Address:*

Best Phone Number to Reach You:*

Is the above phone # a landline or cell phone?

If you provided a cell phone number, may we text you about your student loan matter?

Birthdate:*

Address*

Street Address Address Line 2 City State ZIP Code

Marital Status:*

If married, did you file your last tax return jointly or separately?

Number of Dependents:*

Name of Employer:

AGI (Adjusted Gross Income) on Last Year's Tax Return. If you don't know the exact amount, please estimate.*

What is your year to date gross (before tax) income? If you don't know the exact amount, please estimate.*

Have you filed for Bankruptcy? If so, when?*

What type of loans to you have?*

Amount of Federal Loans:

Amount of Private Loans

Please list all Student Loans to which you are obligated, please include company name and approx amount due:*

Are you disabled?

Are you currently being sued for any student loan?*

Have you been garnished for any student loan?

Have you consolidated your loans?

Do you have credit card or medical bill debt?

How can we help?*

Is there anything else that would be helpful for us to know?

Feel free to upload any legal documents that you've received (Complaint, Summons, etc.) or other helpful document:

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