Personal & Contact Info

First Name *

Nickname

Last Name *

Date of Birth * +

Birth Country *

Birth State/Province *

Citizenship *

Street Address *

Address Line 2

City *

State *

Zip Code *

How long have you lived at this address? *

Phone Number *

Email Address (personal address is preferred, as opposed to school/work since these sometimes expire) *

Education and Career Path Info

Please describe yourself *

Medical School Attended *

Residency Type *

Residency Location *

Fellowship? *

Fellowship type *

Completion Date (estimate if uncertain) * +

Attending Start Date * +

Working for or plan to work for a non-profit? *

Debt Info (student, home, credit, auto, etc)

Federal Student Loan Balance *

Current repayment status *

Monthly Payment *

Private Student Loan Balance (including institutional loans from your school) *

Current repayment status *

Monthly Payment *

Family Loan Balance (if you've borrowed from family) *

Credit cards (balance/payment) *

Auto Loan (balance/payment) *

Mortg/rent (balance/payment) *

Income, Assets, and Tax Filing Information

Current annual income *

If still in residency/fellowship, estimated attending income *

Current cash on hand (checking, savings, liquid investments, etc) *

Relationship status (can impact student loan repayment plan recommendations) *

Partner's/Spouse's First Name *

Partner's/Spouse's Last Name *

Partner's/Spouse's current annual income *

Partner's/Spouse's Federal Student Loan Balance *

How did you file taxes last year *

Upload Supporting Documents

Please upload documentation for your student loans, as this is critical to ensuring our guidance is as accurate as possible. Please make sure that if you don't upload your NSLDS file, that all of your loan types are specified (Stafford, Direct Stafford, etc). You can obtain your NSLDS text file (yes it looks ugly but it's what I prefer!) of all of your federal student loans by doing the following: please visit https://studentaid.gov/, log in, select "Manage My Loans", click on your name, click "Dashboard", click "View Details" by My Aid, and then "Download My Aid Data". Save the text file to your computer, then upload here

Please upload documentation for any other student loans here (private, institutional, etc). Please ensure that this documentation shows the loan balance, payment (if any is due), interest rate, etc). This may require uploading an actual statement as opposed to a screenshot, or viewing Loan Details as opposed to Loan Summary.

By checking the box below, I agree to the terms and conditions contained herein. PFG will review appropriate documentation, and will provide guidance and offer insight as to possible approaches for managing my student loans. I understand that many of the state and federal loan repayment or forgiveness programs that may appear to be applicable to my situation are subject to change, and that changes in my personal circumstances may reduce or eliminate the effectiveness of said programs. I understand and acknowledge that I am only receiving guidance, not a specific recommendation, and that it is my obligation to make an informed decision and implement the strategy I believe is most appropriate. *

I agree