Institution Name

  Social Security Number

  LEAP Reversion Amount

After submitting data, a confirmation page will appear on screen.  Click the print button of your browser.  Make sure that you have a printed copy before you continue with entering more data.  You can only print the confirmation page while it is on screen.  You will need to send a signed copy of the confirmation page to the LEAP Program Manager. Send an email to notify the LEAP Program Manager that you submitted applications .