2009 INITIAL APPLICATION

Transcription

1 WASHINGTON AND LEE UNIVERSITY SCHOOL OF LAW SHEPHERD LOAN REPAYMENT ASSISTANCE PROGRAM 2009 INITIAL APPLICATION G:\LRAP\2009\FINAL Initial Application.doc 1

2 WASHINGTON AND LEE UNIVERSITY SCHOOL OF LAW SHEPHERD LOAN REPAYMENT ASSISTANCE PROGRAM Application Checklist IMPORTANT NOTE: The Lender Certification and the Employer Certification forms must be provided to the Committee no later than the application deadline. Please provide these forms to your lender(s) and employer(s) in sufficient time to enable them to return the forms to W&L Law by February 15. NAME: _GRADUATION YEAR: Please submit, or arrange to have submitted, the following documents assembled in this order to the Committee no later than February 15: This Checklist Resume Personal Statement (double spaced and no more than two pages), detailing your public interest employment, the community served, your reasons for entering public service, your future plans and any additional information you would like the Committee to consider Application, signed and dated Actual Income and Major Expenses Worksheet Loan Indebtedness Worksheet Asset Worksheet Copy of your most recent Federal Income Tax Return (or a certification that you did not file a federal income tax return, and the reason) and most recent end of year pay stub or W-2 Copy of your spouse's most recent Federal Income Tax Return ONLY if Tax Return filed separately (or a certification that s/he did not file a federal income tax return, and the reason) Employer Certification was submitted to my employer(s) on _ (date) -- see Important Note (above) Lender Certification was submitted to my lender(s) on _ (date) -- see Important Note (above) Submit materials to: Washington and Lee University School of Law Shepherd Loan Repayment Assistance Program Career Planning and Professional Development Sidney Lewis Hall, Room 490 Lexington, VA Fax:

3 WASHINGTON AND LEE LAW LOAN REPAYMENT ASSISTANCE PROGRAM APPLICATION FOR CALENDAR YEAR 2009 Please Type or Print Legibly Applicant s Name: Graduation Year:_ Social Security Number Date: Home Address: City: _ State: Zip:_ Home Telephone: ( ) Personal Name of Spouse (if applicable): _ Name and birth date of dependent children under the age of 19: Applicant s Employment Information Employer Name: _ Employer Address: City: _ State: Zip:_ Applicant s Position/ Title: _ Current Annual Salary: Estimated Salary for 2009: _ Work Telephone: ( ) Work _ If you have been employed by other employers since graduating from W&L Law, please provide the name of those employer(s) and dates of employment: _ Applicant s Immediate Supervisor Information Name: Title: _ Telephone: () Fax: Employer s website: _ Spouse s Employment Information Required ONLY if Separate Tax Return Filed Employer Name: _ Employer Address: City: _ State: Zip:_ Spouse s Position/Title: _ Current Annual Salary: _ Work Telephone: (_)_ Work _ Supervisor s name, Title: _ Supervisor s Telephone/ () 3

4 WASHINGTON AND LEE LAW LOAN REPAYMENT ASSISTANCE PROGRAM APPLICATION FOR CALENDAR YEAR 2009 Certification and Agreement I certify that the information provided in this application and in all supporting materials provided to the Committee is complete, true and accurate. I understand that: the Committee will annually determine the total amount available under the LRAP; W&L Law need not award the entire amount available in any given year; there is no guarantee that graduates selected for LRAP funding one year will be selected in future years; in order to continue to be eligible for LRAP funding, I must provide the Committee with certain postaward documentation as well as annual renewal applications, as outlined in the LRAP; Assistance is contingent on my continuing to meet financial and employment eligibility criteria and to provide all required or requested documents as discussed in the LRAP materials; Failure to abide by the terms of the LRAP or otherwise to become ineligible for assistance as determined by the Committee, will trigger the obligation to re-pay any loans made to date under the LRAP in accordance with the repayment terms set forth in the related Promissory Note(s); if awarded assistance, I will be required to sign a Promissory Note setting forth my obligation to re-pay LRAP loans that are not subsequently forgiven; I agree to: abide by the rules of W&L Law s LRAP; use any assistance received under the LRAP for the sole purpose of repaying the student loans listed in my application; provide required documentation and to notify the Committee within thirty (30) days of any changes in my address and employment or financial circumstances as set forth in the LRAP; and cooperate with publicity efforts to publicize the Shepherd Loan Repayment Assistance Program and authorize the use of my name, photograph, and information relating to the public service work, but not the amount of the loan repayment assistance received. _ Signature of Applicant _ Date 4

5 ACTUAL INCOME WORKSHEET Name: Date: _ Please report your actual income for the current calendar year. If applicable, you must also report your spouse s actual income. Wages and Salaries Overtime/Bonus/Commissions Total Interest Income Total Dividend Income Business Income Alimony/Child Support Received Unemployment Compensation Rental Income Trust Fund Income / Inheritance/Gift Other Income - Specify TOTALS Applicant Spouse MAJOR EXPENSES WORKSHEET Please report your annual major expenses. If applicable, you must also report your spouse s expenses. Mortgage or Rent Extraordinary Medical Expenses (including premiums) Child Care Expenses Other Major Expenses - Specify Applicant Spouse TOTALS 5

6 ASSET WORKSHEET Name: _ Date: _ Please report your assets as of the date closest to the date of your application. If applicable, you must also report your spouse s assets as of that date. Cash and Bank Account Applicant Spouse Joint Investments Trusts Other Assets (please list and provide additional information) TOTALS Do you own a home? yes no If yes, what is the current market value? How much do you owe on the mortgage? Do you own other real estate? yes no If yes, please indicate the current market value and the amount owed for each property: 6

7 LOAN INDEBTEDNESS WORKSHEET 2009 LRAP Application Name:_ Date: If applicable, your spouse must also submit a copy of this worksheet. Law School Loans (e.g., Subsidized Stafford, Unsubsidized Stafford, Perkins, Law Access, CitiAssist, etc.) Lender/ Type of Loan Original Loan 2/09 Balance Monthly payments Date Final Payment Due 7

8 Non-Law School Education Loans (including undergraduate loans) Lender/ Type of Loan Original Loan 2/09 Balance Monthly payments Date Final Payment Due Total-Due on ALL educational loans _ Total Monthly Payment: _ Loan Repayment Assistance from Other Sources List any loan repayment assistance that you or your spouse are currently receiving, have applied for, or otherwise expect to receive (include recipient, amount, source, and dates of any assistance): 8

9 LENDER CERTIFICATION FORM INSTRUCTIONS: Complete Part A and forward the form to the holder of each of your educational loans, including bar study loans. Part A: To be completed by the applicant. Name: Social Security Number: I authorize the lender at _ to provide the information requested in Part B to Washington and Lee University School of Law in connection with my application for the Shepherd Loan Repayment Assistance Program. Applicant s Signature: Date: _ Part B: To be completed by the lender. Dear Sir or Madam: The individual listed above has applied for a special program which requires information regarding any monies the applicant has borrowed from you. Please complete the required information and return it to our office by mail or fax as soon as possible, but no later than February 15. Thank you for your assistance. Washington and Lee University School of Law, Career Planning and Professional Development Sydney Lewis Hall, Lexington, VA Phone: Fax: Type of Loan Amount Outstanding Monthly Payment Interest Rate Repayment Period (years) Is the applicant delinquent or in default? _ How many days? _ Are the applicant's loans in deferment or forbearance? _ Until when? _ Comments: Name of lender Date (_) Address City State Zip Telephone Name (printed) and Title Authorized signature 9

10 EMPLOYER CERTIFICATION FORM Part A: To be completed by the applicant. Name: SS# _ I authorize my employer: _ to provide the information requested in Part B to Washington and Lee University School of Law in connection with my application for the Shepherd Loan Repayment Assistance Program. Applicant s Signature: Date: _ Part B: To be completed by the employer. Dear Sir or Madam: The above-named graduate has applied for a special program which requires certification from the employer of the applicant's employment status. Please complete the following information and return it to our office by mail or fax as soon as possible, but no later than February 15. Thank you for your assistance. Washington and Lee University School of Law, Career Planning and Professional Development Sydney Lewis Hall, Lexington, VA Phone: Fax: Employment start date: _ Full Time: Part time: Annual Gross Salary: Job Title: Is a JD required for this position? _ Please attach job description. Please attach a breakdown of the long and short-term benefits paid to this employee, including health/dental insurance, life, disability and related insurance, retirement, bar or other dues, professional liability insurance, CLE allowance, housing and any other additions to salary. Comments: Employer address: City: State: _ Zip: _ Telephone: () Name (printed): Title: _ Authorized Signature: Date: 10