LRAP APPLICATION Deadline: February 16, 2018

Transcription

1 APPLICANT INFORMATION LRAP APPLICATION Deadline: February 16, 2018 LOAN REPAYMENT ASSISTANCE PROGRAM (LRAP) Name: Social Security #: Last First MI Driver s License #: State: Date of Birth: Telephone: ( ) ( ) Home Work Law Matriculation Year: Law Graduation Year: MM / DD/ YYYY EMPLOYMENT INFORMATION Employer Name: Employer Supervisor Name: Supervisor Telephone: ( ) Position Title: Annual Salary: Nature of Work: SPOUSE INFORMATION Spouse/Partner Name: Spouse/Partner Spouse/Partner Salary: DEPENDENT INFORMATION Dependent Name Last Name First Name Age Last Name First Name Age Last Name First Name Age

2 FINANCIAL INFORMATION - INCOME 2018 PROJECTED INCOME Total Salary/Wages: Annual Bonus: APPLICANT SPOUSE/PARTNER OTHER INCOME Gifts: Alimony Received: Child Support Received: Capital Gains: Interest Income: Dividends: Trust Income: Other: ASSETS (Current Value) Home/Condominium/Cooperative: Amount Owed on Property: Stocks/Bonds/Trusts: Retirement Funds: Cash Value of Life Insurance Policy: Cash/Savings: Other: FINANCIAL INFORMATION - EXPENSES 2018 PROJECTED ANNUAL EXPENSES * ATTACH DOCUMENTATION OF THESE EXPENSES TO YOUR APPLICATION Child Care/Elder Care: *Undergraduate (prior) Educational Loan Payments: *Spouse/Partner Educational Loan Payment: *Alimony Paid: *Child Support Paid: *Other: (Unreimbursed Medical/ Dental Expenses) APPLICANT SPOUSE/PARTNER SPECIAL CIRCUMSTANCES Please describe and document any special circumstances you would like the Board to consider when reviewing your application

3 LRAP APPLICATION HISTORY Is this your first LRAP application? Y N If yes, what year did you submit your first application? LOAN REPAYMENT ASSISTANCE PROGRAM (LRAP) Are you currently eligible for/receiving funds from any other loan repayment program? If so, explain the source and amount of this funding LAW SCHOOL DEBT INFORMATION To ensure that we have received all lender verification forms for your covered loans, please provide the names of each lender, and the type of loan you received from that lender during Law School. These should include your Stafford Loans, Perkins Loans, Graduate PLUS Loans and private educational loans associated with your attendance at -Newark. LENDER/SERVICER TYPE OF LOAN Amount of Debt Attach the following to your application and submit by February 3, 2017 NEW: Print out of your one-page federal loan summary from Copy of your 2016 or 2017 Federal Tax Return (1040), or submit an affidavit of Non-Filing Copy of your (& your spouse s/partner s) 2017 final pay stub(s), W2 forms, 1099 forms, Copy of your (& your spouse s/partner s) most recent pay stubs Copy of your most recent monthly loan statement/coupon for each educational loan. Resume/Employment History Returning LRAP recipients must also attach documentation that last year s LRAP funds were applied to law school debt. CERTIFICATION I/We certify that the loans listed on this application are currently in good standing. I/We certify that all the information submitted on this application is true and complete to the best of my/our knowledge. I/We understand that failure to provide all requested information in compliance with program guidelines and deadlines will result in my/our ineligibility to receive benefits under this program. I/We agree that all funds received from LRAP will be used solely for the purpose of repaying my outstanding law school loans. Applicant Initials Spouse/Partner Initials Applicant Signature: Spouse/Partner Signature:

4 EMPLOYMENT HISTORY (Provide information for all positions held since graduating from ; attach current resume) Start Date End Date

5 Lender Verification Form Part A: TO BE COMPLETED BY APPLICANT Name: Social Security #: Last First MI I,, authorize the release of the information requested below to the Newark Loan Repayment Assistance Program. Applicant Signature:. Part B TO BE COMPLETED BY LENDER / SERVICER Please provide the following information on all loans owed by the person referenced above and return this form to the Rutgers Law School-Newark LRAP at the address listed above as soon as possible. Type of Loan: Capitalized Interest: Initial Disbursement Required Monthly Payment: Original Amount Borrowed: Interest Rate: Current Outstanding Balance: Amount Paid in Past 12 months: 1 st Payment Due Final Payment Due Is this loan currently in Default/Deferment/Forbearance? Authorized Signer: Title: Lender/Servicer: Telephone:

6 Employment Certification Form Part A: TO BE COMPLETED BY THE APPLICANT Name: LOAN REPAYMENT ASSISTANCE PROGRAM (LRAP) I,, authorize my employer,, to provide information requested in Part B to Newark s Loan Repayment Assistance Program. Applicant Signature: Part B: TO BE COMPLETED BY THE EMPLOYER Please complete the information requested below concerning the employment status of the above-referenced individual, and return this form to the -Newark LRAP as soon as possible. If you have any questions regarding this matter, please contact our office at the above address or phone number. Thank you for your cooperation. Dates of Employment: Full Time: Y N Hours per week: Current Annual Gross Salary: Increase Expected for 2017: Value of Employee Benefit: Retirement: Housing Allowance: Other: Please describe the nature of work performed: Loan Repayment Assistance: Life Insurance (Cash Value): Employer Name: Employer Employer Telephone: Authorize Respondent Name: Authorized Respondent Signature: Title: IS YOUR ORGANIZATION QUALIFIED FOR TAX EXEMPTION AS DETERMINED BY THE INTERNAL REVENUE SERVICE? Y/N IF SO, PLEASE PROVIDE A COPY OF YOUR DETERMINATION LETTER OR CERTIFICATION OF YOUR TAX STATUS.

7 Have you completed and signed the LRAP Application? LRAP Application Checklist Have you attached copies of these required documents to your application? Print out of federal loan summary 2016 or 2017 Federal Income Tax Return 2017 Year-End Pay Stubs, W2 Forms, 1099 Forms Most Recent Pay Stub Most Recent Loan Statement/Coupon for each loan Resume/Employment History If you are a returning LRAP recipient, have you attached documentation which shows that last year s LRAP funds were applied to your law school debt? Have you submitted the Lender Certification Form to each of your lenders? Have you submitted the Employer Certification Form to your employer? Application Deadline is February 16, 2018 Submit application & supporting documentation to: Loan Repayment Assistance Program