2017 Funding Application Loan Repayment Assistance Program

Transcription

1 2017 Funding Applicatin Lan Repayment Assistance Prgram Lewis & Clark Law Schl Deadline May 30, 2017 Eligibility is based n the factrs in the brchure entitled Overview f the Lan Repayment Assistance Prgram (Prgram Descriptin), which is incrprated by reference int this applicatin. Applicants are respnsible fr understanding the terms and requirements in the Prgram Descriptin. Defined terms used herein but therwise undefined carry the definitin prvided in the Prgram Descriptin. Lan Repayment Assistance Prgram (LRAP) lans prvide mney t service eligible law-schl educatinal lans. In additin t estimated incme data required in this applicatin, yu will need t furnish supprting infrmatin (tax returns and a frgiveness applicatin) after the LRAP Year fr verificatin. Because awards are structured as frgivable lans, failure t cmplete the frgiveness applicatin r failure t meet the incme, emplyment, r ther requirements culd result in being required t partly r fully repay an award. This Applicatin is fr an LRAP lan fr calendar year 2017 (r the LRAP Year expressly determined by the applicant and the PILC). Cmpleted applicatins and requested attachments must be received by Tuesday, May 30, Late applicatins may be cnsidered at the cmmittee s discretin. Persnal Infrmatin Name: Graduatin Date: Name at the time f law schl registratin, if different: Hme Address: City: State: Zip: Wrk Phne: Hme Phne: Fax: LRAP Year: January 2017 t December 2017 Other: t Resume Attach an up-t-date resume including paid and unpaid Public Interest wrk. LRAP Eligible Emplyer Infrmatin Jb Title: Name f Emplyer: Address: City: State: Zip: Start Date: Number f Hurs per Week: Duties/Nature f Wrk: Categry f Emplyer: Gvernment Tax-exempt rganizatin under Internal Revenue Cde sectin 501(c)(3), (4), r (5) A qualified Indian entity as defined by IRS 7873(b) Attach a letter frm yur emplyer cnfirming emplyment, dates, and 2017 salary. Attach a cpy f yur emplyer s IRS tax-exempt certificate. 1

2 Family Infrmatin Reprt infrmatin regarding yur partner: D yu have a Partner (married r in a dmestic partnership see Prgram Descriptin)? Yes N Partner s Name: Partner s Emplyer: Attach a letter frm yur partner s emplyer cnfirming 2017 salary Partner s Outstanding Student Lan Balance: Partner s Mnthly Student Lan Payment: Expected Mnths Partner s Student Lans will be in Repayment During 2017: Reprt infrmatin regarding yur and yur partner s dependents: Name(s), age(s), and relatinship(s) t applicant r partner f dependents: Applicant Partner Will all dependents be claimed n tax frms? Yes N Yes N If dependents will nt be claimed n tax frms, explain and verify expenses f at least $5,000 fr the care f each. Financial Infrmatin Tiered Incme Caps: My qualifying emplyment is in a Tier I city/metr area (see Prgram Descriptin Sectin 4) My qualifying emplyment is in a Tier II city/metr area (see Prgram Descriptin Sectin 4) I am submitting a Request fr Cst f Living Adjustment and supprting dcumentatin with this applicatin (see Prgram Descriptin Sectin 5). Reprt yur and yur partner s anticipated 2017 incme: Ttal grss wages, salaries, and tips: Incme Surce Applicant Partner Ttal investment incme (capital gains, interest, and dividends) ther than taxdeferred retirement accunts: Net rental, business, and self emplyment incme: Child/spusal supprt received: Other incme taxable r nn-taxable, e.g., trust, ryalty, frgiven lans, gifts, inheritances, in-kind remuneratin (e.g. rm and bard), r thers: Reprt yur and yur partner s assets: Real estate: Autmbile: Categry Fair Market Value: $ Mrtgage Balance: $ Fair Market Value: $ Value 2

3 Checking savings & investment accunts (stcks, bnds, depsits, and ther investments whether held in an accunt r individually): Tax-deferred retirement accunts (401K, IRA, pensin, annuity): Other significant assets: Lan Balance: $ Ttal Value: Ttal Value: Item: Value: $ Other LRAP Funding Have yu already, r will yu be applying fr any ther LRAP assistance in 2017? Yes N Which prgram: Expected amunt: $ Applicatin date: Student Lans Federal Student Lans Attach a printut f yur Financial Aid Summary frm the Natinal Student Lan Data System (NSLDS) listing all yur undergraduate and law schl federal student lans (Perkins, Staffrd, and Grad PLUS). NSLDS ( keeps a recrd f all yur federal student lans. In rder t access the infrmatin yu will need yur FSA ID (username and passwrd fr Federal Student Aid websites). T get yur Financial Aid Summary, g t and click n Financial Aid Review. Accept the privacy terms and enter yur FSA ID. If yu have frgtten yur FSA ID, there will be links n the lg in page t assist yu. Yur Financial Aid Summary shuld be displayed after successfully lgging in. Which repayment plan are yu using fr yur federal lans (Perkins, Staffrd, Grad PLUS, and cnslidatin)? Standard 10 year Graduated Extended Term (12, 15, 20, 25, 30 year): Incme Cntingent Type B (Classic Incme Cntingent) Incme-based (15% f dispsable incme) Pay as Yu Earn (10% f dispsable incme) Revised Pay as Yu Earn (10% f dispsable incme in revised prgram) If yu are nt using ne f the fur incme driven repayment prgrams, have yu cnsidered these ptins? (Federal, incme-driven repayment prgrams may reduce current lan payments fr graduates.) Yes N Have yu cnslidated yur federal student lans? Yes N If yu have cnslidated: Actual r expected mnthly cnslidatin lan payment: $ If yu have nt cnslidated: Actual r expected mnthly nn-law schl federal lan payment: $ Actual r expected mnthly law schl federal lan payment: $ 3

4 Other undergraduate and nn-law schl educatinal lans: Private educatin lans (nt listed n yur NSLDS Summary) Other Student Lans nt listed elsewhere (specify) Ttal Principal Brrwed Current Balance (w/n 60 days) Expected Mnthly Payment Other lans brrwed while attending Law Schl: Private law schl lans (nt listed n yur NSLDS Summary) Other law schl lans nt listed elsewhere (specify) Bar Study Lan Ttal Principal Brrwed Current Balance (w/n 60 days) Expected Mnthly Payment Repayment Timing When did r des yur law schl lan repayment bligatin begin? T yur knwledge, will yur lan repayment be suspended r reduced in the cming year? Yes N If yes, please describe: Yu must infrm PILC if yur lan payments are suspended r reduced fr any reasn during the curse f yur LRAP lan perid. Persnal Statement Attach a statement sharing unique experiences, persnal characteristics, r any ther aspect f yur situatin that might aid PILC in making its determinatin. Certificatin This is a lan applicatin. Prviding false infrmatin may be a vilatin f the law, and if discvered will be reprted. All infrmatin n this frm is true and cmplete t the best f my (ur) knwledge. If asked, I (we) agree t prvide prf f the infrmatin supplied n this frm. I (We) understand that awards may be adjusted r rescinded upn receipt f verifying infrmatin. I authrize my law schl t release t PILC infrmatin regarding lans. Applicant s Signature Date Partner s Signature (if applicable) Date Electrnic signatures are acceptable in Adbe Reader, click n the signature bx and fllw the prmpts t sign. In Apple Preview, frm the Tls Menu, select Anntate > Signature > Create Signature frm Facetime Camera, sign a piece f paper and fllw the prmpts, then click n the signature line t place yur signature. If yu fill ut the applicatin electrnically and then print, sign, and scan it, please submit bth the scanned applicatin and the un-signed, saved riginal.pdf file. Dcuments Enclsed: Cmpleted Applicatin Emplyer letter cnfirming dates and salary Current Resume Emplyer s IRS tax-exempt certificate 4

5 Dcumentatin frm Partner (if applicable) Persnal Statement Federal Financial Aid Summary frm All applicatins and supprting materials must be received by Tuesday, May 30, 2017 Submit applicatin and all supprting materials t: Career & Prfessinal Develpment Center Lewis & Clark Law Schl SW. Terwilliger Blvd. Prtland, OR Tel: Fax: Electrnic submissins are preferred and need nt be fllwed with a physical applicatin. 5