Berkeley Law - LOAN REPAYMENT ASSISTANCE PROGRAM (LRAP) -

LOAN REPAYMENT ASSISTANCE PROGRAM (LRAP)

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ONLINE APPLICATION FOR CANCELLATION OF LRAP LOANS

Name (First, Middle, Last, Suffix) (required)

Student ID Number (required)
Graduating Class

Email Address (required)

* Email is our primary method of contacting you. Please provide an email which you will check regularly and notify us of any changes.

My current and permanent addresses have not changed. Complete the following fields only if your address has changed:

Preferred Mailing Address	Please select your preferred mailing address.
Current Address Line 1
Current Address Line 2
Current City
Current State
Current Zip Code

Permanent Address Line 1
Permanent Address Line 2
Permanent City
Permanent State
Permanent Zip Code

My marital and dependent status has not changed
Complete the following fields only if your status has changed:

Marital Status
If married, spouse's name
Number of Dependent Children	as defined by the federal tax code
Ages of Dependent Children

Briefly list any changes in your loan portfolio such as consolidation, paid off loans, or other notes.

My salary/income has not changed
Complete the following fields only if your salary has changed:

Date of Salary Change
Previous Salary
New Salary

My employment/position has not changed
Complete the following fields only if your employment has changed:

Date of employment change
Previous Salary
Start Date at Previous Salary
End Date at Previous Salary

New Salary
Start Date at New Salary
End Date at New Salary

REQUIRED: Please report actual gross income for the length of your contract. Your contract start and end dates are shown on your award letter.
(If you are married, your spouse's income must also be reported.)

Applicant
Wages and Salaries
Other Income (please specify)
Total Income
Spouse
Wages and Salaries
Other Income (please specify)
Total Income

REQUIRED: Attach a copy of the Employer Verification Form completed and signed by your employer verifying your income.

Employer Verification Form

REQUIRED: Attach proof of payment for all of your loans in the form of payment history or statements of payments. Proof of payment for Direct Loans can be obtained from your Payment History at www.direct.ed.gov.

Proof of Payment Document
Proof of Payment Document
Proof of Payment Document
Proof of Payment Document
Proof of Payment Document
Proof of Payment Document

By typing my name below, I certify that all of the information provided on this form is true and complete to the best of my knowledge. I agree to provide verification of the information that I have supplied on this form if requested by the School of Law or the program administrators.
Please type your full name (required)

LOAN REPAYMENT ASSISTANCE PROGRAM (LRAP)

ONLINE APPLICATION FOR CANCELLATION OF LRAP LOANS

UC Berkeley School of Law