LOAN REPAYMENT ASSISTANCE PROGRAM (LRAP) $form_text APPLICATION FOR FIRST-TIME AND CONTINUING PARTICIPANTS Application Type I am a first-time applicant. I am a continuing applicant. Anticipated Begin Date Select One January February March April May June July August September October November December Select One 2021 2022 2023 2024 This date cannot be earlier than the 1st day of the month you are submitting this application and should only include the month whereby you are in qualifying employing employment and have (or will have) a student loan payment due. Track I choose the Standard track. (Only available for the graduating classes of 1997 through 2012.) I choose the Income Driven Repayment (IBR, PAYE) track for the entire length of my LRAP participation. For the class of 2013 and beyond, the IDR track is your only option. To receive LRAP funding for the IDR track, your federal loans must be in the IBR or PAYE plan. You will need to provide proof of your IBR or PAYE payment amount. Once you opt for the IBR Track, you are required to remain in IBR. I am in a 1-year clerkship. You must have qualifying LRAP employment immediately following your clerkship. I am applying for the LRAP Low Bono/Union coverage. While you may be eligible for LRAP, this type of employment is not eligible for Public Service Loan Forgiveness. Please include a statement or proof that at least 50% of the work of the firm and the applicant involves providing legal services on a pro-bono, reduced fee, or court awarded fee basis to underrepresented persons or organizations. Biographical Information Name (First, Middle, Last, Suffix) (required) Student ID Number (do NOT enter your Social Security Number) Graduating Class (YYYY) Email Address * Email is our primary method of contacting you. Please provide a non-berkeley.edu email which you will check regularly and notify us of any changes. I am a continuing applicant and my current and permanent addresses have not changed. Contact Information - Please fill in both current and permanent address completely. Current Address 1 Current Address 2 Current City Current State Current Zip Code Permanent Address 1 Permanent Address 2 Permanent City Permanent State Permanent Zip Code Preferred mailing address Select One Current Permanent Choosing a preferred mailing address is important in case payment is made by paper check. We encourage all participants to sign up for EFT to receive funds electronically and avoid lost checks. This is a different EFT account than that which you had as a student. Did you enter Berkeley Law as a transfer student? Select One Yes No Do you anticipate a marital status change in the next year? Yes Marital Status Select One Single Married Divorced/Widowed If married, spouse's name Number of Dependent Children (required) (as defined by the federal tax code) Ages of Dependent Children References Please list two references who will always know where to contact you and do not reside at the same address (e.g. relatives or friends). I am a continuing applicant and my references have not changed. Reference's Name Relationship Address Phone Number Reference's Name Relationship Address Phone Number Loan Indebtedness Information Only first time applicants must complete the information in this section for all of their educational loans (both federal and private). Use the spaces provided to attach documentation of your total loan balance. Interest rates can be found by logging into your loan servicer's portal. For loans of the same type, please average the interest rates. For the classes of 2013 and beyond, Perkins, FFEL, Bar Study, and Private loans do not qualify for LRAP support. Only Direct loans are eligible for LRAP support and for the federal Public Service Loan Forgiveness program. Are you a continuing applicant and receiving support for a private loan? Please attach your most recent billing statement for private loans. For the IDR track, please attach your most recent IDR approval letter or statement which should show your approved monthly payment amount and when that payment amount expires. Because your IDR payment amount will change every 12 months when you recertify your income to renew your IDR plan, please provide the date you anticipate your IDR payment amount will change. This will ensure that your LRAP award is as accurate as possible. Recent IBR Payment Date Select One January February March April May June July August September October November December Select One 2021 2022 2023 2024 2025 Berkeley Law Loans Amount Borrowed Current Outstanding Balance Monthly Payment Average Interest Rate(%) Loan Type Documentation of Your Current Repayment Plan Direct Subsidized or Unsubsidized Loans Select One fixed variable Direct Subsidized or Unsubsidized Consolidation Loans Select One fixed variable Perkins Loans Select One fixed variable Direct Grad PLUS Loans Select One fixed variable Private Educational Loans Select One fixed variable Other Berkeley Law Loans Select One fixed variable Law/Graduate School Loans (Non-Berkeley Law) Amount Borrowed Current Outstanding Balance Monthly Payment Average Interest Rate(%) Loan Type Documentation of Your Current Repayment Plan Direct Subsidized or Unsubsidized Loans Select One fixed variable Direct Subsidized or Unsubsidized Consolidation Loans Select One fixed variable Perkins Loans Select One fixed variable Direct Grad PLUS Loans Select One fixed variable Private Educational Loans Select One fixed variable Other Non-Berkeley Law Loans Select One fixed variable Undergraduate Loans Amount Borrowed Current Outstanding Balance Monthly Payment Average Interest Rate(%) Loan Type Documentation of Your Current Repayment Plan Direct Subsidized or Unsubsidized Loans Select One fixed variable Direct Subsidized or Unsubsidized Consolidation Loans Select One fixed variable Perkins Loans Select One fixed variable Other Undergraduate Loans Select One fixed variable Totals Amount Borrowed Current Outstanding Balance Monthly Payment Total Debt If you have additional documents that you are unable to attach to this application please email them to email@example.com Financial Statement Please report anticipated gross income for the next 12 months. If you are married, your spouse's income must be reported. If you and/or your spouse are expecting a significant salary increase or decrease over the next year, please email firstname.lastname@example.org with details. If you can expect an annual bonus or other salary increase, please include that information. Applicant Spouse Wages and Salaries Overtime/Bonus/Commissions Taxable Interest Income Dividend Income Business Income Alimony Unemployment Compensation Rental Income Trust Fund Income Other Income (please specify below) Total Income Please specify Other Income (if any) Employer Information Please complete this information as accurately as possible. If you are married, please provide information regarding your spouse's employment Applicant Spouse Employer Name of Supervisor Street and Apt # City, State, Zip Employer/Supervisor Phone # Employment Starting Date (and ending date if applicable) Annual Salary Full Time/Part Time Select One Full Time Part Time Hours per Week Brief Job Description //DisplayTextArea("", "job_desc_applicant", $job_desc_applicant, "", 60); ?> characters left Statements First-time applicants must attach a copy of their total loan indebtedness, published job description, and a personal statement. All applicants must submit an LRAP Employer Verification Form (see our Forms Page), as well as a published job description if the official job posting does not indicate that a J.D. is required. We need an LRAP Employer Verification Form recently signed by your employer that includes your salary, job title and duties, and start date. Please do not send us a PSLF Employment Certification Form or verification of your employment that does not include this information. For participants on the IDR track, please submit or email proof of your monthly IDR payment amount. This documentation should include when that payment amount began and when it expires. Please do not include your IDR application, as it includes sensitive information like your SSN. We only need your IDR approval letter or payment schedule. LRAP Employer Verification Form/Job Description (Employer Verification form is required and can be signed by supervisor or HR. Only submit official job description if the position does not require a J.D.) Personal Statement (Required for first-time applicants only) Proof of Monthly Payment Amount (Required if on the IDR track) Additional documentation may be requested and can be emailed to email@example.com. The length of your participation based on this application is subject to the discretion of the Financial Aid Office but is typically granted in 6 to 12 month participation periods. 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. I understand I must notify LRAP if any of the above information changes after the submission of this application, and that e-mail is the primary means of communication used by the LRAP office. Lastly, I understand that my LRAP eligibility will be calculated based on the information contained on this application. Should the information change, I may be required to return a portion of the LRAP funding I receive. I understand that if approved for LRAP funding, I will need to document proof of my income, employment, and student loan payments to the LRAP office following each participation period.