DUKE UNIVERSITY SCHOOL OF LAW

LOAN REPAYMENT ASSISTANCE PROGRAM

Application

Modified April, 2005 to accompany Revisions

Graduates must apply each year by June first to be eligible for the Loan Forgiveness through that year. Graduates will either reapply in November or certify that there have been no changes since the June application. Forgivable Loans are disbursed twice a year, after the June application and again after the November application. If the Graduate has remained in eligible employment through the entire year, the loans will be forgiven the following June.

In the event that the level of participation in the program would cause costs to exceed the budgetary limits described above, future payments to individual participants will be reduced proportionately to meet those budgetary limits.

I

CHECKLIST

Be sure to complete all the attached forms and provide the following documents. Your application is not complete and cannot be evaluated unless all information is submitted.

Completed LRAP Application including:(attached)

*Completed Law Loan Indebtedness Worksheet

*Signed power or attorney form (attached)

Official job description and requirements.

Promissory note agreement (will be sent with check)

W-2 if available (for self and spouse)

* Military personnel should provide a copy of the LES

Copy of most recent paycheck stub (for self and spouse)

Payment information sheet/ payment coupon from your lender that includes monthly payment amount and account numbers.

Payment information sheet/ payment coupon for any other educational loans held by you or your spouse.

Copy of your most recent tax return, and your spouse if filing separately

Receipts for Childcare expenses (if applicable)

Resume

II

Information Sheet

  1. Applicant Data

Applicant Name:

Are you already participating in this program?

If so, when did you start receiving Loan Repayment Assistance?

Social Security #:

Home Address:

Home Telephone:

Email Address:

Marital Status:

Names and Social Security numbers of Dependants you are claiming (please explain their relationship to you).

Name:SSN:

Name:SSN:

Name:SSN:

Name:SSN:

Law School Graduate Date:

  1. Applicant Employment Data:

Name of Employer:

Address:

Telephone:

Position/Job Title:

Starting Date of Employment:

Current Annual Gross Income:

Is this a full-time position?:YN

Employment Data for Spouse:(Please fill this out even if you claim your spouse as a dependant.)

Name of Employer:

Address:

Telephone:

Position/Job Title:

Starting Date of Employment:

Current Annual Gross Income:

Is this a full-time position?:

  1. Certification:

I certify that all information provided is true and accurate as of this date. I understand that the deadlines to apply for the Loan Repayment Assistance Program are June 1 and December 1. I further agree to notify the Financial Aid Office at Duke University School of Law of any changes in employment status, address, marital status, or income and provide any additional information requested by the Financial Aid Office at Duke University School of Law.

______

SignatureDate

III

Law Loan Indebtedness Worksheet

Name:Social Security Number:

This worksheet is for Law School Loans only. Undergraduate and other educational loans will be considered on another sheet.

This only includes educational loans taken for attending Duke University School of Law (GSL, Subsidized Stafford, Unsubsidized Stafford, Perkins, Private/Alternative Loans).

Lender/ Type of LoanAmount of LoanMonthly PaymentMonth/Year Payment Began

  1. Loans Taken in Year One of Law School
  1. Loans Taken in Year Two of Law School

Lender/ Type of LoanAmount of LoanMonthly PaymentMonth/Year Payment Began

  1. Loans Taken in Year Three of Law School

Lender/ Type of LoanAmount of LoanMonthly PaymentMonth/Year Payment Began

  1. Bar Study Loan

Lender/ Type of LoanAmount of LoanMonthly PaymentMonth/Year Payment Began

  1. Federal Consolidation Loan

# of years to pay off consolidation loan: 10years 15years 20 Years 25 Years 30 Years

Lender/ Type of LoanAmount of LoanMonthly PaymentMonth/Year Payment Began

Totals

Total monthly loan payment:

Multiply your total monthly loan payment by 12 and write that total below.

Monthly amount X 12 months:

IV

Asset Worksheet

For this worksheet, use assets of both yourself and your spouse. Retirement Accounts are not included as assets.

Cash and Bank Accounts

Home Equity

Other Real Estate and Investment Equity

Trust or Inheritances

Other Assets (automobiles and household

goods should not be included, unless they are

collector’s items and not for everyday use)

V

Other Worksheet

Childcare expenses:

Other educational debt monthly expense:

Additional explanation of circumstances (if necessary):

POWER OF ATTORNEY

State of ______

County of ______

Know all persons by these presents, that I,of

county, state ofdo

appoint the Office of Financial Aid for Duke University School of Law, as my true and

lawful attorneyinfact, for me and in my name, and on my behalf, to do for me anything

which I might do or perform for myself if personally present and acting. I do specifically

authorize my attorneyinfact, in my name and on my behalf, to access any and all

information related to my student loans, including but not limited to, obtaining

repayment information, signing deferments, signing income contingent repayment

agreements, signing consolidation applications, endorsing checks, signing promissory

notes and any other agreements pertaining to my participation in Duke University

School of Law Loan Repayment Assistance Program.

This theday of, 20_____.

(Seal)

(Name)

State of ______

County of ______

Sworn to and subscribed to before me theday of20____.

______

Notary Public

My Commission Expires: ______

Notarial Seal