Alumni – Loan Repayment Assistance Program Application

Applicant Information

Applicant Name *

Law School Graduation Date *

Mailing Address *

Home Phone

Cell Phone *

Email *

Date of Admission to Louisiana Bar *

Bar Number *

Other Bar Admissions

Marital Status *

If single, please indicate whether you live alone or with a roommate *

Spouse's/Domestic Partner's Name (If applicable)

Number of Dependent Children Under Age 19

Names and Ages of Dependent Children Under Age 19 *

Applicant's Employment Information

Employer Name *

Employer Address *

Position/Job Title *

Employment Start Date (and End Date, if applicable) *

Annual Salary or Estimate *

Hours Per Week *

Job Responsibilities

Supervisor

Supervisor's Telephone

Do you have another job/Second Employer? *

Yes

No

Applicant's Employment Information (Second Employer)

Second Employer Name *

Second Employer Address *

Position/Job Title *

Employment Start Date (and End Date, if applicable) *

Annual Salary or Estimate *

Hours Per Week *

Job Responsibilities

Supervisor

Supervisor's Telephone

Spouse/Partner's Employment Information

Spouse Employer Name

Spouse Employer Address

Spouse Position/Job Title

Spouse Employment Start Date (and End Date, if applicable)

Spouse Annual Salary or Estimate

Applicant Income Information

Please report your estimated gross income for the twelve months for which you will be eligible for the program. If you are married, your spouse's estimated income must be reported.

Applicant Wages and Salaries *

Applicant Overtime/Bonus/Commission

Applicant Total Interest Income

Applicant Total Dividend Income

Applicant Business Income

Applicant Alimony/Child Support Received

Applicant Unemployment Compensation

Applicant Rental Income

Applicant Trust Fund Income

Applicant Other Income

Applicant Description of Other Income

Add Additional 'Other Income' Remove

Total Applicant Income (automatically calculated)

Spouse/Partner's Income Information

Spouse Wages and Salaries

Spouse Overtime/Bonus/Commission

Spouse Total Interest Income

Spouse Total Dividend Income

Spouse Business Income

Spouse Alimony/Child Support Received

Spouse Unemployment Compensation

Spouse Rental Income

Spouse Trust Fund Income

Spouse/Partner's Other Income

Spouse Other Income

Spouse Description of Other Income

Add Additional 'Other Income' Remove

Total Spouse/Partner Income (automatically calculated)

Law School Debt Information

Only law school loans (including federal and private/commercial), bar review and bar examination loans for law school purposes will be considered. Family, personal, undergraduate and non-educational loans are excluded. Federal and private commercial loans obtained outside of enrollment in law school, or intra-family or other non-commercial loans, do not qualify for consideration in the application process.

Please provide information requested below for all law school loans, including bar review and bar examination loans. Click the 'Add Additional Law School Debt' button below to add fields for each Law School loan. Attach documentation of your repayment obligations and evidence of your good standing with lenders via DocuSign (instructions at the end of this application).

Law School Debt Information

Lender/Servicer Name

Type of Loan

Original Loan Amount

Current Loan Balance (as of application date)

Monthly Payment

Period Due (month/year payments begin and end)

Add Additional 'Law School Debt' Remove

Total Original Loan Amount (automatically calculated)

Total Current Loan Balance (automatically calculated)

Total Monthly Payment (automatically calculated)

Are any of these loans consolidated?

Yes

No

Law School Consolidated Loan Information

Provide a breakdown below on each loan type, original loan amount, current balance, monthly payment, and due date.

Law School Consolidated Loan Information

Type of Loan

Original Loan Amount

Current Loan Balance (as of application date)

Monthly Payment

Period Due (month/year payments begin and end)

Add Additional 'Consolidated Loan' Remove

Other Loan Repayment Assistance

List any loan repayment assistance you or your spouse currently receive, have applied for, or otherwise expect to receive. Include recipient, amount, source and dates of assistance. Priority will be given to applicants who have not received loan repayment assistance from any source.

Other Loan Repayment Assistance

Recipient

Amount

Source

Dates of Assistance

Add Additional 'Other Loan' Remove

Asset Worksheet

Please report your assets as of thirty (30) days before the date of your application. If you are married, you must also report your spouse's or partner’s assets on that date.

Applicant – Cash and Bank Accounts *

Applicant – Investments

Applicant – Trusts

Spouse – Cash and Bank Accounts

Spouse – Investments

Spouse – Trusts

Joint – Cash and Bank Accounts

Joint – Investments

Joint - Trusts

Other Assets

Please list other assets. (Do not include primary home equity under $50,000, retirement accounts, automobiles or household contents.) Click the 'Add Applicant Other Asset' button below for each additional asset.

Applicant's Other Assets

Applicant – Other Asset Description

Applicant – Other Asset Value

Add 'Applicant Other Asset' Remove

Spouse/Partner's Other Assets

Spouse – Other Asset Description

Spouse – Other Asset Value

Add 'Spouse Other Asset' Remove

Joint Other Assets

Joint – Other Asset Description

Joint – Other Asset Value

Add 'Joint Other Asset' Remove

Total Applicant Assets (automatically calculated)

Total Spouse Assets (automatically calculated)

Total Joint Assets (automatically calculated)

Attachments

1. Personal Statement – Please provide a statement describing why you chose a legal career in public service, your commitment to public service, what you see yourself doing over the next five years, and if applicable, any extenuating circumstances you feel make you a compelling applicant. (One-page limit)

2. Current Resume

3. Employer Certification Form – Stating start date and projected yearly gross income. Download the form here– to be completed by your employer and uploaded below.

4. Documentation of Loans and Bar Exam Expenses – Documentation verifying the applicant’s law school loans and bar examination expenses, if applicable, including current loan balance, current monthly payment and current loan status. Please upload these documents via DocuSign (link below).

5. Recent Tax Return – Most recent Federal Income Tax Return (or joint return if married) with social security numbers redacted. Please upload these documents via DocuSign (link below).

1. Personal Statement *

Maximum file size: 104.86MB

2. Current Resume *

Maximum file size: 104.86MB

3. Employer Certification Form *

Maximum file size: 104.86MB

4. Documentation of Loans and Bar Exam Expenses and 5. Recent Tax Return

Please provide these documents via DocuSign here: LRAP Supporting Documents

Certification and Agreement

I (we) hereby certify that all information contained in this application, including addenda, is true and complete to the best of my (our) knowledge as of this date. I (we) agree to provide documentary proof of anything in this application including verification of law school and bar exam loans and a federal income tax return to verify my (our) projected income. I (we) understand that I (we) must arrange for my employer to submit the required Employer Certification Form on my behalf to complete the application.

I (we) agree to use any loan repayment assistance obtained from the LSU Paul M. Hebert Law Center and Louisiana Bar Foundation Kendall Vick Public Law Fund under this program only to satisfy obligations arising from eligible loans. I (we) further agree to provide any additional or clarifying information or documentation that the Program Administrator may request, to notify the Administrator within two weeks of any significant changes in my/our circumstances, such as change in job or address, unemployment, reduction from full-time to part-time employment, or any other changes that would affect my eligibility. I (we) also understand that it is my (our) responsibility to maintain my educational loan payments regardless of the date of any anticipated LRAP assistance.

If selected to receive loan reduction assistance and prior to receipt of funds, I agree to secure a letter from my employer verifying twelve months of continuous employment in a qualifying public service position and certifying my current salary. I also agree to provide documentation verifying timely repayment of loans during the 12-month period of qualifying employment.

I understand the LSU Law Center cannot give any applicants legal advice as to whether loan repayment assistance funds must be treated as taxable income. I acknowledge the LSU Law Center encourages applicants to consult with an independent tax professional regarding potential tax consequences from program participation. I understand the LSU Law Center reasonably believes it has structured this LRAP so the award may not be considered taxable income to the recipient, and thus may not have to be reported as such. I further understand, however, award recipients remain solely responsible for any federal, state or local income tax liability they (and their spouse/partner, if applicable) may incur because of loan forgiveness awards.

If selected to receive loan reduction assistance, I also agree to cooperate with publicity efforts. LSU Law Center may use my name, photograph and information about my public service work to publicize the Loan Repayment Assistance Program, both within the university community and to outside audiences in print, electronic and any other format.

Applicant's Signature *

Type your name here to sign that you agree to the above

Spouse’s/Domestic Partner’s Signature

Type your name here to sign that you agree to the above

Date *