Application Deadline: March 31, 2024 You must have JavaScript enabled to use this form. Name Title Title - None -MissMsMrMrsDrOther… Enter other… First Middle Last Suffix Degree Social Security # Previous Name (if applicable) Date of Birth Address Address Address 2 City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle EastArmed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Country - None -AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua & BarbudaArgentinaArmeniaArubaAscension IslandAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia & HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCanary IslandsCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicCeuta & MelillaChadChileChinaChristmas IslandClipperton IslandCocos (Keeling) IslandsColombiaComorosCongo - BrazzavilleCongo - KinshasaCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d’IvoireDenmarkDiego GarciaDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard & McDonald IslandsHondurasHong Kong SAR ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao SAR ChinaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorth MacedoniaNorwayOmanOutlying OceaniaPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSt. BarthélemySt. HelenaSt. Kitts & NevisSt. LuciaSt. MartinSt. Pierre & MiquelonSt. Vincent & GrenadinesSudanSurinameSvalbard & Jan MayenSwedenSwitzerlandSyriaSão Tomé & PríncipeTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad & TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks & Caicos IslandsTuvaluU.S. Outlying IslandsU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis & FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Telephone Email Email Confirm email Albany Law School Graduation Date (Month, Year) Married? Yes No Name of spouse/partner Is this your first LRAP Application? Yes No If no, first year applied? Are you currently eligible for/receiving funds from any other loan repayment assistance program? Yes No If yes, what is the source and amount of funding? List of dependents whom you support and claim on Federal Income Tax Return. Name - Age - Relationship Applicant - Income - Total wages earned - 2023 Applicant - Income - Total projected wages - 2024 Applicant - Other taxable & nontaxable income - Gifts Applicant - Other taxable & nontaxable income - Alimony Applicant - Other taxable & nontaxable income - Child Support Applicant - Other taxable & nontaxable income - Capital Gains Applicant - Other taxable & nontaxable income - Interest Income Applicant - Other taxable & nontaxable income - Dividends Applicant - Other taxable & nontaxable income - Trust Income Applicant - Other taxable & nontaxable income - Other Applicant - Other taxable & nontaxable income - Housing, food and clothing allowances for Military Personnel Spouse/Domestic Partner - Income - Total wages earned - 2023 Spouse/Domestic Partner - Income - Total projected wages - 2024 Spouse/Domestic Partner - Other taxable & nontaxable income - Gifts Spouse/Domestic Partner - Other taxable & nontaxable income - Alimony Spouse/Domestic Partner - Other taxable & nontaxable income - Child Support Spouse/Domestic Partner - Other taxable & nontaxable income - Capital Gains Spouse/Domestic Partner - Other taxable & nontaxable income - Interest Income Spouse/Domestic Partner - Other taxable & nontaxable income - Dividends Spouse/Domestic Partner - Other taxable & nontaxable income - Trust Income Spouse/Domestic Partner - Other taxable & nontaxable income - Other Spouse/Domestic Partner - Other taxable & nontaxable income - Housing, food and clothing allowances for Military Personnel Applicant - Assets - Cash, savings, and checking accounts Applicant - Assets - Real estate (other than primary residence) Applicant - Assets - Trust funds Applicant - Assets - Money market funds Applicant - Assets - Mutual funds Applicant - Assets - Certificates of Deposit Applicant - Assets - Stocks Applicant - Assets - Stock Options Applicant - Assets - Bonds Applicant - Assets - College savings plans Applicant - Assets - Installment and land sale contracts Applicant - Assets - Commodities Applicant - Assets - Net worth of business and/or investment farm Applicant - Assets - Interest in annuity or life insurance policy (being named a beneficiary in a life insurance policy shall not be considered an asset) Applicant - Assets - Assets in an individual retirement account (amount in an account recognized for preferential treatment under the Federal Internal Revenue Code that exceeds the amount allowed by the Federal Code, deposited since graduation from law school) Spouse/Domestic Partner - Assets - Cash, savings, and checking accounts Spouse/Domestic Partner - Assets - Real estate (other than primary residence) Spouse/Domestic Partner - Assets - Trust funds Spouse/Domestic Partner - Assets - Money market funds Spouse/Domestic Partner - Assets - Mutual funds Spouse/Domestic Partner - Assets - Certificates of Deposit Spouse/Domestic Partner - Assets - Stocks Spouse/Domestic Partner - Assets - Stock Options Spouse/Domestic Partner - Assets - Bonds Spouse/Domestic Partner - Assets - College savings plans Spouse/Domestic Partner - Assets - Installment and land sale contracts Spouse/Domestic Partner - Assets - Commodities Spouse/Domestic Partner - Assets - Net worth of business and/or investment farm Spouse/Domestic Partner - Assets - Interest in annuity or life insurance policy (being named a beneficiary in a life insurance policy shall not be considered an asset) Spouse/Domestic Partner - Assets - Assets in an individual retirement account (amount in an account recognized for preferential treatment under the Federal Internal Revenue Code that exceeds the amount allowed by the Federal Code, deposited since graduation from law school) Applicant’s Law School Loans One loan per line FORMAT - Loan Type - Servicer - Outstanding Balence - Mothly Payment - Status (Repayment, Deferment, Forbearance) - Current (Yes/No) NOTE: This list MUST be accompanied by your most recent loan statements, which indicate your balance, monthly payment, and loan status. Loans eligible for repayment assistance include any Federal Stafford Loans, Federal Grad PLUS Loans, Federal Perkins Loans, or private educational loans certified by the Albany Law School Financial Aid Office. Educational debt owed to family, friends, or non-institutional sources does not qualify. An applicant in default on any educational loan is not eligible for assistance. Applicant’s Loans Borrowed While Attending Other Institutions One loan per line FORMAT - Loan Type - Servicer - Outstanding Balence - Mothly Payment - Status (Repayment, Deferment, Forbearance) - Current (Yes/No) NOTE: This list MUST be accompanied by your most recent loan statements, which indicate your balance, monthly payment, and loan status. Loans eligible for repayment assistance include any Federal Stafford Loans, Federal Grad PLUS Loans, Federal Perkins Loans, or private educational loans certified by the Albany Law School Financial Aid Office. Educational debt owed to family, friends, or non-institutional sources does not qualify. An applicant in default on any educational loan is not eligible for assistance. Spouse’s/Domestic Partner’s Educational Loans One loan per line FORMAT - Loan Type - Servicer - Outstanding Balence - Mothly Payment - Status (Repayment, Deferment, Forbearance) - Current (Yes/No) NOTE: This list MUST be accompanied by your most recent loan statements, which indicate your balance, monthly payment, and loan status. Loans eligible for repayment assistance include any Federal Stafford Loans, Federal Grad PLUS Loans, Federal Perkins Loans, or private educational loans certified by the Albany Law School Financial Aid Office. Educational debt owed to family, friends, or non-institutional sources does not qualify. An applicant in default on any educational loan is not eligible for assistance. I understand that my application must be submitted with the following documents: Copy of applicant’s (and spouse’s/domestic partner’s) signed 2023 federal income tax return and W-2's. Copies of applicant’s (and spouse’s/domestic partner’s) most recent statement from each lender. Completed Employment Verification Form. Applicant Signature Sign above I/We certify that loans listed on this application are currently in good standing. I/We agree to notify the Albany Law School Financial Aid Office of any changes to my/our personal or financial situation, including changes in employment, income, address, marital status, etc. within one month of the occurrence. I/We certify that all of the information submitted on this application is true and complete to the best of my/our knowledge. I/We understand that failure to provide all requested information in compliance with program guidelines and deadlines will result in my/our ineligibility to receive benefits under this program. I agree that all funds received from the Albany Law School LRAP will be used solely for the purpose of repaying my outstanding law school loans Signature Date Spouse/Domestic Partner Signature Sign above I/We certify that loans listed on this application are currently in good standing. I/We agree to notify the Albany Law School Financial Aid Office of any changes to my/our personal or financial situation, including changes in employment, income, address, marital status, etc. within one month of the occurrence. I/We certify that all of the information submitted on this application is true and complete to the best of my/our knowledge. I/We understand that failure to provide all requested information in compliance with program guidelines and deadlines will result in my/our ineligibility to receive benefits under this program. I agree that all funds received from the Albany Law School LRAP will be used solely for the purpose of repaying my outstanding law school loans Signature Date Leave this field blank
