JRJ Loan Repayment Program Pre-Application Form 2012


All Entry Fields are 'Required' *
Legal Name:*
Home Address:*
Email:*
Mailto
Text (optional): 
Job Title:*
How Many Years Have You Been Employed as a Public Defender or District Attorney?*
Employing County:*
Are You a Full Time Employee?*
  
  
Have you received JRJ assistance previously*
  
  
Instructions for Completing the Income and Loan Sections:
Income:

Line 1: Select the source of your 2011 Federal Taxable Income from the appropriate line in your 2011 Federal Tax Return

Line 2: Select your County of Residence from the COLI Drop Down Menu.

Loans:

Line 3: Enter the Total Principal Balances as of December 31, 2011 for all eligible loans.
Income:
Line 1:*
Select the Source of Your 2011 Federal Taxable Income, Then Enter the Amount Below.
Federal Taxable Income Amount*
Line 2:*
County of Residence Cost of Living Index (COLI)
Loans:
Line 3:*
Total of ALL Eligible Loan Balances.
See List of 'Eligible Loans'
Please be sure to double-check your information. Your application will be submitted by clicking on the 'SAVE' button.