FY 2023 John R Justice (JRJ) Pre-Application
FY 2023 John R Justice (JRJ) Pre-Application
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1.
Legal Name
(Required.)
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2.
Home Address
Please include city, state, and zip code
(Required.)
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3.
E-mail
(Required.)
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4.
Phone
(Required.)
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5.
Job Title
(Required.)
Public Defender
District Attorney
Federal Public Defender
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6.
Number of Years Employed?
(Required.)
0-1 year
1-5 years
More than 5 years
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7.
Employing County
(Required.)
Adams
Allegheny
Armstrong
Beaver
Bedford
Berks
Blair
Bradford
Bucks
Butler
Cambria
Cameron
Carbon
Centre
Chester
Clarion
Clearfield
Clinton
Columbia
Crawford
Cumberland
Dauphin
Delaware
Elk
Erie
Fayette
Forest
Franklin
Fulton
Greene
Huntingdon
Indiana
Jefferson
Juniata
Lackawanna
Lancaster
Lawrence
Lebanon
Lehigh
Luzerne
Lycoming
McKean
Mercer
Mifflin
Monroe
Montgomery
Montour
Northampton
Northumberland
Perry
Philadelphia
Pike
Potter
Schuylkill
Snyder
Somerset
Sullivan
Susquehanna
Tioga
Union
Venango
Warren
Washington
Wayne
Westmoreland
Wyoming
York
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8.
Are You a Full Time Employee?
(Required.)
Yes
No
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9.
Has the JRJ program impacted your decision to remain employed with a government entity?
(Required.)
Yes
No
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10.
Have you received JRJ assistance previously?
(Required.)
Yes
No
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11.
Income Source
Select the source of your 2023 Federal Taxable Income from the appropriate line in your 2023 Federal Tax return, then Enter the Amount below.
(Required.)
Line 43, Form 1040
Line 27, Form 1040A
Line 6, Form 1040 EZ
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12.
Federal Taxable Income Amount
(Required.)
*
13.
County of Residence
(Required.)
Adams
Allegheny
Armstrong
Beaver
Bedford
Berks
Blair
Bradford
Bucks
Butler
Cambria
Cameron
Carbon
Centre
Chester
Clarion
Clearfield
Clinton
Columbia
Crawford
Cumberland
Dauphin
Delaware
Elk
Erie
Fayette
Forest
Franklin
Fulton
Greene
Huntingdon
Indiana
Jefferson
Juniata
Lackawanna
Lancaster
Lawrence
Lebanon
Lehigh
Luzerne
Lycoming
McKean
Mercer
Mifflin
Monroe
Montgomery
Montour
Northampton
Northumberland
Perry
Philadelphia
Pike
Potter
Schuylkill
Snyder
Somerset
Sullivan
Susquehanna
Tioga
Union
Venango
Warren
Washington
Wayne
Westmoreland
Wyoming
York
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14.
Loan Balance
Enter the Total Principal Balances as of June 15, 2024 for ALL eligible loans.
(Required.)