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2. NJ League of Municipalities Attorney Financial Hardship Application Form

   Income Level	Scholarship Amount
   Unemployed	Full scholarship
   Household Income up to $35,000	75% discount
   Household Income $35,000 to $50,000	50% discount
   Household Income above $50,000	No discount

   
   

   CONFIDENTIAL: This information is solely for the use of the NJLM Scholarship Administrator: NO further distribution or publication is permitted except: (1) as necessary to administer the scholarship program, and (2) as required by auditors of NJLM.

   Application must be received by NJLM no later than 10 business days before the seminar.

4. Name*
6. Mailing Address*
8. City*
9. State*
10. Zip*
12. Phone
13. Fax
14. Email*
16. Date admitted to the practice of law:*
18. Seminar Title*
19. Credit Hours*
21. Date of Seminar*
22. Location of Seminar*
24. Are you attending to meet your current NJ MCLE requirements:*
    -- Select One --YesNo
26. What is your total household income?*
28. Please explain your financial need:*
30. Have you received an NJLM scholarship during your current compliance year?*
    -- Select One --YesNo
32. Certification*

    1. I certify that the foregoing information about my total household income and financial need is accurate. I understand that if any of the financial information provided is false, I am subject to any resulting consequences.
34. Digital Signature*
35. Date*
39. Office Use Only

    Scholarship Granted: ____________________

    Tuition	$	Date received: _______________ Payment received: ___Y ___N
    Minimum Fee	$
    CLE Credit Fee	$	Owes: _______  Balance due (if any): ________ Balance paid: __________
    Misc. fee	$	Scholarship Number: ________ Date notified: __________

Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field