York County Bar Association

RICHARD P. NOLL SCHOLARSHIP

APPLICATION

General Instructions. Please print or type all information in the space provided. If the space provided is insufficient, please attach a separate sheet of paper. Attach a current resume showing your college grade point average, law school grade point average and class standing, if available, and a copy of your latest financial aid application.

Questionnaire

1. Full Name:___________________________

2. Date:________________________________

3. Present Mailing Address:___________________________________

_________________________________

4. List all Residences for past ten years beginning with current.

Month - Year

From/To Address

____________ _________________________________

_________________________________

____________ _________________________________

_________________________________

____________ _________________________________

_________________________________

____________ _________________________________

_________________________________

____________ _________________________________

_________________________________

5. Law school you are attending:_______________________________

6. When do you expect to graduate from law school?_______________

7. Describe your extra curricular activities and employment during law school. Attach a separate sheet if necessary.

________________________________________________________________________

8. The Richard P. Noll Scholarship was established to assist a deserving, needy law student from the greater York area with law school tuition and costs. Describe on no more than two typewritten, double-spaced pages how you meet these criteria (deserving, needy, from the greater York area) and why you consider yourself a good candidate to receive this scholarship.

The undersigned hereby authorizes to

[Law School Name]

release to the Richard P. Noll Scholarship Committee of the York County Bar Association financial aid, academic and other information relating to the undersigned upon request.

____________________________________

Law student signature

RICHARD P NOLL SCHOLARSHIP

FINANCIAL INFORMATION

The following must be completed in its entirety and signed by you (and spouse if applicable) and your parents if you wish to be considered for the Richard P. Noll Scholarship. This information will be kept confidential and shared only with the Richard P. Noll Scholarship Committee.

LAW SCHOOL EXPENSES:

Tuition __________________

Room & Board (9-month period) __________________

Books & Supplies __________________

Health (explain if over $500) __________________

Miscellaneous (e.g. recreation) __________________

TOTAL EXPENSES __________________

How did you meet the above expenses during the previous year? (1st year students - estimate how you will meet these expenses in your first year).

Parent contribution __________________

Scholarship/grants __________________

Student loans __________________

Your own assets (explain) __________________

_____________________

Employment __________________

Social security or VA benefits __________________

Other sources (explain) __________________

EDUCATIONAL DEBT STATUS:

Specify loan types and balances from undergraduate school:_________________________________

______________________________________________________________________________

Specify loan types and balances from law school:_________________________________________

______________________________________________________________________________

TOTAL EDUCATIONAL DEBT: __________________

	Student	Parents
Earned income^**	_________________	_________________
Interest & Dividend income^**	_________________	_________________
Itemized deductions^**	_________________	_________________
Income from Trusts and Estates^**	_________________	_________________
U.S. income tax paid^**	_________________	_________________
Number of exemptions^**	_________________	_________________
^Most Recent Tax Year:**
****************************************
Total cash, savings/checking	_________________	_________________
Do you own your home? (yes/no) If yes, purchase year?_____________ Purchase price?__________________	_________________	_________________
Fair market value of your home	_________________	_________________
Mortgage balance of your home	_________________	_________________
Fair market value of other real property	_________________	_________________
Mortgage/debt on other real property	_________________	_________________
Investments value	_________________	_________________
Investments debt	_________________	_________________
Business value	_________________	_________________
Business debt	_________________	_________________
Other Assets (Trust Accounts, UGMA Accounts)	_________________	_________________
****************************************
Father's Occupation	_________________	_________________
Mother's Occupation	_________________	_________________
IF APPLICABLE:
Spouse's occupation	_________________	_________________
Stepfather's occupation	_________________	_________________
Stepmother's occupation	_________________	_________________

If you believe your parents are affected by highly unusual circumstances which should be taken into consideration in determining their ability to financially assist you, you may address the circumstances in your attached one-page statement.

I CERTIFY THAT THE INFORMATION CONTAINED IN THIS FINANCIAL INFORMATION QUESTIONNAIRE CONTAINS THE TRUTH TO THE BEST OF MY KNOWLEDGE.

______________________________ Date:____________________

Student

______________________________ Date:____________________

Father

______________________________ Date:____________________

Mother