FY 2022 John R Justice (JRJ) Pre-Application FY 2022 John R Justice (JRJ) Pre-Application Question Title * 1. Legal Name Question Title * 2. Home AddressPlease include city, state, and zip code Question Title * 3. E-mail Question Title * 4. Phone Question Title * 5. Job Title Public Defender District Attorney Federal Public Defender Question Title * 6. Number of Years Employed? 0-1 year 1-5 years More than 5 years Question Title * 7. Employing County 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 Question Title * 8. Are You a Full Time Employee? Yes No Question Title * 9. Has the JRJ program impacted your decision to remain employed with a government entity? Yes No Question Title * 10. Have you received JRJ assistance previously? Yes No Question Title * 11. Income SourceSelect the source of your 2021 Federal Taxable Income from the appropriate line in your 2021 Federal Tax return, then Enter the Amount below. Line 43, Form 1040 Line 27, Form 1040A Line 6, Form 1040 EZ Question Title * 12. Federal Taxable Income Amount Question Title * 13. County of Residence 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 Question Title * 14. Loan BalanceEnter the Total Principal Balances as of April 1, 2023 for ALL eligible loans. Done