Zak's Plan for Achieving Self-Support

Name: Zak SSN:

PART I - Your Goal

A. What is your work goal? (Show the specific job you expect to have at the end of the plan. If you are undergoing vocational evaluation to determine a feasible goal, show "VR Evaluation." If your goal involves a supported employment position, show the amount of job coaching you expect to need after the plan is completed compared to the amount you currently receive or will receive when you begin working.) My goal is to become an Attorney-at-Law. I have been accepted for admission to Anystate University, where I will earn a Bachelor of Applied Science degree. During this time I will undertake studies to prepare me for admission to the Anystate University's Law School, where I will earn a Juris Doctor degree. During my undergraduate years I will complete the Legal Assisting program at the Anystate University's College of Technology, and attend summer sessions to complete my B.A.S. Degree. Upon completion of my education, I will be employable as an attorney at law. I am working directly with Ms. J. D. Anystate Department of Vocational Rehabilitation, as well as with several counselors, and advisors at the Anystate University regarding my educational plan.

B. Describe the duties you will be expected to perform in this job: Upon passing the Bar Examination, I will be admitted to practice law in Local, State, and Federal Courts. I will practice law as a member of the Anystate Bar, or another state, and specialize in the field of Civil Rights, with interests including Intellectual Property Law, and education. I am interested in a curriculum that can promote a future Law Professorship.

C. How much do you currently earn (gross) each month in wages or self-employment income? $125.00 /month. This is an approximate figure based on a projection for 1999. In 1998 my approximate monthly earnings were $75.00 monthly.

How much do you expect to earn each month (gross) after your plan is completed? $4200.00/month. According to statistics reported by the Research & Analysis Division of the Anystate Department of Labor and Industry for 1998, median salaries for Lawyers average $24.25 hourly ($50,440 annually) in U.S.A. and $33.71 hourly ($65957.00 Annually) nationally.

How do you expect to find a job by the time your plan is completed? I will work in a private law firm, state, federal government, or an educational institution.

D. If your goal involves self-employment, explain why you believe that operating your own business is more likely to result in self-support than if you worked for someone else. N/A

PART II - Medical/Vocational/Educational Background

A. What is the nature of your disability? I am a survivor of a Closed Head Injury, suffering from Chronic Migraines, Chronic Cervical Spine Pain, and Chronic Low Back Pain, and Post Concussion Syndrome. Additional illnesses included Severe Depression, and Post Traumatic Stress Disorder, Post Concussion Syndrome, Severe Migraines, and Chronic Cervical Spinal and Low Back Pain, and 0-Thoracic Syndrome.

B. Explain any limitations you have because of your disability (e.g., limited amount of standing or lifting, etc.). I am limited physically by Severe Migraines, Headaches, Neck and Back Pain. I have also been limited severely in the past by Depression, and Post Traumatic Stress Disorder and Cognitive Functioning problems. I also suffer a neurological disorder of the spine affecting my arms and hands, which is very painful, and causes near-constant numbness. I am unable to withstand long periods of standing, or walking, and can only lift about 15 pounds comfortably. I require frequent rest periods, to help control my chronic Migraine headaches, cervical spinal and low back pain. However, with proper medical care, reasonable accommodation, and self-discipline, I am able to successfully complete my academic plan, and achieve the goal of becoming an Attorney-at-Law.

B. List the types of jobs you have had most often in the past few years and those you have had which are similar to your work goal. Also show how long you worked (i.e., how many months or years) in each type of job. Job Type - Dates

Deputy Sheriff - Anystate 1978-1983
Photojournalist (News Photographer) 1981-1990
Photographer (self-employed) 1991-1995

D. Check the block that describes the highest educational level you have completed:

X Elementary school X High school graduate or G.E.D.
? Some college ? College graduate
? Post graduate courses ? Postgraduate degree
X Trade or Vocational School ? Other (Specify)

If you completed college, list your major and degree(s) attained; if you completed one or more courses in a trade or vocational school, list the trade(s) you learned:

D. Describe any other training you have received:

Vocational School -The Anystate Law Enforcement Academy, Basic Session, 1979

F. Have you ever undergone a vocational evaluation? ? Yes X-No If yes, show the name, address and phone number of the person or organization who conducted the evaluation: I am working with Ms. J. D., Rehabilitation Specialist, Department of Vocational Rehabilitation, Anystate. I will undergo a comprehensive neuropsychological evaluation by Dr. M. D., of Anystate on March 23, 1999.

G. Have you ever had a Plan for Achieving Self-Support before?? Yes X-No

When was your prior plan approved (month/year)?
When did it end (month/year)?
What was your goal in the prior plan?
Why did your prior plan not enable you to be come self-supporting?
Why do you believe that this plan will be successful? My PASS will enable me to obtain the education I need to work as an Attorney-at-Law. I will successfully complete my PASS and secure employment as an attorney specializing in Civil Rights, with an interest in Intellectual Property Law, and education.

If someone is helping you prepare this plan, please give their name, address and telephone number: K. W.; Project Director; Institute on Disabilities; XXX Street; Anytown, Anystate 00000; (XXX) 111-0000.

Do you want us to contact the person who is helping you if we need additional information about your plan? X-Yes ? No

K. W.; Project Director; Institute on Disabilities; XXX Street; Anytown, Anystate 00000; (XXX) 111-0000.

Do you want us to send a copy of our decision on your plan to the person who is helping you?
X-Yes ? No

Part III - Your Plan

List the steps, in sequence, that you will take to reach the goal and show the dates you expect to begin and complete each step. Be sure to show when you expect to purchase the items or services listed in Part IV.

Step Start Date Completion Date

#1. Rent an Apartment in Anytown, Anystate May 1, 1999 Aug 1,1999

#2. Purchase New Car May 1, 1999 Oct 1, 1999
Anystate University
Summer Semester-1999 Registration May 1, 1999 May 15, 1999

#3. B.A.S. Degree and Pre-Law Studies Lower Division

MAT 196-Intermediate Algebra 5-credits May 24, 1999 Jul 30, 1999
PSY 100S-Intro to Psychology 4-credits May 24, 1999 Jul 30, 1999
POL 100S-Intro to American Gov't 3-credits May 24, 1999 Jun 25, 1999
COM 100-Basic English Comp. 2-credits May 24, 1999 Jun 25, 1999
COM 101-English Composition 3-credits May 24, 1999 Jun 25, 1999
POL 102S-Intro to Comparative Gov't 3-credits Jun 28, 1999 Jul 30, 1999

#4. Anystate College of Technology Registration
Fall Semester-1999

#5. Legal Assisting Program 1st year

CRT 114T Word Processing 2 credits Sep 1999 Dec 1999
COM 101 English Composition 3 credits Sep 1999 Dec 1999
MAT 100T Basic Algebra 3 credits Sep 1999 Dec 1999
LEG 179T Legal Terminology 2 credits Sep 1999 Dec 1999
LEG 180T Legal Procedures 3 credits Sep 1999 Dec 1999
LEG 187T Into to Legal Research 1 credit Sep 1999 Dec 1999

POL 146S Am Gov't and Politics 3 credits Sep 1999 Dec 1999
SEC 107T Keyboarding 1 credit Sep 1999 Dec 1999

#6. Anystate College of Technology Registration Nov 1999 Jan 2000
Spring Semester-2000

#7. Legal Assisting Program-1st Year

ACC 132T Accounting I 4-credits Jan 2000 May 2000
COM 160A Oral Communications 3-credits Jan 2000 May 2000
LEG 192T Contracts 2-credits Jan 2000 May 2000
LEG 194T Torts 2-credits Jan 2000 May 2000
LEG 195T Legal Ethics 1-credit Jan 2000 May2000
LEG 197T Legal Research & Writing 2-credits Jan 2000 May 2000
PSY 110T Organizational Psychology 3-credits Jan 2000 May 2000
SEC 105T Electronic Calculators 1-credit Jan 2000 May 2000

#8. Anystate University
Summer Semester-2000 Registration Mar 2000 April 2000

#9. Courses for B.A.S Degree, and Pre-Law Studies
Lower Division May 2000 July 2000

Curriculum to follow after meeting with Pre-Law Advisory Committee

#10. Anystate College of Technology Registration
Fall Semester-2000

#11. Legal Assisting Program-2nd Year

CRT 188T Computers & Law 3-credits Sep 2000 Dec 2000

LEG 190T Civil Litigation for Legal Assistants 3-credits Sep 2000 Dec 2000
LEG 270T Real Estate 2-credits Sep 2000 Dec 2000
LEG 273T Criminal Procedures 3-credits Sep 2000 Dec 2000
LEG 279T Legal Research & Writing II 2-credits Sep 2000 Dec 2000
LEG 287T Bankruptcy 1-credit Sep 2000 Dec 2000
LEG 294T Business Organizations 1-credit Sep 2000 Dec 2000
SOC 120S Contemporary Social Problems 3-credits Sep 2000 Dec 2000

#12. Anystate College of Technology Registration Nov 2000 Jan 2001
Spring Semester-2001

#13. Legal Assisting Program-2nd Year

LEG 272T Administrative Law 2-credits Jan 2001 May 2001
LEG 280T Leg. Research & Writing III 2-credits Jan 2001 May 2001
LEG 283T Trial Preparation 3-credits Jan 2001 May 2001
LEG 285T Family Law for Legal Assistants 3-credits Jan 2001 May 2001
LEG 288T Estates & Probate 2-credits Jan 2001 May 2001
LEG 296T Law Office Management 1-credit Jan 2001 May 2001
LEG 298T Legal Assisting Internship 2-credits Jan 2001 May 2001

#14. University of Anystate
Summer Semester-2001 Registration Mar 2001 May 2001

#15. Bachelor of Applied Science Degree
and Pre-Law Curriculum
Lower Division Courses May2001 Jul 2001

Curriculum to follow after meeting
with Pre-Law Advisory Committee

#16. University of Anystate
Fall Semester-2001 Registration Jul 2001 Aug 2001

#17. Bachelor of Applied Science Degree
and Pre-Law Curriculum
Upper Division Studies Sep 2001 Dec 2001

Curriculum to follow after Pre-Law
Advisory Committee meeting

#18. University of Anystate
Spring Semester-2002 Registration Nov 2001 Jan 2002

#19. Bachelor of Applied Science Degree
and Pre-Law Curriculum Jan 2002 May 2002

Upper Division Studies
Curriculum to follow after meeting with Pre-Law Advisory Committee

#20 University of Anystate
Summer Semester-2002 Registration Mar 2002 May 2002

#21. B.A.S Degree, and Pre-Law Studies
Upper Division

Curriculum to follow after meeting
with Pre-Law Advisory Committee

#22 University of Anystate
Fall Semester-2002 Registration Jul 2003 Sep 2003

#23 B.A.S Degree, and Pre-Law Studies
Upper Division Sep 2003 Dec 2003

Curriculum to follow after meeting with Pre-Law Advisory Committee

#24 University of Anystate
Spring Semester-2003 Registration Nov 2002 Jan 2003

#25 B.A.S Degree, and Pre-Law Studies Jan 2003 May 2003
Upper Division Graduation - B.A.S Degree

Curriculum to follow after meeting with Pre-Law Advisory Committee

#26 University of Anystate
Summer Semester-2003 Registration Apr 2003 May 2003

#27 Graduate and Pre-Law Courses May 2003 Jul 2003

Curriculum to follow after meeting with Pre-Law Advisory

#28. University of Anystate
Fall Semester-2003 Registration Jul 2003 Sep 2003

#29. 1st Year Law School Sep 2003 Dec 2003

Curriculum to follow after meeting with Pre-Law Advisory Committee

#30 University of Anystate
Spring Semester 2004 Registration Nov 2003 Jan 2004

#31. 1st Year Law School Jan 2004 May 2004

Curriculum to follow after meeting with Pre-Law Advisory Committee

#32 University of Anystate
Fall Semester 2004 Registration Jun 2004 Jul 2004

#33. 2nd Year Law School Sep 2004 Dec 2004

Curriculum to follow after Law School advisor meeting.

#34. University of Anystate
Spring Semester 2005 Registration Nov 2004 Jan 2005

#35. 2nd Year Law School Jan 2005 May 2005

Curriculum to follow after Law School advisor meeting.

#36. University of Anystate
Fall Semester 2005 Registration Jun 2005 Jul 2005

#37. 3rd Year Law School Sep 2005 Dec 2005

Clinical Internship

#38. University of Anystate
Spring Semester 2006 Registration Nov 2005 Jan 2006

#39. 3rd Year Law School
Graduate Clinical Internship Law School Juris Doctor Degree Jan 2006 May 2006

#40. Prepare for Anystate Bar Examination Jun 2006 Jul 2006

#41 Successfully Pass Anystate Bar Examination Jul 2006 Jul 2006
(presently offered twice annually in Jul & Feb)

#42 Search for employment as an Attorney at Law in the private, government, or educational sector

Aug 2006 Nov 2006

#43. Begin work as an Attorney at Law in the private, Government, or educational sector. Dec 2006 Dec 2006

#44. PASS successfully completed. Jan 2007 Jan 2007

Part IV - Plan Expenditures and Disbursements

A. List the items or services you are buying or will need to buy in order to reach your goal. Be as specific as possible. Where applicable, include brand and model number of the item. (Do not include expenses you were paying prior to the beginning of your plan; only additional expenses incurred because of your plan can be approved.) Explain why each is needed to reach your goal. Also explain why less expensive alternatives will not meet your needs. Part III should show when you will purchase these items or services.

1. Item/service: Gateway Notebook Computer, with modem, additional RAM, carrying case, extra battery, and HP Office Jet Printer. Computer Accessories, and Hewlett Packard Office Jet Printer $350.00 Total…$2,300.00
Vendor/provider: Gateway

Why needed: For writing assignments, etc. in class, at my home in Any other state, and at my home in Anystate.

How will you pay for this item (e.g., one-time payment, monthly payments)? $75.00 monthly on 3-Year lease or payment plan, paid from PASS savings account.

How did you determine the cost? Advertised Prices via Internet Web Page

2. Item/service: New Car e.g., Toyota Corolla, Ford Escort, Chevrolet Prism, or Chevrolet Cavalier. Cost: $11,500 to $12,500.00

Vendor/provider: Local Chevrolet, Toyota, or Ford Dealership in Anytown, Anystate.

Why needed: I propose to purchase a new compact car, e.g., Toyota Corolla, Ford Escort, Chevrolet Prism, or Chevrolet Cavalier priced at approximately $12,000.00. I will seek to finance the vehicle over a period of 60-72 months, using my car as a trade-in. This will also afford me economy regarding fuel consumption, and I expect my payments not to exceed $220.00 per month, including principal and interest. During telephone conversations with sales representatives at the local Chevrolet in Anytown, and Local Toyota or Ford Dealership, in Anytown. I learned of the option to purchase a lease return vehicle, such as the aforementioned makes, and models. I learned when comparing costs of the 1998 Chevrolet Cavalier, Ford Escort, and Toyota Corolla, selling prices for these cars were similar, and ranged from $11,500 to $12,500 for a vehicle with approximately 12,000 miles registered on the odometer. In each case, my required payment plan could be realized, and all vehicles would include the remaining warranty coverage, which generally is three years/36,000 miles. Each vehicle can be purchased with an extended warranty at an additional cost of $500.00 to $700.00. A lease-return car with low mileage can be expected to have the life expectancy I require completing my education. It is imperative that I have reliable transportation when commuting from my home in Any other town. to the Anystate University. Approximate round-trip distance is 140 miles, and. according to my projected class schedule; I need to commute from my home in Any other town to Anytown, at least twice weekly. I will travel at least 280 miles weekly and a conservative estimate of 14,000 miles annually and at least 84,000 miles during the course of my education. It is reasonable that I be permitted to purchase a new car for these reasons.

How will you pay for this item (e.g., one-time payment, monthly payments)? $200.00 monthly from PASS savings account. I propose to purchase a car no later than October 1, 1999 and during the months leading up to the purchase, I will save the $220.00 monthly payments allowed, to pay for vehicle registration, and licensing fees.

How did you determine the cost? Telephone discussions with sales representatives at the local Chevrolet, and Toyota or Ford Dealerships, in Anytown, Anystate. Cost of a new car (or lease return, low mileage vehicle)

3. Item/service: Anystate University Housing - Apartment Rent including utilities. Cost: $ 350.00/monthly and a Security Deposit of $350.00.

Vendor/provider: Anystate University Family Housing

Why needed: I need housing in Anytown on days I do not commute from my Any other town home. I must maintain my subsidized apartment in Any other town where I can be near my children. Currently my rent is $116.00 monthly. I will need to live in Anytown approximately three or four days a week, and need housing for those three or four nights. Motel room charges of $35.00 to $40.00 nightly are not cost-effective, and would cost $105.00 weekly at least for three nights a week, and a total of $420.00 monthly. Renting a small apartment at the University, or in the Anytown area for $350.00 monthly would be more cost effective, and allow additional schedule flexibility, comfort, and a better environment in which to study. My projected schedule will require me to be in Anytown on Monday, Tuesday, Wednesday, and Friday for classes. I will return home to be with my children on Thursday, in accordance with my visitation schedule, and also on weekends.

How will you pay for this item (e.g., one-time payment, monthly payments)? Monthly rent payments to the Anystate University Family Housing Department.

How did you determine the cost? Published University rent rates determined the cost of housing at this time. Rent rates at Anystate University include utilities in many instances.

B. If you propose to purchase, lease, or rent a vehicle, please provide the following additional information:
1. Do you currently have a valid driver's license? X-Yes ? No
If no, Part III must include the steps necessary to attain a driver's license.

Explain why alternative forms of transportation (e.g., public transportation, cabs, having friends or relatives drive you) will not allow you to reach your goal? Public transportation is not a viable consideration due to my lengthy commute to Anytown from my Any other town home. My class schedule requires great flexibility in my transportation plan. Moreover, I have no friends, family, or other relatives on whom I can rely for transportation.

2. If you are proposing to purchase a vehicle, explain why renting or leasing is not sufficient. When discussing the lease option with the sales representatives, each suggested that leasing would not be a cost-effective consideration due to the commuting I will be doing. Leasing a car would limit me to about 12,000 miles per year, for the duration of a three-year lease, which would not be practical, as I will travel in excess of 14,000 miles per year commuting. Purchasing a new car is the only cost-effective solution.

3. If you are proposing to purchase a new vehicle, explain why purchasing a reliable used vehicle is not sufficient. My present car is nearly 14 years old, requires a lot of maintenance, and has reached its life-end. No longer is it reliable, as I have been plagued with very expensive repair bills during the past few months, and these are expected to continue as the car ages. With reliable transportation, I will be spared unnecessary anxiety caused by mechanical breakdowns as I travel to and from school. Liberally speaking, my car has about 15,000 miles of useful use before the time for a major overhaul will arrive. In November 1998, I sustained more than $400.00 in repairs, and in January 1999, an additional $550.00 in repair charges. I also incurred a $40.00 towing bill, and was forced to rent a car for three days costing me an additional $100.00. In March 1999 I incurred more than $250.00 in repair charges, and I learned I need to replace the main engine belts at an estimated $100.00, and repair of the turn signal lever was estimated by a mechanic to be $175.00. The shock absorbers need replacing, at a cost of about $200.00, and I will soon need to purchase new tires at an estimated cost of $300.00. Conservatively, my future repairs which are known at this time, will cost an estimated $775.00. Additional concerns are bearings, CV boots, joints, and repair of the electrical system. It is only a matter of time before the engine must be rebuilt at an estimated cost of $2,500.00 and automatic transmission repairs estimated at $1,200.00. The aforementioned repair costs were obtained by mechanics I have consulted during the past few months.

4. Explain why you chose the particular vehicle rather than a less expensive model. The car models I have suggested are among the lowest price new cars on the market today. I have selected models that are economical to operate. The purchase of lower price cars such as the Geo Metro, or Dodge Neon, which have 3-cylinder engines is not preferred. These engines are not known for endurance, and can be prone to mechanical failure after logging high mileage. This is according to my experience of owning a Geo Metro, and knowledge of similar cars. A four cylinder, or 6-cylinder motor will offer good economy, and better durability for multi-year, heavy commuting use, and this belief is supported by sales representatives I have consulted.

C. If you propose to purchase computer equipment or other expensive equipment, please explain why a less expensive alternative (e.g., rental or purchase of less expensive equipment) will not allow you to reach your goal. Explain why you need the capabilities of the particular computer/equipment you identified. Also, if you attend (or will attend) a school with a computer lab for students use, explain why use of that facility is not sufficient to meet your needs. I must study, and accomplish a monumental amount of writing, and research while pursuing my education. A notebook computer is needed, as I must have the ability to pursue my academic writing, research, and legal writing at all hours of the day. Additionally some of my courses require computers for classroom use. Computer labs at the University are limited, and the demand is high. Because I require great flexibility in my class, study, research, and writing schedule due to medical concerns, it is imperative that I have my own notebook computer. Moreover, the requirement that I maintain homes in Any other town, and Anytown requires portability, and the ability to study, research, and write in both communities I live. Only with the advantage of computer technology will I be able to meet the writing, and research demands of my legal studies program at the University, and at home in Any other town, and Anytown. I propose to purchase or lease a notebook computer & accessories, software, and printer no later than September 1, 1999.

If you indicated in Part II that you have a college degree or specialized training and your plan includes additional education or training, explain why the education/training you already received is not sufficient to allow you to be self-supporting.

Part V - Income/Resource Exclusion

A. List any items you already own (e.g., equipment or property) which you will use to reach your goal. Show the value of each item and explain why you need each of the items to attain your goal. I currently own a 1986 Olds Cutlass 4 door sedan, value $1500.00 needed for transportation to school and as a trade-in for proposed new car.

B. What money do you already have saved to pay for the expenses listed in Part IV? (Include cash on hand or money in a bank account.) I have no cash, or investments of any kind to contribute to my educational plan. I must rely on my SSDI, Voc-Rehab, Pell Grant, and Educational Loans and Scholarships (if any) to accomplish my educational goal.

C. Other than the earnings shown in Part I, what income do you receive (or expect to receive)? (Show how much you receive and how frequently you receive or expect to receive it.) I have no other sources of income on which to draw for my educational plan.

D. How much of this money will you use each month to pay for the expenses listed in Part IV? $500.00 monthly

E. Do you plan to save any or all of this money for a future purchase, which is necessary to complete your goal? X Yes ? No. I propose to utilize my $500.00 monthly, from my SSDI check, for deposit in my PASS account for the aforementioned expenses.

If yes, explain how you will keep the money separate from other money you have. (If you will keep the savings in a separate bank account, give the name and address of the bank and the account number.) I will establish a checking and savings account at Any other town Bank, FSB, Any other town, Anystate 00000, where I will deposit funds for my PASS plan, and pay allowed expenses.

F. What are your current living expenses each month (e.g., rent food, utilities, etc.)? $575.00

If amount of income you will have available for living expenses after making payments or saving money for your plan expenses is less than your current living expenses, explain how you will pay for those living expenses. Additional income for monthly expenses will be offset by lower apartment rent for my Any other town, Anystate home which is a Section-8 subsidized apartment. I will save approximately $50.00 monthly with lower rent. Additionally I expect to receive Pell Grant funds amounting to approximately $3000.00 annually, which will further enhance my income, and Medicaid qualification will save about $1,200 annually in medical costs, which I would otherwise, be obligated to pay. Mileage paid by Voc Rehab for round-trip travel to the Anystate University will help with travel expenses and thereby lowering my monthly travel expenses.

Current SSDI $734.00 PASS Plan Costs: Car $220.00/mo.
Current Monthly Bills <$575.00> Rent: $350.00/mo.
Total SSDI Remaining $159.00 Computer $ 75.00/mo.
$645.00/mo.
Add:
SSI Benefits Proposed $500.00
Mileage from Voc Rehab @$.32/mile x 1120 miles/mo, $358.40

Add:
Reduced Subsidizd Rent/mo. $50.00 Current Living Exp. $575.00/mo.
Medicaid Coverage/mo. $100.00
$1067.40 Sub Total
Pell Grant Income
$3000.00 ¸ 12 $250.00/mo avg.

$1417.40 Total Income Total Expenses: $1220.00

Total Amount Excess: $197.40

***I am not sure if I calculated this according to the way you figure things…these are the best figures I have…???

G--Do you expect any other organization (e.g., Vocational Rehabilitation) to pay for, reimburse you for any part of the items and services listed in Part IV or to provide any other items or services you will need? X Yes ? No

If yes, please provide details as follows:

Vocational Rehabilitation Tuition and Books for Undergraduate are estimated at $4,765.00 Annually according to 1998/1998 projections. 1999-2003 This amounts to a total of $14,295.00 during my 9-semesters of undergraduate
studies. (Three semesters yearly, for three years).

Tuition and Books for Law School are currently estimated at $3,512.00 Annually for a total of $10,536.00 according to
1998/1999 projections. (Two semesters yearly, for three years of Law School) 2003--2006. These are only estimates as the cost of a college education rises each year.

Vocational Rehabilitation per Diem travel reimbursement is paid according to "actual mileage" traveled 2003-2006 to my Any other town home, to the Anystate University.

Part VI - Remarks

While there is no question my proposed educational PASS is very comprehensive, and involves many years of school, I will successfully complete each step, if given the opportunity. Although I did sustain disabling injuries, I have the ambition, desire, drive, and intellectual capacity to complete this PASS achieving my goal to become employed as an attorney-at-law.

Part VII - Agreement

If my plan is approved, I agree to:

X Comply with all of the terms and conditions of the plan as approved by the Social Security Administration;

X Report any changes in my plan to SSA immediately;

X Keep records and receipts of all expenditures I make under the plan until the next review of my plan at which time I will provide them to SSA;

X Use the income or resources set-aside under the plan only to buy the items or services approved by SSA.

I realize that if I do not comply with the terms of the plan or if I use the income or resources set aside under my plan for any other purpose, SSA will count the income or resources that were excluded and I may have to repay the additional SSI I receive. I also realize that SSA may not approve any expenditures for which I do not submit receipts or other proof of payment.

I know that anyone who makes or causes to be made a false statement or representation of material fact in an application for use in determining a right to payment under the Social Security Act commits a crime punishable under Federal Law/State Law. I affirm that all the information I have given on this form is true.

Signature _________________ Date: ____________________