Applicants may also self-attest to having a disadvantaged background by uploading a document that validates that they meet the criteria included on the disadvantaged background form. Verification of Disadvantaged BackgroundĪ school official may complete the Verification of Disadvantaged Background (PDF - 406 KB).Use the Accreditation Council for Graduate Medical Education (ACGME) or The Commission on Dental Accreditation to look up your program identification number. If you completed a postgraduate medical or dental training program funded by HRSA through the THCGME Payment Program, you are required to submit the residency identification number and residency completion certificate, if available. Such documentation may include an official completion certificate. This documentation is in addition to the postgraduate training related to your practice area. This document verifies that you completed the PCTE: Training Primary Care Champions (applies to physicians and physician assistants only) or AMF Program If you select a specialty, you are required to upload a copy of the certificate of completion or diploma from the training program where you matriculated. Submit these documents if we list them on the “Supporting Documents” page of the online application. You may need to submit additional supporting documents. Include the original loan date (must be prior to the date you submit your application) Īdditional Supplemental Documentation (if applicable).Verifies the originating loan information and should: Include the current outstanding balance (principal and interest) or the current payoff balance and.Include the date of the statement (cannot be more than 30 days from the date you submit your application).Include the name of the borrower (i.e., the NHSC LRP applicant).Be on official letterhead or other clear verification that it comes from the lender/holder.Provide two types of documentation for each loan you submit:Ĭurrent information on your qualifying educational loans. Unacceptable documents: driver’s license or Social Security card. passport’s ID page, or a certificate of citizenship or naturalization. Proof of status as a United States citizen or United States nationalĪcceptable documents: birth certificate, current U.S.If a consolidated loan, we need to know:Īn application is incomplete without the following required supplemental documents: Current outstanding balance (no more than 30 days from the date you submit your application).Name and contact information for the lender/holder. We'll review supporting documents, contact lenders/holders, and check your credit report. Provide information on each qualifying educational loan for which you seek repayment. It's your responsibility to ensure that the site point-of-contact completes the EV. The site(s) must complete the electronic EV before you can submit your application. We'll notify you once the site(s) point(s) of contact completes it. We will notify the point(s)-of-contact at the NHSC-approved service site where you work (or plan to work), about your request. You must request an Employment Verification (EV) through the Bureau of Health Workforce (BHW) Customer Service Portal. You will search for and select the NHSC-approved site(s), where you currently provide or will provide patient care. Provide information about your education, training, and licensure/certification. Provide contact information such as your name, social security number, mailing and email addresses, as well as information about individual and family background. If you do not pass this initial screening portion of the application, you cannot continue with the application. There is no guarantee that you will receive a continuation contract.Ĭomplete each of the sections below to submit your application.Once you complete the initial two-year service contract, you may be eligible to apply for additional loan repayment funds to pay any remaining educational loans through one-year continuation service contracts. Note: If you serve in a private practice, you aren't eligible to practice half-time. Half-time service: Up to $25,000 for a two-year initial term NHSC loan repayment funds are exempt from federal income and employment taxes.įull-time service: Up to $50,000 for a two-year initial term You will receive funds to repay your outstanding, qualifying, educational loans. Two year half-time clinical practice at an NHSC-approved site.Two year full-time clinical practice at an NHSC-approved site.You have an opportunity to increase access to primary care services to communities in need.
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