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  1. 1. The Health Professions Scholarship Program (HPSP) The Health Professions Loan Repayment Program ( HPLRP) How to complete your Application Physician Assistant Nurse Practitioner Certified Nurse Midwifery Dental Hygiene Dentistry Spring Postmark Deadline: March 24, 2009 Fall Postmark Deadline: September 11, 2009
  2. 2. Application Page 1 <ul><li>Please refer to the application instructions when completing the application. Complete all pages of the application form and make sure all supporting documents are submitted with your application. </li></ul><ul><li>All documents must be postmarked by the application deadline. Late or </li></ul><ul><li>incomplete application packets will not be evaluated. </li></ul><ul><li>Top of page 1: Indicate which program you are applying for – </li></ul><ul><ul><ul><ul><ul><li>Scholarship (up to $10,000) or </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Loan Repayment (up to $20,000) </li></ul></ul></ul></ul></ul><ul><li>Please enter the award amount you are requesting. You may not request more money than you owe in educational debt. </li></ul><ul><li>Part A - Personal Information: Complete all personal information. Please </li></ul><ul><li>type or print your answers legibly in the space provided. </li></ul>
  3. 3. Application Page 2 <ul><li>Part B - Work Experience: List all relevant nursing and non-nursing work experience in medically underserved areas. </li></ul><ul><li>Part C - Community background: Provide information about your specific background including family structure and the community where </li></ul><ul><li>you grew up. </li></ul><ul><li>Part D - Linguistic Competency: Indicate any languages that you may be fluent in. </li></ul><ul><li>Part E - Program of Study: Check any of the health professional programs </li></ul><ul><li>you are a student or graduate of. </li></ul><ul><li>Part F - Personal Statement: Your statement must be typed and no more than two pages. Restate and number each question along with your answer. </li></ul><ul><ul><ul><ul><li>Scholarship applicants must answer questions numbered 1-6. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Loan repayment applicants must answer questions numbered 2-6 . </li></ul></ul></ul></ul>
  4. 4. Personal Statement <ul><li>When writing your personal statement, consider these recommendations: </li></ul><ul><li>Convey your career goals as they relate to your chosen health profession. </li></ul><ul><li>Explain your volunteer service in community outreach as well as any </li></ul><ul><li>organizational memberships that you have recently been involved with. </li></ul><ul><li>Tell about the communities and populations you currently serve or would like </li></ul><ul><li>to serve and your cultural and linguistic experiences in a health professional </li></ul><ul><li>setting. </li></ul><ul><li>Explain the actual or potential difficulty you may have in completing your education/employment in the absence of an award. </li></ul><ul><li>Tell about your community background including your family structure, </li></ul><ul><li>socio-economic background, and community where you grew up. </li></ul><ul><li>Note: It is key that you elaborate in your personal statement and provide as much detail as possible. Personal statements that lack detail may be </li></ul><ul><li>considered incomplete and thus, ineligible. </li></ul>
  5. 5. Application Page 3 Part G - Questionnaire: Applicants who indicate that they currently owe an existing service obligation are ineligible to apply for this program until the current obligation is completed. “ Service Obligation” means the contractual obligation agreed to by the recipient of the scholarship or loan repayment where the recipient agrees to practice their profession for a specified period of time in or through a designated facility. Part H - Application Certification: Be sure to complete the information required in this section and sign the application. If this section is not signed, the application will be deemed incomplete.
  6. 6. Graduation Date Verification Form (page 5) (For Scholarship Applicants only) <ul><li>This form is to be completed by the program Director or an appropriate designee. The person signing this form must not be related to the applicant by blood, </li></ul><ul><li>marriage, or adoption. </li></ul><ul><li>This form requires a statement from the Program Director or an appropriate designee on the student’s performance and potential for academic success. </li></ul><ul><li>The designee signing this form should verify any second language the applicant </li></ul><ul><li>speaks. </li></ul><ul><li>This document must bear an original ink signature. Photo copies and faxed </li></ul><ul><li>copies of the completed form are not acceptable. </li></ul><ul><li>Note: Be sure to attach the tuition costs for the program you are </li></ul><ul><li>enrolled in or accepted to. </li></ul>
  7. 7. Employment Verification Form (Page 6) (For Loan Repayment Applicants Only) <ul><li>This form is to be completed by an official in the Personnel or Human </li></ul><ul><li>Resources Department. </li></ul><ul><li>The person signing this form may not be related to the applicant by </li></ul><ul><li>blood, marriage, or adoption. </li></ul><ul><li>The individual signing this form should verify any second language the </li></ul><ul><li>applicant speaks. </li></ul><ul><li>This form must bear an original ink signature. Photocopies and faxed </li></ul><ul><li>copies of the completed form are not acceptable. </li></ul>
  8. 8. Educational Debt Reporting Form (page 7) <ul><li>List the source and amounts of your outstanding educational loans used </li></ul><ul><li>to finance your education. </li></ul><ul><li>If payments are deferred, an amount must be entered into the monthly </li></ul><ul><li>payment space. </li></ul><ul><li>You must submit current lender statements (dated within six months) </li></ul><ul><li>of the educational debts listed. They should include the current </li></ul><ul><li>balance, account number, name, and address to which payment is </li></ul><ul><li>submitted. In the case of loan consolidation, please include proof </li></ul><ul><li>of the original loan sources. </li></ul><ul><li>All spaces must be completed. If any information is missing, the </li></ul><ul><li>application will be considered incomplete. </li></ul>
  9. 9. Technical Assistance The Foundation will convene a technical assistance call to discuss the application process for this program. Please contact the Foundation staff to obtain the phone number and pass code if you would like to participate in this call. Please also visit the Frequently Asked Questions (FAQ’s) section of our website in order to find out more information about this program as well as the other programs offered by the Foundation.
  10. 10. Contact Information <ul><li>Mail completed application to: </li></ul><ul><li>Health Professions Education Foundation </li></ul><ul><li>400 R Street, Suite 460 </li></ul><ul><li>Sacramento, CA. 95811 </li></ul><ul><li>Attention: James E. Hall, Program Officer </li></ul><ul><li>(800) 773-1669 or (916) 326-3643 </li></ul><ul><li>www. healthprofessions. </li></ul>