Application
Submission
Applications
(will be available on June 11, 2008)
In
order for an application to be complete,
the following documents must be submitted:
-
Online Application closed at 5 PM July
11, 2008
-
Proof of U.S. citizenship (must be submitted
(e.g., a copy of a birth certificate,
a certificate of citizenship, passport
or naturalization certificate).
-
Intent
of Employment Form from an accredited
eligible health professions college
or university documenting that the employing
institution will employ the applicant
as a faculty member for a minimum of
two years. If the employing institution
requests a waiver of the matching requirement,
it must provide supporting documentation.
(
33 KB)
-
Signed and Dated Contract
(with original signature) (
30 KB)
-
Direct Deposit Sign Up Form (Government
Agency Copy Only), available at http://www.fms.treas.gov/eft/1199a.pdf
-
Loan
Information and Verification Form
(
38 KB)
-
Promissory Note for each eligible loan
submitted. Highlight the original loan
date, original loan amount and the type
of loan.
-
Lender statement showing the account
holder’s name, account number and current
Principal Balance.
-
W-4, available at http://www.irs.gov/
-
Authorization
to Release Information Form completed
and signed. (
17 KB)
-
Certification
Regarding Debarment, Suspension, Disqualification
and Related Matters (
71 KB)
Submission
Deadline
Applications and all other required documentation
must be received by 5 PM ET, July 11,
2008.
Mail
all required supplemental documents to
Contact
Information
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