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Indian Health Service Scholarship Branch Logo
Forms Available to Scholarships Recipients

These forms are provided to students in an effort to meet the necessary requirements for graduation. Students are hereby advised to consult their Scholarship Handbook, Scholarship Coordinator or contact the Scholarship Program at 301/443-6197, for further details encompassing the above forms and their requirements for submission.



D-02--Lost Stipend Check Please submit the following request if you have not received your stipend check by the 7th day of the subsequent month. (PDF 46K)
F-02--Progress Report Within 30 days from the beginning of each semester or quarter, you must submit an Initial Progress Report, signed by your advisor or registrar's office verifying your are enrolled. (PDF 47K)
F-04--Academic Problems or Change If you experience any academic problems, are placed on academic probation, or fall below the minimum part-time course load, you must submit the following report. (PDF 47K)
G-02--Tutorial Assistance This form may be used to request tutorial assistance through the academic year. (PDF 48K)
G-04--Summer School Request Students may need to take summer courses to graduate or complete course requirements for graduation, provided is the form requesting summer school courses be taken. (PDF 55K)
H-07--Placement Update 60 days after graduating a Placement Update form must be submitted to the I H S Headquarters Placement Officer, regarding attempts at securing employment. (PDF 59K)
H-08--Notice of Impending Graduation At least one month before graduation, the graduating student must contact the I H S Scholarship Program via a Notice of Impending Graduation. (PDF 52K)
J-04--Extern Site Preference Request The Scholarship Program annually allows Scholarship recipients to be employed as an I H S extern for up to 120 work days per calendar year. Provided is the request for externship. (PDF 55K)
J-05--Reimbursement Request for Extern Travel Recipients may be provided for some expenses incurred during their externship with I H S. Provided that expenses fall under Travel and Transportation Allowances in the Joint Travel Regulations and Federal Travel Regulations. (PDF 46K)
K-03--Annual Status Report Recipients are required to submit an Annual Status Report in order to receive credit toward their service obligation. (PDF 48K)
K-04--Scholarship Program Preferred Assignment Form provided to recipients designating their choice as to where they would like to complete/fulfill their obligation. (PDF 55K)
L-03--Request for Deferment Document provides for the request to defer incurred service obligation. (PDF 46K)
Scholarship Handbook Student Handbook (PDF 1MB)
Part 1 - Scholarship Application Booklet
Part 2 - IHS-856 (Application: Bubble Sheet)
Federal Register Information
Scholarship Application Information Booklet (PDF 814K)

Note: Please contact your Scholarship Coordinator for the Official Copy of the Application Form.

Please contact Eric Pinto at if you have any questions or comments.

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This file last modified:   Wednesday January 31, 2007  8:14 AM