Health Resources and Services Administration

Bureau of Health Professions

Division of Health Careers Diversity and Development

Updated 8/06/2004

Standards for Campus Based Programs
 
STANDARDS
 PDF MS WORD
Electronic Promissory Notes with Electronic Signatures Prom Note Standards Prom Note Standards

Forms for Campus Based Programs
 
Current versions of forms are available from this site for the following campus based programs
HPSL - Health Professions Student Loan
NSL    - Nursing Student Loan
PCL    - Primary Care Loan
LDS    - Loans for Disadvantaged Students
EFN    - Exceptional Financial Need Scholarship
SDS    - Scholarships for Disadvantaged Students
FAD    - Financial Assistance for Disadvantaged Health Professions Students Scholarship

NOTE:
Click here for General Guidance to capture the Sample Promissory Note templates in HTML code and a table containing the Data Fields used. The HTML forms are NOT active. They are presented here to encourage the use of electronic Promissory Notes and serve as examples. Each institution must develop and maintain their own databases to utilize these HTML forms.
You will need Adobe Acrobat Reader to view and print the PDF forms.
If you do not have it, you can Download Acrobat Reader without charge from Adobe.

Policy Memo 2004-2: Guidelines for Issuing Master Promissory Notes to HPSL, PCL, LDS and NSL Program Borrowers (Updated 8/6/2004)
FORM
 HTML SAMPLE FORM PDF FORM
HPSL Promissory Note HPSL - html HPSL - pdf
NSL Promissory Note NSL - html NSL - pdf
PCL Promissory Note (Updated 8/6/2004) PCL - html PCL - pdf
LDS Promissory Note (Updated 8/6/2004) LDS - html LDS - pdf


FORM
(Click on Form Name to View)		 APPLIES TO PROGRAM
HPSL NSL PCL LDS EFN FAD SDS
Entrance Interview Checklist/Questionnaire X X X X      
Exit Interview Checklist X X X X      
Statement of Rights and Responsibilities X X X X      
Truth-in-Lending Statement X X X X      
Disability Checklist X X X X      
Medical Release Form     [MS Word]   [PDF] X X X X      
Certification of Deferment X X X X X X  
Post-residency Self-certification     X   X X  
SDS Return of Funds 2004-2005   
[MS Word]   [PDF] 		            X

 
Division of Health Careers Diversity and Development
 

Department of Health and Human Services (HHS)

 Health Resources and Services Administration (HRSA)

 Bureau of Health Professions (BHPr)
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