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EXIT INTERVIEW FORM
DEPARTMENT OF HEALTH & HUMAN SERVICES
Bureau of Health Professions
APR 17 1984
Dear Financial Aid Officer:
The enclosed table identifies Health Education Assistance Loan (HEAL) borrowers scheduled to graduate between April and June 1984. The table displays the amount borrowed and the lender.
Although the HEAL regulations do not require an exit interview, we encourage you to counsel each borrower, either individually or in groups, concerning their responsibilities as slated in Section 60.8 of the regulations, and as summarized below:
- the borrower must pay all bills on time; and
- the borrower must keep the lender informed of his/her whereabouts and any change in status.
The HEAL Lender/School Manual contains an EXIT INTERVIEW FORM as Exhibit VI‑1.
We request that you encourage HEAL borrowers who are entering deferment to pay the interest on their loans. By paying the interest as it comes due, borrowers will preclude the interest compounding and thus decrease the dollars ultimately repaid. In addition, borrowers in deferment must complete the HEAL BORROWER STATUS FORM and return it to the lender. This is required by regulation, but more importantly will preclude a lender from erroneously placing a borrower in repayment status.
We hope this information is helpful and will appreciate any reaction that you have to this approach. Please call the HEAL Branch at 301 443‑1540 with your thoughts and ideas.
Sincerely yours,
Michael Heningburg
Director
Division of Student Assistance
Enclosure
EXIT INTERVIEW FORM EXIBIT VI
(Print or Type in Duplicate)
SUMMARY OF PERSONAL INFORMATION
Social Security Number_________________ Student I.D. Number______
Middle or
Last Name________________ First_____________ Maiden Name______________
Permanent Family Address
Street__________________________________ Phone Number_____________
City and State__________________________ Zip Code_______________
Internship or Residency Address
Hospital Name______________________ Expected Completion Date____________
Street
City and State_____________________ Zip Code_______________
Driver's License Number
Driver's License Number___________________________________________________
Bank Accounts
Bank Name City and State Type of Account
___________________________ ________________ ________________
___________________________ ________________ ________________
Life Insurance
Company Name Policy Number
___________________________________________________ ____________________
___________________________________________________ ____________________
Credit References
Company Name Credit Card Number
_____________________________________________________ ______________________
_____________________________________________________ ______________________
Relatives or Friends who will know how to locate you
Name Address Phone Number
Plans for the next two years
(1) I expect( ) Do not expect( ) to serve in the Armed Forces, Peace
Corps, or Vistaafter I leave school.
(2) I expect( )Do not expect( to resume my studies at Name of Institution
(3) I expect( ) Do not expect( ) to practice medicine or other health
profession.
(4) Other plans__________________________________________________________
Expected Address_________________________________________________
