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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_________________________________________________
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