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 |
MS WORD | |
Electronic Promissory Notes with Electronic Signatures | Prom Note Standards | Prom Note Standards |
Forms for 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 |
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