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Forms and Handbooks
Application Handbook
Download entire Application Handbook (PDF - 3926KB)
The following is a list of links to the forms (pdf format) that will be needed for a new application.
Acknowledgement Card (PDF - 80KB)
Application Checklist Form (PDF - 43KB)
Verification of Course Curriculum Form (PDF - 44KB)
Delinquent Federal Debt Form (PDF - 44KB)
Faculty/Employer Evaluations Form (PDF - 46KB)
Health Related Job Experience (MPH Only)(PDF - 47KB)
Reasons for Requesting Scholarship Form (PDF - 43KB)
Verification of Acceptance or Decline of Award (PDF - 44KB)
Student Handbook
Download entire Student Handbook (PDF - 3268KB)
The following is a list of links to the forms (pdf format) that you will need during your scholarship period.
Annual Status Report (PDF - 42KB)
Extern: Site Preference Request (PDF - 41KB)
Extern: Travel Reimbursement Request (PDF - 39KB)
Federal Income Tax Withholding - Form W4
Initial Program Progress Report (PDF - 39KB)
Lost Stipend Checks/Direct Deposit (PDF - 35KB)
Notice of Impending Graduation (PDF - 35KB)
Notification of Academic Problem or Change (PDF - 39KB)
Placement Update (PDF - 47KB)
Preferred Assignment (PDF - 42KB)
Request for Prior Approval of Deferment (PDF - 34KB)
Request for Tutorial Assistance (PDF - 41KB)
Summer School Request (PDF - 53KB)
Sample Contracts
IHS Scholarship Program Agreement (PDF - 34KB)
IHS Scholarship Program Contract (PDF - 45KB)
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