Faculty Loan Repayment Program Supplemental Forms
Overview | 2007 Application Guidance

• The 2007 application deadline was Thursday May 31, 2007. Mailed forms and documentation postmarked after May 31, 2007 will not be accepted.
• FLRP expects to receive 160 applications and make 35 awards in 2007
• Awards will be announced August 24
• Sign up to be notified by e-mail when the 2008 application is available.

• Intent of Employment Form (Word) | Intent of Employment Form (Acrobat/pdf) to be completed by your employing school
• Disadvantaged Certification Form (Word) | Disadvantaged Certification Form (Acrobat/pdf) to be completed by your employing school or the school where you obtained your health professions degree. If the institutions cannot certify your disadvantaged background, you may submit copies of your parents' federal income tax returns, official documentation from government assistance programs or describe how you meet the FLRP disadvantaged definition, providing as much detail as possible.

In addition to these supplemental forms, you must provide

• Copies of your current official lender statement(s) for health professions education loans you are currently repaying. Statements must include your name and account number. Highlight the current balance on each statement. Provide the total amount of all submitted loans.
• Documentation of U.S. citizenship if you were born outside the U.S.

Your on-line application must be submitted and all supplemental forms and required documentation must be received by the application deadline, 5 pm ET, May 31, 2007, to be considered for funding.

Mail all supplemental forms and required documentation to:

Faculty Loan Repayment Program
HRSA, Bureau of Health Professions
5600 Fishers Lane
Room 8-42
Rockville, Maryland 20857