Health Resources and Services Administration

Bureau of Health Professions

Division of Health Careers Diversity and Development

General Guidance
to Capture Sample Promissory Note Templates
and List of Data Fields
 
If you use Microsoft Internet Explorer 6.0:
To copy the Promissory Note Templates in HTML using Microsoft Internet Explorer 6.0 please follow the following directions.
1. Open the HTML page by selecting the appropriate form from the"HTML Sample Form" column.
2. Right click on the page and select "View Source".
3. Click on "File" on the menu bar, then select "Save As."
4. Select the folder to which you would like to save the file, then click on "Save."


If you use Netscape Navigator 6.0:
To copy the Promissory Note Templates in HTML using Netscape Navigator please follow the following directions.
1. Open the HTML page by selecting the appropriate form from the"HTML Sample Form" column.
2. Right click on the page and select view source
3. Highlight everything on the page by pointing your cursor to the upper left corner of the document; left click and hold the button while dragging the cursor to the very bottom right of the document.
4. Hit the "C" key while holding the Control ("Ctrl") key. This will copy the document.
5. Create a new blank document in your Text Editing software.
6. Left click on the blank document then Hit the "V" key while holding the control ("Ctrl") key. This will paste the file into the document.
7. Save the new document.
Data Fields
  FIELD NAME FIELD DESCRIPTION FIELD TYPE FIELD SIZE
FirstName First Name Text 20
Initial Middle Initial Text 1
LastName Last Name Text 20
SchoolName Institution Name Text 60
SchoolCity City Text 20
SchoolState State Text 2
DateM Date Text 10
SignatureOfBorrowerM Signature of Borrower Text 30
Address1 Address Line 1 Text 50
Address2 Address Line 2 Text 50
SocSec Social Security Number Text 9
Date of Birth Date of Birth Text 10
BorrowerInitialYes BorrowerInitial (Yes) Text 4
BorrowerInitialNo BorrowerInitial (No) Text 4
SchoolEnterDate School Entrance Date Text 10
SchEnterDateInitial Borrower Initial (School Entrance Date) Text 4
SchoolExitDate School Exit Date Text 10
SchExitDateInitial Borrower Initial (School Exit Date) Text 30
RECORD NUMBER FIELD NAME FIELD DESCRIPTION FIELD TYPE FIELD SIZE
1. AmountAdvanced1 Amount Advanced Text 10
TotalToDate1 Total to Date Text 10
Date1 Date Text 10
SignatureOfBorrower1 Signature of Borrower Text 30
2. AmountAdvanced2 Amount Advanced Text 10
TotalToDate2 Total to Date Text 10
Date2 Date Text 10
SignatureOfBorrower2 Signature of Borrower Text 30
3. AmountAdvanced3 Amount Advanced Text 10
TotalToDate3 Total to Date Text 10
Date3 Date Text 10
SignatureOfBorrower3 Signature of Borrower Text 30
4. AmountAdvanced4 Amount Advanced Text 10
TotalToDate4 Total to Date Text 10
Date4 Date Text 10
SignatureOfBorrower4 Signature of Borrower Text 30
5. AmountAdvanced5 Amount Advanced Text 10
TotalToDate5 Total to Date Text 10
Date5 Date Text 10
SignatureOfBorrower5 Signature of Borrower Text 30
6. AmountAdvanced6 Amount Advanced Text 10
TotalToDate6 Total to Date Text 10
Date6 Date Text 10
SignatureOfBorrower6 Signature of Borrower Text 30
7. AmountAdvanced7 Amount Advanced Text 10
TotalToDate7 Total to Date Text 10
Date7 Date Text 10
SignatureOfBorrower7 Signature of Borrower Text 30
 
Division of Health Careers Diversity and Development
 

Department of Health and Human Services (HHS)

 Health Resources and Services Administration (HRSA)

 Bureau of Health Professions (BHPr)
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