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Forms for Scholarship and Loan Programs

Use these forms for the following programs:

• Health Professions Student Loan (HPSL)
• Nursing Student Loan (NSL)
• Primary Care Loan (PCL)
• Loans for Disadvantaged Students (LDS)
• Exceptional Financial Need Scholarship (EFN)
• Financial Assistance for Disadvantaged Health Professions Students Scholarship (FAD)

Promissory Notes

• Electronic Promissory Notes with Electronic Signatures for HPSL, NSL, LDS and PCL Programs (PDF - 45 KB)
• Policy Memo 2004-2: Guidelines for Issuing Master Promissory Notes to HPSL, PCL, LDS and NSL Program Borrowers (PDF - 30 KB)
• HPSL Promissory Note (PDF - 37 KB)
• LDS Promissory Note (PDF - 29 KB)
• NSL Promissory Note (PDF - 36 KB)
• PCL Promissory Note (PDF - 67 KB) for loans made on or after March 23, 2010

Forms for HPSL, NSL, PCL, LDS

• SAMPLE Annual Operating Report for HPSL, LDS and NSL (PDF - 153 KB)
• SAMPLE Annual Operating Report for PCL (PDF - 150 KB)
• Annual Operating Report for Loan Programs Guidance (PDF - 515 KB)
• Entrance Interview Checklist/Questionnaire (PDF – 14 KB)
• Exit Interview Checklist (PDF – 13 KB)
• Statement of Rights and Responsibilities (PDF – 21 KB)
• Truth in Lending Statement (PDF – 13 KB)
• Disability Checklist (PDF – 11 KB)
• Medical Release Form (PDF – 17 KB)
• Certification of Deferment (PDF – 21 KB)

Forms for EFN and FAD

• Certification of Deferment (PDF – 21 KB)
• Post-Residency Self-Certification (PDF – 14 KB)