Primary Care Loan Interest Form - Federal Title Vii Loan Program printable pdf download

PRIMARY CARE LOAN INTEREST FORM

Federal Title VII Loan Program

IF YOU ARE INTERESTED IN APPLYING FOR A PRIMARY CARE LOAN, WHICH REQUIRES A

PRIMARY CARE SERVICE OBLIGATION, PLEASE COMPLETE AND RETURN THIS FORM TO

THE STUDENT FINANCIAL AID OFFICE BY MARCH 31.

Do NOT submit this form if you are not interested in a Primary Care Loan.

The Primary Care Loan Program requires both student and parent information on the FAFSA.

The purpose of this form is to assist the Student Financial Aid Office with identifying students who are

interested in receiving a Primary Care Loan. Your Student Aid Report will determine if you are eligible for

consideration. Funds are limited and priority will be given to eligible students who are approved for the

Community Match and/or Arkansas Rural Practice Loan/Scholarship programs, then seniors, juniors,

sophomores and freshmen respectively.

For the Primary Care Loan Program, Primary Care Medicine is defined as: Family Medicine, General Internal

Medicine, General Pediatrics, General Medicine/Pediatrics, or Preventive Medicine. (Note: OBGYN is not

considered Primary Care for the federal Title VII programs)

TERMS OF THE PRIMARY CARE LOAN

• 5% Fixed Interest Rate

• No fees are deducted from your loan.

• No interest accrues during medical school.

• No interest accrues during approved periods of residency training.

CONDITIONS OF THE PRIMARY CARE LOAN

• You must enter and complete a residency training program in primary health care not later than 4 years after

completing medical school.

• You must practice primary care medicine until the loan is repaid.

• If you fail to comply with the agreement, the interest rate will increase to 18%, and will begin to accrue on

the date of noncompliance.

Please sign below if you wish to be considered for a Primary Care Loan. You will be approved on the basis

of your Student Aid Report (which MUST contain your parents’ information) and on the availability of funds.

This form is not an official promissory note, but will be used by our office to identify students who wish to be

considered for Primary Care Loans. You will be sent a financial aid award letter to let you know whether or

not you have been approved.

PRINTED NAME: _______________________________________ SSN: ____________________________

SIGNATURE:

______________________________________ DATE: ____________________________

Primary Care Loan Interest Form - Federal Title Vii Loan Program