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pdfU.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
Bureau of Clinician Recruitment and Service
NURSING SCHOLARSHIP PROGRAM APPLICANT INFORMATION BULLETIN
SCHOOL YEAR 2009-2010
FOR STUDENTS IN TRAINING TO BE REGISTERED NURSES
Health Resources and Services Administration
Bureau of Clinician Recruitment and Service
Division of Applications and Awards
Nursing Scholarship Program
5600 Fishers Lane, Room 8-37
Rockville, Maryland 20857
Contact Nursing Scholarship Program
HRSA Call Center
Monday through Friday between 9:00 a.m. – 5:30 p.m., Eastern Time (ET)
Telephone: 1-800-221-9393
TTY 1-877-897-9910
E-mail: [email protected]
On-line application and BCRSIS Banking Information must be submitted by 5:00 p.m. ET on
May 14, 2009, and all Supporting Documents must be postmarked by May 14, 2009
Mail completed forms to:
Nursing Scholarship Program
c/o HRSA Call Center
12530 Parklawn Drive, Suite 350
Rockville, MD 20852
Authority: Section 846(d) of the Public Health Service Act as amended
DISCRIMINATION PROHIBITED
Title VI of the Civil Rights Act of 1964, as amended, and its Department of Health and Human
Services (HHS) implementing regulation, 45 Code of Federal Regulations (CFR) Part 80,
provide that no person in the United States shall, on the ground of race, color, or national origin,
be excluded from participation in, be denied the benefits of, or be subjected to discrimination,
under any program or activity receiving Federal financial assistance.
Title IX of the Education Amendments of 1972, as amended, and its implementing regulation, 45
CFR Part 86, provide that no person in the United States shall, based on his/her sex, be excluded
from participation in, be denied the benefits of, or be subjected to discrimination under, any
educational program or activity receiving Federal financial assistance.
Section 504 of the Rehabilitation Act of 1973, as amended, and its HHS implementing
regulations, 45 CFR Parts 84 and 85, provide that no otherwise qualified individual with a
disability in the United States shall, solely by reason of his/her disability, be excluded from
participation in, be denied the benefits of, or be subject to discrimination under any program or
activity receiving Federal financial assistance or any program or activity conducted by HHS.
Title III of the Age Discrimination Act of 1975, as amended, and its HHS implementing
regulations, 45 CFR Parts 90 and Part 91, provide the general rule that no person in the United
States shall, on the basis of age, be excluded from participation in, be denied benefits of, or be
subject to discrimination under, any program or activity receiving Federal financial assistance.
NOTICE
PLEASE PRINT AND KEEP THIS BULLETIN
Applicants selected to participate in the Nursing Scholarship Program should retain this
Applicant Information Bulletin as a reference guide to the scholarship award.
The Applicant Information Bulletin describes the Nursing Scholarship Program authorized by
Section 846(d) of the Public Health Service Act (42 U.S.C. 297n(d)), as amended by Public Law
107-205 on August 1, 2002, including applicable provisions of the National Health Service
Corps Scholarship Program, and Nursing Scholarship Program administrative guidelines in
effect as of January 1, 2009. Future changes in the governing statute, regulations and Program
guidelines may also be applicable to your participation in this Program. The Nursing Scholarship
Program is listed as number 93.908 in the Catalog of Federal Domestic Assistance.
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PRIVACY ACT NOTIFICATION STATEMENT
General
This information is provided pursuant to the Privacy Act of 1974 (Public Law 93-579), as
amended, for individuals supplying information for inclusion in a system of records.
Authority
Section 846(d) of the Public Health Service Act as amended.
Purposes and Uses
The purpose of the Nursing Scholarship Program is to provide scholarships to nursing students in
exchange for a service commitment at an eligible health facility with a critical shortage of nurses.
The information you provide will be used to evaluate your qualifications and suitability for
participating in the Nursing Scholarship Program.
Selections are made on a competitive basis. The Nursing Scholarship recipient’s application and
related data are made part of the file to be used within the U.S. Department of Health and Human
Services for recordkeeping and management during the recipient’s participation in the Nursing
Scholarship Program. The information may also be disclosed outside the Department, as
permitted by the Privacy Act and Freedom of Information Act (e.g., to the Congress, the
National Archives, the General Accounting Office, and pursuant to court order).
The name of a scholarship recipient, the professional school he or she is attending, and the date
of graduation may be made available to health professions associations, to groups which have
responsibility for coordinating funds paid to students from Federal and other sources, and to
individuals and organizations deemed qualified by the Secretary, Health and Human Services to
carry out specific research, solely for the purpose of carrying out such research. In addition, a
participant’s name, business address, business telephone number, and completion date of
commitment may be provided to professional placement firms in response to requests made
under the Freedom of Information Act. See also the Authorization to Release Information.
Effects of Non-disclosure
Disclosure of the information sought in this application is voluntary; however, if not provided,
except for the race or ethnic identity of the applicant, an application will not be considered for an
award under this announcement.
Paperwork Reduction Act Public Burden Statement
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a current OMB control number. The current OMB control number
for information collected through this application process is 0915-0301. Public reporting burden
for this collection is estimated to average 120 minutes per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information. Send comments regarding
this burden estimate or any other aspect of this collection of information, including suggestions
for reducing this burden, to HRSA Reports Clearance Office, 5600 Fishers Lane, Room 10-33,
Rockville, Maryland 20857.
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TABLE OF CONTENTS
EXECUTIVE SUMMARY .......................................................................................................... 5
SECTION I. APPLICANT INFORMATION BULLETIN: 2009-2010 ACADEMIC YEAR
................................................................................................................................................. 8
INTRODUCTION .................................................................................................. 8
PROGRAM ADMINISTRATION ........................................................................... 8
APPLICANT ELIGIBILITY ................................................................................... 8
FUNDING PREFERENCES AND AWARDS...................................................... 12
SUBMITTING THE APPLICATION .................................................................... 13
SCHOLARSHIP BENEFITS ............................................................................... 16
FULFILLING THE SERVICE COMMITMENT .................................................... 22
DEFAULTING ON THE SCHOLARSHIP COMMITMENT: BREACH OF
CONTRACT ....................................................................................................... 25
WAIVER, SUSPENSION OR CANCELLATION OF THE SERVICE
OBLIGATION ..................................................................................................... 26
DEADLINE ......................................................................................................... 27
POWER-OF-ATTORNEY ................................................................................... 27
SECTION II. GLOSSARY OF TERMS................................................................................... 28
SECTION III. SUMMARY OF IMPORTANT DEADLINES ............................................... 32
SECTION IV. SUPPORTING DOCUMENTS ....................................................................... 33
Forms Package .................................................................................................. 34
2009 NSP AIB
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EXECUTIVE SUMMARY
The Nursing Scholarship Program Application Information Bulletin (AIB) provides a summary
of the rights and liabilities of applicants who are selected to become participants in the Nursing
Scholarship Program (NSP). This AIB also contains instructions for completing the application
and all required forms. The information outlined below includes important information for
successfully applying for the NSP and describes some of the changes implemented during this
application cycle.
1. Electronic Submission of the Application
All individuals applying for this funding opportunity are required to submit the
application electronically no later than 5:00 p.m. Eastern Time (ET) on May 14, 2009.
2. Electronic Submission of BCRSIS Banking Information
All applicants who meet the first funding preference (see item 4 below) are required to
submit the Bureau of Clinician Recruitment and Service Information System (BCRSIS)
banking information (for direct deposit of stipend payments) electronically no later than
5:00 p.m. ET on May 14, 2009. The applicant must also print a copy of the “BCRSIS
Receipt of Submission.” A copy of the “BCRSIS Receipt of Submission is required
supporting documentation to complete the application packet. See item 3 below.
If you are unable to print a copy of the “BCRSIS Receipt of Submission,” please
complete the following 2 steps:
•
Contact the HRSA Call Center to log a help-ticket toll-free at 1-800-221-9393 (TTY:
1-877-897-9910), Monday-Friday (except Federal Holidays), 9:00 a.m. to 5:30 p.m.
ET.
•
Complete the Banking Update form which may be found at
https://www.fms.treas.gov/eft/1199a.pdf. The completed form must be received or
postmarked by May 14, 2009. Please mail the completed form to: Division of
Applications and Awards, Scholarship Branch, 5600 Fishers Lane, Room 8-37,
Rockville, MD 20857.
Only the Health Resources and Services Administration (HRSA) staff can enter changes
to the electronic banking information once it has been submitted through BCRSIS and a
“BCRSIS Receipt of Submission” has been printed. If changes are required, applicants
must complete the Banking Update Form which may be found at
https://www.fms.treas.gov/eft/1199a.pdf and mail the completed form to the Division of
Applications and Awards, Scholarship Branch, 5600 Fishers Lane, Room 8-37,
Rockville, MD 20852.
3. Submission of Supporting Documentation to Complete Application Package
In addition to submitting the electronic application and banking information through the
Bureau of Clinician Recruitment and Service Information System (BCRSIS), all
applicants who meet the first funding preference (see Item 4 below) must submit all
2009 NSP AIB
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required supporting documentation including a copy of the “BCRSIS Receipt of
Submission,” described in this Applicant Information Bulletin, by May 14, 2009
(postmark date) to:
Nursing Scholarship Program
c/o HRSA Call Center
12530 Parklawn Drive, Suite 350
Rockville, MD 20852
Any applicant in the first funding preference who fails to submit all required documents by
the deadline will be deemed ineligible and will not be considered for funding under this
announcement. Application packages deemed incomplete (i.e., missing, inconsistent, or
incomplete supporting documents) will not be considered for funding. The NSP will not
accept submission or re-submission of incomplete, rejected, or otherwise delayed
applications after the deadline. It is the applicant’s responsibility to submit a complete
application package.
The educational information submitted in the online application must be consistent with what
is reported by the school on the Verification of Enrollment/ Good Standing form.
4. Funding Preference
First funding preference will be given to qualified applicants with the greatest financial need
(those who have an expected family contribution [EFC] of zero) and are enrolled or accepted
for enrollment in an accredited undergraduate nursing program as full-time students.
Because of the competitive nature of the NSP, scholarship awards since the inception of the
program in 2003 have not gone beyond this funding preference. Therefore, please do not
submit the BCRSIS banking information and supporting documents unless you meet the
funding preference referenced above. In the unlikely event that the program would reach a
lower funding preference, lower preference applicants will be given an opportunity to submit
the BCRSIS banking information and other required documentation at a later date.
To receive an EFC determination, applicants must submit a Free Application for Federal
Student Aid (FAFSA) to the Department of Education. See http://www.fafsa.ed.gov. In
response to the FAFSA, the Department of Education will provide the applicant with a
Student Aid Report (SAR), which will contain the EFC determination. It takes a minimum of
2 weeks from the date of submission to receive an original FAFSA. Therefore, it is
recommended that you complete the FAFSA form before completing the Nursing Scholarship
Program application or as soon as possible.
5. NSP and Taxes
The scholarship consists of payment for tuition, fees, other reasonable educational costs, and
a monthly support stipend. All of these benefits are subject to Federal income taxes.
2009 NSP AIB
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6. Program Changes for New Applicants
•
Summer School
The NSP will only pay tuition and fees for pre-approved summer school sessions when
summer school is an academic term normally required by the school for all students in
the same program.
•
NSP School Year
All NSP scholarship contracts are for a specific year. The school year is defined as July 1
through the following June 30 during which an applicant is enrolled in a school. If, for
example, a student is in a 24-month program that begins on August 3, 2009, and he/she
signs contracts for 2 school years, the student will receive stipend, ORC and tuition
payments through June 30, 2011. Funding for the extra months of the program beyond
June 30, 2011, would require a request for a third year of scholarship funding, and if
granted, obligates the recipient to 3 full years of service commitment. If a student is in a
24-month program that begins on May 3, 2009, and he/she signs contracts for 2 school
years, the student will receive a stipend, ORC and tuition payments from July 1, 2009,
through June 30, 2011, or the month the recipient completes the required classes for
graduation, whichever comes first.
7. Telephone Conferences for Applicants
The NSP will conduct two (2) telephone conferences for applicants who may have questions
during the Fiscal Year 2009 application cycle. The telephone conferences will be held on
April 23, 2009 and May 7, 2009. The telephone conferences will be available for 2 hours
from 2:30 pm to 4:30 pm, ET. If you are interested in participating in a telephone conference
please register for the event. There are a limited number of lines available for this call, early
registration is recommended.
To register for this event:
Register for April 23 call (https://www.mymeetings.com/emeet/rsvp/index.jsp?customHeader
=mymeetings$Conference_ID=3138609$passcode=4955079)
Register for May 7 call (https://www.mymeetings.com/emeet/rsvp/index.jsp?customHeader=
mymeetings$Converence_ID=3138614$passcode=4955079)
2009 NSP AIB
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SECTION I. APPLICANT INFORMATION BULLETIN: 2009-2010 ACADEMIC YEAR
INTRODUCTION
The Nursing Scholarship Program (NSP or "Nursing Scholarship") is a competitive Federal
program which awards scholarships to individuals for attendance at schools of nursing. The
scholarship consists of payment for tuition, fees, other reasonable educational costs, and a
monthly support stipend. In return, the students agree to provide a minimum of 2 years of fulltime clinical service (or an equivalent part-time commitment, as approved by the NSP) at a
health care facility with a critical shortage of nurses.
Nursing Scholarship recipients MUST be willing and are required to fulfill their NSP service
commitment at a health care facility with a critical shortage of nurses in the United States, the
District of Columbia, the Commonwealth of Puerto Rico, the Territory of Guam, the
Commonwealth of the Northern Marianas, the U.S. Virgin Islands, the Territory of American
Samoa, the Republic of Palau, the Republic of the Marshall Islands, or the Federated States of
Micronesia.
Students who are uncertain of a commitment to provide nursing in a health care facility with a
critical shortage of nurses in the United States are advised not to participate in this program.
PROGRAM ADMINISTRATION
The Bureau of Clinician Recruitment and Service (BCRS), Health Resources and Services
Administration (HRSA), administers the NSP. Within BCRS, the Division of Applications and
Awards (DAA) awards the scholarships and is responsible for all payments to scholars and
schools; the Division of Scholar and Clinician Support (DSCS) monitors scholars while in
school, reviews and approves requests for initial service site and service transfers, and monitors
scholars’ service until they have completed their service commitment. The Legal and
Compliance Office (LCO) reviews scholar and clinician compliance referrals, handles default
determinations, and reviews requests for suspensions and waivers.
APPLICANT ELIGIBILITY
Applicants must meet the following requirements in order to be eligible for scholarship awards.
1. U.S. Citizenship
Scholarship applicants must be citizens or nationals of the United States (U.S.) to receive
Nursing Scholarship awards. Nationals are individuals who owe permanent allegiance to the
U.S. and were born in certain outlying possessions of the U.S. (e.g., American Samoa and
Swains Island) on or after the date of formal acquisition of such possession by the U.S. All
applicants must submit documentation to verify U.S. citizenship or status as a U.S.
national (e.g., a copy of a birth certificate, a certificate of citizenship, passport or
naturalization certificate) with the application material. Permanent residents of the U.S.
are not eligible to apply.
2009 NSP AIB
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2. Enrollment in Accredited Nursing Schools and Programs
The nurse education program must be accredited by a national nurse education accrediting
agency or State approval agency recognized by the Secretary of the U.S. Department of
Education. Currently, these agencies include the Commission on Collegiate Nursing
Education (CCNE), the National League for Nursing Accrediting Commission (NLNAC),
Kansas Board of Nursing, Maryland Board of Nursing, Missouri Board of Nursing, Montana
Board of Nursing, North Dakota Board of Nursing and New York Board of Nursing.
To be considered for a scholarship award for the 2009-2010 school year, applicants must be
enrolled or accepted for enrollment in a nursing degree program and must begin classes for the
Fall term on or after July 1, 2009, and no later than September 30, 2009, in one of the
following:
1) AN ASSOCIATE DEGREE SCHOOL OF NURSING - A department, division, or other
administrative unit in a junior college, community college, college, or university which
provides primarily or exclusively a two-year program of education in professional nursing
and allied subjects leading to an associate degree in nursing or to an equivalent degree and is
an accredited program;
2) A COLLEGIATE SCHOOL OF NURSING - A department, division, or other
administrative unit in a college or university which provides primarily or exclusively a
program of education in professional nursing and related subjects leading to a degree of
bachelor of arts, bachelor of science, bachelor of nursing, graduate degree in nursing, or to an
equivalent degree, and including advanced training related to such program of education
provided by such school and is an accredited program; or
3) A DIPLOMA SCHOOL OF NURSING - A school affiliated with a hospital or university,
or an independent school, which provides primarily or exclusively a program of education in
professional nursing and allied subjects leading to a diploma or to equivalent training and is
an accredited program.
PLEASE NOTE: STUDENTS ENROLLED IN LPN PROGRAMS, SELF-PACED
STUDY PROGRAMS (ON-LINE), BRIDGE PROGRAMS AND DUAL DEGREE
PROGRAMS ARE NOT ELIGIBLE FOR A SCHOLARSHIP AWARD.
Full-Time or Part-Time Enrollment
Applicants may be enrolled as full-time or part-time students; however, a funding preference will
be given to full-time students. See “Funding Preferences and Awards.”
A student will be considered full-time if the student meets the nursing school program's
definition of a full-time student. A less than full-time student will be considered part-time if the
student is enrolled on at least a half-time basis. Students who are enrolled on a less than halftime basis are ineligible to participate in the NSP.
ALL STUDENTS - PLEASE NOTE: Individuals planning to be on a leave of absence from
school such that they will not begin class attendance on or before September 30, 2009, should
2009 NSP AIB
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not submit an application this year, but may apply next year. Please be advised that any nonrequired or unrelated courses will not count toward the schools’ required hours in determining
full-time or part-time status.
Schools and Programs Must be Located in a State
The schools and educational programs for which scholarship support is requested must be in a
State (includes the 50 States, the District of Columbia, the Commonwealth of Puerto Rico, the
Commonwealth of the Northern Marianas, the U.S. Virgin Islands, the Territory of Guam, the
Territory of American Samoa, the Republic of Palau, the Republic of the Marshall Islands, and
the Federated States of Micronesia). Students attending schools outside of these geographic
areas are not eligible for Nursing Scholarships, even though they may be citizens of the
United States.
Submission of Signed Contract
To be eligible for an NSP scholarship, the statute requires that an applicant sign and submit a
contract. The contract is for the 2009-2010 school year with contract extensions for up to 3
subsequent school years, not to exceed a total of 4 school years of NSP scholarship support. The
2009-2010 contract, if countersigned by the Secretary or his/her designee, obligates the applicant
to the minimum 2-year service commitment. Therefore, applicants are strongly encouraged to
sign the 2009-2010 contract and an optional contract for the 2010-2011 school year, if the
applicant will need additional support for all or part of the subsequent school year (2010-2011).
The contract(s) must be signed by the student through the date of graduation in order for the
student to receive support through the date of graduation. Before an applicant decides not to
request scholarship support through his/her graduation date, the applicant should read the
Continuing Support after the 2009-2010 School Year section of this Bulletin.
No Judgment Lien for a Federal Debt
An applicant must be free of any judgment lien against his/her property arising from a debt owed
to the United States. Debtors with judgment liens for Federal debts are ineligible to receive
Federal financial assistance. Please be advised that a credit check will be conducted as part of
the application process.
No Exclusion or Disqualification from Covered Transactions
The receipt of funding under the NSP is a “covered transaction” pursuant to Title 2 of the Code
of Federal Regulations (CFR) Part 180, as adopted by HHS pursuant to 2 CFR Part 376. Before
entering into a scholarship contract, the applicant is required, under Subpart C of Part 180, to
report certain information, which is described in the “Certification Regarding Debarment,
Suspension, Disqualification and Related Matters.” The applicant should sign the Certification
that is applicable to his/her situation.
Individuals who are currently excluded (suspended or debarred) or disqualified by any Federal
agency from participating in covered transactions are ineligible to receive an award under the
NSP. Individuals with reportable problems other than exclusion or disqualification may, or may
not, be selected to participate in the NSP, based on the Program’s consideration and evaluation
of the applicant’s circumstances.
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As a condition of participating in the NSP, a participant must agree to comply with the
requirements of Subpart C of Part 180, which include providing immediate written notice to
DAA if the applicant learns that he/she failed to make a required disclosure or that a disclosure is
now required due to changed circumstances.
No Conflicting Service Commitments
Applicants, except military reservists, who are already obligated to a Federal, State or other
entity for professional practice or service after academic training are not eligible for NSP awards.
An exception may be made if the obligating entity provides documentation that there is no
potential conflict in fulfilling the service commitment to the NSP and that the NSP service
commitment will be served first.
A scholarship recipient who meets the above exception should not expect to serve in a State,
community, or medical facility to which the recipient already owes a commitment for
service. The NSP cannot make any such advance placement commitments to NSP recipients.
Scholarship recipients, except military reservists, who subsequently enter other service
commitments and are not immediately available after completion of their degrees to fulfill their
scholarship service commitments, will be subject to the breach-of-contract provisions described
later in this Bulletin.
Members of a Reserve Component of the Armed Forces
Individuals in the Reserve component of the Armed Forces or National Guard are eligible to
participate in the NSP. However, reservists should understand the following:
•
First, military training or service performed by reservists will not satisfy the NSP service
commitment. If a participant's military training and/or service, in combination with the
participant's other absences from the service site, exceed 7 weeks (28 work days) per
service year, the participant should request a suspension. See “Waiver, Suspension or
Cancellation of The Commitment. for more information. The NSP service commitment
end date will be extended to compensate for the break in NSP service.
•
Second, if the critical shortage facility where the reservist was serving at the time of
his/her deployment is unable to re-employ that reservist, the participant must transfer to
another critical shortage facility to complete his/her remaining NSP service commitment.
Any expenses associated with the participant’s transfer are wholly the responsibility of
said participant. In some cases, a participant may be asked to sign an employment
contract with the facility, which extends beyond the completion date of his/her NSP
service commitment.
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FUNDING PREFERENCES AND AWARDS
The NSP for the 2009-2010 school year is expected to be very competitive. The Program
anticipates more applicants for scholarship awards than there are funds available.
Students may want to apply for other funding sources also, due to the expected
competitiveness of the NSP.
Funding Preferences for the 2009-2010 School Year
The following funding preferences will be used to make NSP awards:
•
First funding preference will be given to qualified applicants who have a zero expected
family contribution (EFC) and are enrolled or accepted for enrollment in an accredited
undergraduate nursing program as full-time students. See the “Student Aid Report”
section of “Submitting the Application” below.
•
Second funding preference will be given to qualified applicants who have a zero EFC
and are enrolled or accepted for enrollment in an accredited graduate nursing program as
full-time students.
•
Third funding preference will be given to qualified applicants who have a zero EFC
and are enrolled or accepted for enrollment in an accredited undergraduate or graduate
nursing program as part-time students.
If funds remain available, qualified applicants who have an EFC that exceeds zero will be
grouped according to their EFC in increments of $500 from highest to lowest need (i.e.,
applicants with EFC of $1-$500, applicants with EFC of $501-$1,000, etc.). These groups will
be funded; to the extent funding remains available, in order of decreasing need. Within each
group, applicants who are enrolled or accepted for enrollment in an undergraduate nursing
program as full-time students will be funded first, applicants who are enrolled or accepted for
enrollment in a graduate nursing program as full-time students will be funded second, and the
remaining qualified part-time applicants within the eligible undergraduate or graduate nursing
program will be funded third.
If there are insufficient funds to award a contract to all qualified applicants who meet a given
funding preference, applicants will be selected randomly within that preference level until all
funds are expended. Please note that the ranking of selectees will not be disclosed.
Notification of Selection
Individuals selected for awards will be notified by e-mail, no later than September 30, 2009. To
accept the award, the selectees must respond by the deadline in the notice of award email. If the
selectee does not respond by that deadline, the offer of award expires and the award will be
offered to an alternate.
Individuals selected for an award must attend classes during the 2009-2010 school year, and
class attendance must begin on or before September 30, 2009. Individuals whose class
2009 NSP AIB
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attendance during the 2009-2010 school year will begin after September 30, 2009, MUST
decline the award.
To ensure timely receipt of NSP communications, applicants should keep their email addresses
up-to-date during the application process. Applicants must log in to their accounts on the NSP
website at www.nis.hrsa.gov to update this information.
Notification of Alternate Status
Individuals selected as alternates will be notified by e-mail no later than September 30, 2009.
Alternates will be notified of selection for an award as selectees decline their awards. Please
note that the ranking of alternates will not be disclosed.
Notification of Non-Selection
Individuals not selected for an NSP award will be notified via e-mail no later than October 30,
2009.
Declining Scholarship Support
Selectees may decline awards without penalty (permitting the promotion of alternates to selectee
status) by mailing or faxing to the NSP a signed letter declining the award offer by the deadline
date specified in the notice of award email.
Once a selectee declines the offer of award, the award will be offered to an alternate. There will
be no opportunity to reclaim the award. A decision to decline the scholarship award is final
and cannot be changed under any circumstances.
SUBMITTING THE APPLICATION
In order to be eligible for a Nursing Scholarship award, all applicants (regardless of funding
preference) must submit an electronic application no later than 5:00 p.m., ET on May 14,
2009. No extensions on the deadline will be granted. Applicants who meet the first funding
preference must complete their applications, as set forth below, by providing banking
information and supporting documentation. Applicants who do not meet the first funding
preference should complete their online applications but not submit banking information and
supporting documents at this time. Should sufficient funds be available to make awards beyond
the first funding preference, applicants will be notified and given an opportunity to complete
their applications.
Submission of Banking Information
For applicants who meet the first funding preference, banking information must be submitted
electronically through the BCRSIS by 5:00 p.m., ET on May 14, 2009. In addition, a copy of
the “BCRSIS Receipt of Submission” must be printed, and submitted with the supporting
documentation.
To submit banking information through BCRSIS and print the “BCRSIS Receipt of
Submission,” go to the following address: HTTPS://NIS.HRSA.GOV/BANKLOGIN.ASPX. If
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an applicant is unable to print a copy of the “BCRSIS Receipt of Submission,” please complete
the following 2 steps:
•
•
Contact the HRSA Call Center to log a help-ticket toll-free at 1-800-221-9393 (TTY: 1877-897-9910), Monday-Friday (except Federal Holidays), 9:00 a.m. to 5:30 p.m., E.T.
Complete the Banking Update Form which may be found at
https://www.fms.treas.gov/eft/1199a.pdf. The completed form must be received or
postmarked by May 14, 2009. Please mail the completed form to: Division of
Applications and Awards, Scholarship Branch, 5600 Fishers Lane, Room 8-37,
Rockville, MD 20857.
Only HRSA Staff can enter changes to the electronic banking information once it has been
submitted and a “BCRSIS Receipt of Submission” has been printed. If changes are required, you
must complete the Banking Update Form which may be found at
https://www.fms.trea.gov/eft/1199a.pdf and mail the completed Banking Update Form to the
Division of Applications and Awards, Scholarship Branch, 5600 Fishers Lane, Room 8-37,
Rockville, MD 20857.
Required Supporting Documentation
For applicants who meet the NSP first funding preference, all supporting documentation
described below must be postmarked by May 14, 2009.
Required supporting documentation includes:
•
•
•
•
•
•
•
•
A Verification of Acceptance/Good Standing Report and Data Collection Worksheet for
Tuition and Fees;
An Authorization to Release Information (discussed below);
A Student Aid Report (discussed below);
FORM W-4 (may be completed online, and submitted with the printed hard copy
application or mailed with supporting documentation);
A copy of your school’s 2009-2010 tuition/fees schedule or most recent fee schedule;
BCRSIS Receipt of Submission;
A Signed and Dated Contract; and
Verification of U.S. citizenship
Verification of Acceptance/Good Standing Report and Data Collection Worksheet for
Tuition and Fees - Students have the sole responsibility of ensuring that the worksheet is
submitted and provided as part of the application packet.
No applicant will receive an award until he or she is enrolled or accepted for enrollment in an
accredited nursing program during the 2009-2010 school year (applicant must begin the Fall
term on or after July 1, 2009, and no later than September 30, 2009). Applicants are required to
use the Verification of Acceptance/Good Standing Report and Data Collection Worksheet for
Tuition and Fees form (Verification Report/Data Collection Form), which is available from the
online application. The Verification Report/Data Collection Form must be completed and signed
2009 NSP AIB
14
by the applicant’s nursing program and bear the nursing school’s raised seal or school stamp if
the seal is not available. FAXES OR PHOTOCOPIES ARE NOT ACCEPTABLE. The school
identified in the Verification Report/Data Collection Form, submitted by May 14, 2009, will be
the applicant’s “initial school of record.”
PLEASE NOTE: If there are discrepancies between the information on the on-line application
and the Verification of Acceptance/Good Standing Report, that application will not be
considered for an NSP award.
Applicants who have not been accepted for enrollment in a nursing degree program and are
therefore unable to provide the Verification Report/Data Collection Form by May 14, 2009, are
not eligible. ONCE THE APPLICATION DEADLINE HAS PASSED, NO CHANGES WILL
BE ACCEPTED IN THE APPLICANT’S CHOICE OF SCHOOL OR PROGRAM PRIOR TO
AWARD. Applicants who elect to enter a different school and/or program after the application
deadline should contact the NSP immediately and withdraw their application. These individuals
would be free to reapply for scholarship support in a subsequent school year.
If the Verification Report/Data Collection Form states that there are conditions (not yet fulfilled)
for acceptance into the school and/or program, other than standard contingencies that apply to all
admitted applicants, applicants will not be eligible for consideration for an award for the 20092010 school year. All contingencies or conditions, other than standard contingencies, for
acceptance must be met and reported to the NSP, in writing, no later than May 14, 2009.
The Verification Report/Data Collection Form also collects tuition and fees data for the
applicant’s initial school of record, for each school year of the applicant’s nursing program. This
data will be used to determine the dollar value of the scholarship award for each school year
contract the applicant has requested and is eligible to receive. The data is to be filled out by the
academic institution. However, the student has the sole responsibility of ensuring that the
worksheet is submitted and provided as part of their application.
Authorization to Release Information
The Authorization to Release Information is required in order for the NSP to obtain information
about the applicant’s/participant’s school enrollment from his/her nursing school.
Student Aid Report
As explained above, a funding preference is given to students of greatest financial need. To
evaluate financial need, the NSP will use the Department of Education's Expected Family
Contribution (EFC) determination. To receive an EFC determination, applicants must submit a
Free Application for Federal Student Aid (FAFSA) to the Department of Education. See
http://www.fafsa.ed.gov. In response to the FAFSA, the Department of Education will provide
the applicant with a Student Aid Report (SAR), which will contain the EFC determination.
PLEASE NOTE: It takes a minimum of 2 weeks from the date of submission to receive an
original FAFSA. Therefore, it is recommended that you complete the FAFSA form before
completing the NSP application, or as soon as possible.
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Signed Contract
When signing the contract, applicants are encouraged to sign contracts for all years required to
complete the nursing program in which the participant is enrolled or accepted for enrollment
when applying for the scholarship. See “Continuing Support After the 2009-2010 School Year.”
SCHOLARSHIP BENEFITS
Awards Limited to 4 School Years
For applicants signing "Full-Time Student" Contracts, scholarship support will be limited to
no more than 4 school years, which includes any partial school year of funding received during
the school year. For applicants signing “Part-Time Student” Contracts, no participant will
receive scholarship benefits that total, in the aggregate, more than 4 years of full-time
scholarship support.
Defining a Participant's Academic School Year
All NSP scholarship contracts are for a specific year. The school year is defined as July 1
through the following June 30 during which an applicant is enrolled in a school. If, for example,
a student is in a 24-month program that begins on August 3, 2009, and he/she signs contracts for
2 school years, the student will receive stipend, ORC and tuition payments through June 30,
2011. Funding for the extra months of the program beyond June 30, 2011, would require a
request for a third year of scholarship funding, and if granted, obligates the recipient to 3 full
years of service commitment. If a student is in a 24-month program that begins on May 3, 2009,
and he/she signs contracts for 2 school years, the student will receive a stipend, ORC and tuition
payments from July 1, 2009, through June 30, 2011, or the month the recipient completes the
required classes for graduation, whichever comes first.
Payment of Tuition & Required Fees
Tuition and fees will be paid directly to the nursing school that the awardee is attending.
If tuition and fees for the initial Fall term of the 2009-2010 school year have been paid from
another source of financial aid (e.g. Pell Grant, state grants or other scholarships), pending notice
of an NSP award, the school may return payments to the source of funding and then submit an
invoice to the NSP for payment. After the initial fall term, if sources of financial aid, other than
NSP, have been used to pay for tuition and fees, the school will be instructed not to submit an
invoice to the NSP for these costs, but to submit documentation stating that it will not be seeking
payment for the term. However, if a balance remains, then the school may submit an invoice for
the balance remaining. Although payments of tuition and fees are made directly to the nursing
school, the student is liable for paying taxes on these amounts. See the “Taxation of the Nursing
Scholarship.”
PLEASE NOTE: The NSP will only pay tuition and fees for pre-approved summer school
sessions when summer school is an academic term normally required by the school for all
students in the same program.
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Eligible fees include:
• Academic Support Services Fee
• Administrative Fee
• Building Use or Facility Fee
• Campus Life Fee
• Computer Lab Fee
• Curriculum Fee
• Disability Insurance (Must be
required of all students regardless of
source of funding)
• Education Fee
• Graduation Fee in last year of
program
• Health Insurance (for students only)
(Must be required of all students
regardless of source of funding)
Ineligible Fees include:
• Accident Insurance
• Attorney Fee
• Automobiles and Automobile
Maintenance Expenses and Accident
Insurance
• Books (as they are covered by the Other
Reasonable Cost payment)
• Certification Boards
• Class Dues
• Counseling Fees
• Dental Insurance
• Educational Associations
• Financial Aid Trust Funds
• ID Maintenance
• Late Charges
• Life Insurance
• NCLEX Review
• Parking Fee
• Penalty Fee
• Personal Laundry
• Post Office Box Rental
• Refundable Property Deposit
• Room and Board Expenses
• Student Association and Union Fee
• Study Abroad Fees
• Testing Fee
2009 NSP AIB
•
•
•
•
•
•
•
•
Health Services Fee and
Immunizations
Laboratory Fees
Library Fee
Malpractice Insurance if it is
mandatory that it be purchased
through the school by all nursing
students
Matriculation Fee
Processing Fee
Recreation Fee
Student Activities Fee
Student Services Fee
Technology Fee
University Fee
•
•
Transportation Fee
Yearbook
•
•
•
17
The NSP will not pay for tuition costs unrelated to the degree program, penalty fees for over
extension of a distance learning program, membership dues for student societies or associations,
loan processing fees, and similar expenses. Also, the NSP will pay ONLY for courses that are
required for graduation. Elective courses not required for graduation are not eligible for
payment. If an applicant is unsure of what is covered by the Nursing Scholarship, please send a
written request for further clarification to HRSA Call Center – NSP, 12530 Parklawn Drive,
Suite 350, Rockville, Maryland 20852.
Please be advised that under the Debt Collection Improvement Act of 1996, all Federal
payments must be processed through Electronic Funds Transfer/ Direct Deposit. Therefore,
all educational institutions must have an electronic funds transfer account which will allow
the Division of Financial Operations (DFO), Program Support Center, Department of Health
and Human Services to make electronic payments for tuition and fees in a timely manner.
Receipt of a Nursing Scholarship award does not automatically preclude a participant from
receiving funds from other programs, as long as no service commitment is involved. However,
many student assistance programs are based on the student's financial need, or may be limited to
the payment of expenses already paid by the NSP. The list of NSP recipients supplied to the
schools will enable the school officials to reevaluate the financial need or eligibility of these
individuals for funds under other aid programs. When continuation of financial assistance under
other programs is not warranted, the school is required to reduce or terminate payments.
Applicants should contact their financial aid officers to determine how the receipt of a Nursing
Scholarship may affect them.
Other Reasonable Costs (ORC)
Financial support will be provided to each participant of the NSP for other reasonable
educational expenses or costs (ORC) incurred by the student. A standardized ORC payment is
established for a full school year, for a full-time student. The ORC payment will be reduced
proportionately for students who plan to attend less than a full school year (e.g., December
graduates). For part-time students, if funded, the ORC payment will be proportionally reduced.
The ORC payment is provided to assist in the payment of the following types of expense:
•
•
•
•
•
•
•
Books
Clinical supplies
Instruments
Insurance (Life or Health Insurance)
School ID Cards/ID Fees
Travel
Uniforms
The ORC payment will be included in the October stipend payment, which should be received by
November 7.
Stipend Amount
During the 2009-2010 school year, the NSP will pay a full-time student a monthly amount of
$1,269.00 (before Federal taxes). If funded, a part-time student would receive a proportional
stipend amount. The first payment for new awardees should be received by November 7 and
will include stipend payments retroactive to July 1 and payment for Other Reasonable Costs.
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Receipt of the stipend payment does not mean that the student is employed by the Federal
Government or participates in any of the benefits available to Federal employees.
Changes in Schools/Programs
Changes in schools or nursing programs are strongly discouraged once the applicant has been
accepted into the NSP. Changes in schools/programs must be approved, in advance by the
Program, to ensure continued eligibility for funding. Funding will be based on the initial school
of record for all school year contracts executed during Fiscal Year 2009. For example, if the
2009-2010 tuition of the initial school of record is $10,000 and the tuition of the proposed
transfer school is $15,000, then the NSP may not have the additional funding of $5,000 to pay
the scholar’s full tuition at the proposed transfer school. Therefore, students should carefully
consider the financial implications of school/program transfers.
Taxation of the Nursing Scholarship
All NSP payments made to scholars, or on their behalf to nursing schools, are taxable (26 USC
117(c)). Although payments of tuition and fees are made directly to the nursing school, the
student is liable for taxes owed on these amounts. The NSP withholds Federal income taxes
from the stipend payments and ORC based on the entire amount of the NSP award (tuition, fees,
ORC and stipends) and information provided on the W-4 by the scholar. Students who want
additional funds deducted from the stipend amount should indicate the additional amount to be
deducted on the appropriate line on the W-4 form and please include the hard copy of the W-4
form with the supporting documentation. We advise students to consult their local tax authority
regarding State or local taxes for which they may be liable, as State and local income taxes will
not be withheld. It is the responsibility of the scholarship recipient to arrange for the payment of
any additional Federal, State, and local taxes that may be owed. Each year, students will receive
a 1099 tax form for amounts paid for tuition and fees and a W-2 tax form for amounts paid for
stipend and ORC.
Treasury Offset Program
Under the Treasury Offset Program, the Treasury Department is authorized to offset a student's
Nursing Scholarship payments, if the student is delinquent on a Federal debt. In addition, the
Treasury Department is authorized to offset Nursing Scholarship payments for application to the
student's State debts, including delinquent child support payments.
Non-Delinquency of Child Support Order
In keeping with the President's Executive Orders concerning compliance with child support
orders, the NSP stresses the importance of honoring any child support obligations the applicant
may have. Federal payments to a participant may be offset due to delinquencies in court-ordered
child support payments.
Termination of Contract
The Secretary of Health and Human Services or his/her designee may terminate a NSP Contract
for a school year if the recipient, on or before June 1 of the school year: 1) submits a written
request to terminate his or her contract for that school year; and 2) repays all amounts paid to, or
on behalf of, that recipient for that school year. If a scholarship recipient does not meet these
requirements, he or she will incur a service commitment for the full or partial year of support
received, as set forth in the "Fulfilling the Service Commitment" Section of this Bulletin.
Discontinuation of Benefits
The NSP will discontinue the payment of all benefits under the following circumstances:
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1) While the recipient is on a leave of absence (for personal, medical or other reasons) which
has been approved by the school;
2) While the recipient is repeating course work for which the NSP has already paid [Exception:
If the student's repeat course work is in addition to new course work and the new course
work (excluding the repeated courses) is of sufficient credit hours to meet the definition of
full-time student (for participants who signed "Full-Time Student" Contracts) (or the
definition of part-time student for participants who sign “Part-Time Student” Contracts), then
payment of the monthly stipend will continue, but the NSP will not pay for the course work
being repeated;
3) If the recipient withdraws or is dismissed from school. Moreover, the recipient's withdrawal
or dismissal from school is also a breach of the scholarship contract, and the recipient will be
liable to repay the amount described in the "Defaulting on the Scholarship Commitment –
Breach of Contract" section of this Bulletin
4) If the recipient is enrolled as a less than full-time student (for participants who signed "FullTime Student" Contracts) or as a less than part-time student (for students who sign “Part-time
Student” Contracts). This includes participants who voluntarily withdraw from courses
during a semester/quarter and no longer meet the definition of a full-time or part-time student
under their applicable Contract;
5) If the recipient transfers to an ineligible school or program or did not get prior approval from
the program, the result may be a discontinuation of benefits and possible default. Prior to
any transfer, it is the recipient’s responsibility to contact the NSP in writing at the Division of
Scholar and Clinician Support, 5600 Fishers Lane, 8A-15, Rockville, Maryland 20857 to
determine his or her eligibility and to receive approval to continue to receive benefits at the
new school/program.
A recipient is required to notify the Division of Scholar and Clinician Support promptly, by
phone and in writing, as soon as one of the following events is anticipated:
• repeat course work;
• a change in the applicant's graduation date;
• a leave of absence approved by the school;
• withdrawal or dismissal from school;
• a change from full-time student status to a less than full-time student status for
participants who sign “Full-Time Student” Contracts (a change from part-time student
status to less than part-time student status for participants who sign “Part-time
Student” Contracts);
• voluntary withdrawal from courses during an academic term; or
• a transfer to another school or program.
The NSP needs to know in advance that the above events may occur, so that timely action can be
taken to discontinue or decrease payments (and avoid overpayments), where applicable. The
recipient must also submit a letter from the school verifying that one of these events has occurred
to the:
Division of Scholar and Clinician Support
5600 Fishers Lane, 8-15
Rockville, Maryland 20857
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Please be advised that if the NSP has any questions concerning a participant's eligibility for
continued support, the NSP may delay the payment of all benefits to that participant
pending clarification of the participant's eligibility status.
Collection of Benefit Overpayments
Scholarship Program payment(s) received by a recipient, including payment(s) made to a school
on the recipient's behalf, during the periods while the recipient is on an approved leave of
absence, is repeating course work, or is otherwise ineligible to receive payments, are considered
overpayments. Overpayments may also occur due to administrative error. A participant
receiving an overpayment should immediately telephone the Scholarship Support Branch and
follow up in writing to make arrangements to promptly return all overpayment(s) to avoid
interest accrual and debt collection procedures.
Debt collection procedures include sending delinquent overpayments to a debt collection agency,
reporting the overpayments to credit reporting agencies, offsetting Federal and/or State payments
due to the participant (e.g., IRS income tax refund) to collect the overpayments, recovery
through Administrative Wage Garnishment, and referral of the overpayments to the Department
of Justice for enforced collection. For scholars who receive subsequent funding under the NSP
and who previously received any overpayments which have not been repaid, the overpayments
will be collected through administrative offset. The NSP will withhold scholarship funds payable
to, or on behalf of, the recipient (including stipends, ORC, and, if necessary, tuition payments)
until the overpayment owed is paid in full. Administrative offset is not a repayment option for
scholars who wish to terminate a contract.
Resumption of Benefits
To resume benefits under existing scholarship contracts, the recipient must submit
documentation from a school official confirming that he/she is now eligible to receive
scholarship support (e.g., is no longer repeating course work, has returned from a leave of
absence, has resumed full-time student status, and the transfer school/program is eligible).
Requests for the resumption of scholarship benefits will be considered on a case-by-case basis by
the designee of the Secretary of the Health and Human Services, to determine the recipient's
eligibility to restart funding. For recipients who have not repaid overpayments previously
received, the resumption of scholarship benefits will be subject to the administrative offset
described in the "Collection of Benefit Overpayments" section of this Bulletin. For recipients
whose benefits were discontinued due to their withdrawal or dismissal from school or due to
their transfer to an ineligible program or school, benefits will not be resumed.
Effect on Veterans Benefits
Educational benefits from the Department of Veterans Affairs (G.I. Bill) continue along with
NSP funds, since these benefits were earned by prior active duty in a uniformed service.
Continuing Support after the 2009-2010 School Year
The NSP award and contract will be for the 2009-2010 school year and additional school years
(Optional Contracts) requested by the applicant and agreed to by the Secretary of Health and
Human Services or his/her designee as indicated on the signed contracts. Support will be paid
for the years agreed to in the contracts, based on the costs of the initial school of record, provided
the student remains eligible to receive NSP support.
If a student signs a contract for only one (1) year of support (2009-2010 school year), his/her
scholarship support will be terminated at the end of the 2009-2010 school year (on June 30,
2010). Should the student subsequently decide that he/she would like additional scholarship
2009 NSP AIB
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support for the next school year (2010-2011) and any subsequent school years through
graduation, the student must submit a new Verification Report/Data Collection Form and a
signed contract for that school year and, if desired, Optional Contracts for subsequent school
years through graduation-subject to the 4 year limit on school years of scholarship support.
Awards limited to 4 school years. "Awards Limited to 4 School Years” in this Bulletin.
Please be advised that since a recipient will incur a 2-year service commitment for one (1)
school year of support, it may be in the best interest of the student to sign contracts for 2
years of support, if the student will need scholarship support for all or part of the 20102011 school year. The Verification Report/Data Collection Form and the signed contract(s) must
be received by no later than May 7 of the year in which support would be continued.
The granting of continuation awards depends upon the:
1) availability of funds for the NSP;
2) current or former participant's continued eligibility to participate in the NSP (good academic
standing, not repeating coursework, etc.). Please be advised that a credit check will be
conducted as part of the eligibility process;
3) limitations set forth in "Awards Limited to 4 School Years" in this Bulletin;
4) current or former participant's compliance with procedures established by the NSP for
requesting continued support; and
5) participant’s past compliance with program policies and requirements. Participants who are
requesting continued support must be able to financially support themselves until the
scholarship benefits payment schedule can be reinstated.
FULFILLING THE SERVICE COMMITMENT
Years of Service Owed
Participants who sign "Full-Time Student" Contracts incur one (1) year of full-time obligated
service for each full or partial school year of support received, with a minimum 2-year full-time
service obligation. For example, a student who receives a full year of support (12 months) the
first school year, a partial year of support (6 months) the second school year, and a full year of
support the third school year will owe the equivalent of 3 years of full-time clinical service.
Participants who sign “Part-Time Student” Contracts incur a 2-year service obligation or the
part-time equivalent of one year for each school year the participant receives a scholarship,
whichever is greater.
Full-Time or Part-Time Clinical Service
Participants may satisfy their service obligations on either a full-time or part-time basis:
•
Full-time clinical practice is defined as a minimum of 32 hours per week for a minimum
of 45 weeks per year. At least 26 hours per week must be spent providing clinical
services to patients.
•
Part-time clinical practice is defined as a minimum of 16 hours per week and up to a
maximum of 31 hours per week, for a minimum of 45 weeks per year. At least 80% of
the hours each week must be spent providing clinical services to patients. (For example, a
nurse scheduled to work 20 hours per week must spend at least 16 hours per week
providing clinical services).
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No more than 7 weeks (28 work days) per service year can be spent away from the approved
practice site for vacation, holidays, continuing education, illness, maternity, or any other reason.
For consecutive periods of absences greater than 7 weeks in a 52-week service year, the
participant should request a suspension. See “Waiver, Suspension, or Cancellation of the
Commitment.” A break in service will extend the service obligation end date.
Participants wishing to serve part-time must obtain approval from the NSP and must agree to
extend their service obligation so that the aggregate amount of service performed will equal the
amount of a full-time service obligation. See “Ending Date of Obligated Service" below for an
explanation of how the length of the part-time service obligation is determined. Requests to
pursue part-time service at less than 16 hours per week will not be approved.
NSP Service Sites
NSP participants must provide full-time or part-time clinical service in a health care facility with
a critical shortage of nurses located in a State. By statute, eligible health care facilities include:
A)
B)
C)
D)
E)
F)
G)
H)
I)
J)
K)
Ambulatory Surgical Centers;
Federally Qualified Health Centers (including Look Alike Health Centers);
Home Health Agencies;
Hospice Programs;
Hospitals;
Indian Health Service Health Centers;
Native Hawaiian Health Centers;
Nursing Homes;
Rural Health Clinics;
Skilled Nursing Facilities; and
State or local Public Health Departments including Public Health Clinics within the
Departments
See glossary for definitions of State and health care facility types set forth above.
Ineligible sites include but are not limited to:
A)
B)
C)
D)
Assisted Living Facilities.
Free Standing Clinics that do not qualify as one of the above critical shortage facilities;
Private Practice Offices; and
Renal Dialysis Centers.
Service Placement Process
Recipients will have up to 6 months from their date of graduation to: 1) obtain a nursing license
and 2) accept an offer of employment from an NSP-approved facility. Recipients will have up to
3 months following the date of the acceptance of such job offer to commence full-time (or if
approved, part-time) clinical services at the facility.
Recipients should contact the Scholar Support Branch of the Division of Scholar and Clinician
Support at 1-800-221-9393 prior to accepting employment to assure facility/position eligibility.
The NSP reserves the right to grant final approval of all service locations, in order to insure a
scholar's compliance with statutory requirements related to the service obligation. Once
employment begins, scholars are required to submit an initial Employment Certification Form
and submit a employment verification form every 6 months thereafter until the service obligation
is completed.
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Recipients who fail to accept an offer of employment from an NSP-approved eligible facility
within 6 months of their date of graduation, or who fail to start service within 3 months of the
date of their acceptance of such offer of employment, may be recommended for default of their
service obligation. Recipients, who default on their NSP service obligation, incur the damages
described below in the "Defaulting on the Scholarship Commitment – Breach of Contract"
section.
Licensure/Certification Required
Prior to commencing service, a scholarship recipient must be permanently licensed to practice
as a registered nurse (or if appropriate, as an advanced practice nurse) in the State where
he/she will be serving. Credit towards fulfillment of the scholarship commitment will not be
given in the absence of a current, unencumbered permanent license in the State of service. In
addition, advanced practice nurses are expected to pass a national certification examination for
their specialty (that is administered by a nationally recognized certifying body) prior to
commencing service. No service credit will be given until the Division of Scholar and Clinician
Support at 5600 Fishers Lane, 8-15, Rockville, Maryland 20857 has received documentation that
all licensure and certification requirements have been met.
Responsibility for obtaining the required State license (and national certification exam, if
applicable) prior to the service start date rests with the scholarship recipient. Scholars are
expected to take the appropriate licensure/certification exams at the earliest possible date. If the
recipient is unsuccessful in obtaining a license or passing the certification exams within 6 months
of his or her graduation date, the recipient should immediately contact the Scholar Support
Branch of the Division of Scholar and Clinician Support, in writing, at 5600 Fishers Lane, 8-15,
Rockville, Maryland 20857 to request a suspension. See "Waiver, Suspension or Cancellation of
the Commitment" section in this Bulletin.
Beginning Date of Service Commitment
Nurses must begin their service at an NSP-approved eligible facility within 3 months of the date
of their acceptance of employment at that facility and within 9 months from the date of
graduation. The recipient and an authorized representative of the NSP-approved facility should
negotiate a start date within this timeframe.
Credit for service toward the nursing scholarship commitment does not begin until: (1) the
scholar has submitted documentation demonstrating that the scholar has met the
license/certification requirements; and (2) the NSP receives documentation that the scholar
begins to provide full-time (or part-time, if approved) clinical services at a NSP-approved
eligible facility/position.
Delaying Start of Service
Recipients with documented, extreme circumstances which jeopardize the start of service may
request to suspend their service commitments for up to one (1) year. Such requests must be sent
in writing to the Scholar Support Branch of the Division of Scholar and Clinician Support at
5600 Fishers Lane 8-15, Rockville, Maryland 20857 See "Waiver, Suspension or Cancellation
of the Commitment" section in this Bulletin(.
Ending Date of Obligated Service
For scholars serving on a full-time basis, the last day of the service commitment is calculated by
counting the number of days of full-time service owed from the service start date. For example,
the last day of service for a recipient with a 3-year service commitment who began service on
July 15, 2009, would be July 14, 2012.
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Scholars serving on a part-time basis must agree to extend their service obligations so that the
aggregate amount of the part-time service performed will equal the amount of their full-time
service obligation. For scholars serving on a part-time basis, the length of their service
commitment will be determined by dividing 100 by the minimum percentage of the full-time
obligation being served and then multiplying that amount by the number of days of full-time
service owed. For example, a nursing student owes 2 years (730 days) of full-time service and
has signed an employment contract to work a minimum of 20 hours per week. Twenty hours per
week represents 62.5% of the full-time service obligation (20/32 = .625 or 62.5 percent).
Dividing 100 by 62.5 equals 1.6, and 1.6 multiplied by 730 equals 1,168. Thus, this scholar
would owe 1,168 days of part-time service, and the service end date would be 1,168 days from
the service start date.
Adjustments to the ending date may be made by the Division of Scholar and Clinician Support if
the scholar takes more than the allowable time away from the site (see "Full-Time or Part-Time
Clinical Service") section and if the service is suspended, interrupted, or otherwise delayed.
Leaving the Service Site (Changing Jobs)
Participants are expected to complete their service obligation at their initial service site. Should
participants be unable to complete their obligation at their initial NSP service site, they must
continue their service at another NSP-approved service site. When a break in service occurs, the
participant’s service end date will be extended.
When a participant desires a transfer, a written request must be submitted to the Division of
Scholar and Clinician Support (DSCS) at 5600 Fishers Lane 8A-15, Rockville, Maryland 20857
for approval. A transfer request should be submitted before the participant leaves his or her
current service site. All transfer sites must be approved by the NSP. Leaving the assigned
site without prior written approval by the DSCS may result in a default recommendation.
DEFAULTING ON THE SCHOLARSHIP COMMITMENT: BREACH OF CONTRACT
If a participant:
1) fails to maintain an acceptable level of academic standing in the nursing program;
2) is dismissed from the nursing program for disciplinary reasons;
3) voluntarily terminates the nursing program; or
4) fails to provide health services in an NSP service site for the applicable period of time as
specified in his or her NSP contract;
then the participant will be liable to the Federal Government to:
5) repay all funds paid to the participant, or on the participant’s behalf, under the NSP and;
6) pay interest on such amounts at the maximum legal prevailing rate from the date of
default.
The amount owed, including interest, must be paid within 3 years of the date of the participant's
default.
Delinquent Debt
Failure to repay the NSP debt within 3 years has the following consequences:
1) The debt will be reported to credit reporting agencies. — During the three-year
repayment period, the debt will be reported to credit reporting agencies as “current.” If the
debt becomes past due, it will be reported as “delinquent.”
2) The debt will be referred to a debt collection agency and the Department of Justice. —
Any NSP debt past due for 45 days may be referred to a debt collection agency. If the debt
collection agency is unsuccessful in receiving payment in full, the debt may be referred to the
2009 NSP AIB
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U.S. Department of Justice for enforced collection.
3) Administrative offset — Federal and/or State payments due to the participant (e.g., an IRS
income tax refund) may be offset by the U.S. Department of Treasury to repay a delinquent
NSP debt. Also, recovery through Administrative Wage Garnishment may be enforced to
repay a delinquent NSP debt.
4) Medicare/Medicaid Exclusion. — Delinquent defaulters who are unwilling to enter into, or
stay in compliance with, an agreement to repay their scholarship debt can be excluded from
participation in Medicare, Medicaid and other Federal health care programs. See section
1128 of the Social Security Act.
WAIVER, SUSPENSION OR CANCELLATION OF THE SERVICE OBLIGATION
Scholarship recipients seeking a waiver (for a permanent situation) or suspension (for a
temporary situation) of the service obligation must submit a written request to the Scholar
Support Branch of the Division of Scholar and Clinician Support (DSCS) at 5600 Fishers Lane,
Room 8A-15, Rockville, Maryland 20857. The request must state the underlying circumstances
and be supported by documentation.
Requests for waivers and suspensions are processed and reviewed by the Legal and Compliance
Office (LCO). Waivers (or suspensions) of the service obligation may be granted by the LCO,
whenever compliance by the individual would be impossible (or temporarily impossible), or
would involve extreme hardship (or temporary extreme hardship) to the individual and
would be against equity and good conscience to enforce.
Compliance would be considered impossible if the LCO, determines that the participant suffers
from a physical or mental disability resulting in his/her inability to perform the commitment
incurred.
To determine whether performance of the obligation would impose an extreme hardship and be
against equity and good conscience, the LCO, will consider: (1) the recipient's present financial
resources and obligations; (2) the recipient's estimated future financial resources and obligations;
and (3) the extent to which the recipient has problems of a personal nature, such as physical or
mental disability, or terminal illness in the immediate family, which so intrude on the recipient's
present and future ability to perform as to raise a presumption that the individual would be
unable to perform the obligation incurred.
In the unfortunate event of a scholarship recipient's death, any commitment to the NSP is
canceled upon submission of documentation to the Division of Scholar and Clinician
Support.
2009 NSP AIB
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DEADLINE
All applicants, regardless of funding preference, must submit an online application by 5:00 p.m.,
ET on May 14, 2009. Applications completed online are considered formally submitted when
the applicant electronically submits the application to BCRS.
For applicants meeting the first funding preference, the BCRSIS banking information must be
submitted online by 5:00 p.m., ET on May 14, 2009, and all required supporting documentation
must be postmarked by May 14, 2009. Supporting documentation should be mailed to:
Nursing Scholarship Program
c/o HRSA Call Center
12530 Parklawn Drive, Suite 350
Rockville, MD 20852
It is incumbent on the applicant to ensure that the applicable deadlines are met. For applicants
meeting the first funding preference, BCRS will not consider additional information and/or
materials submitted after the deadline and will not accept the resubmission of incomplete,
rejected or otherwise incomplete applications after the deadline.
POWER-OF-ATTORNEY
If you are submitting and executing an application on behalf of another person, it is mandatory
that a copy of the agreement granting you Power-of-Attorney to act for the applicant be
submitted with the application materials.
2009 NSP AIB
27
SECTION II. GLOSSARY OF TERMS
CONTRACT - A written contract under Section 846(d) of the Public Health Service Act, as
amended, for a school year pursuant to which (1) the individual agrees to serve as a nurse for a
period of not less than 2 years at a health care facility with a critical shortage of nurses and (2)
the Federal government agrees to provide the individual with a scholarship, for attendance at a
school of nursing during that school year.
FULL-TIME CLINICAL PRACTICE - Full-time clinical practice is defined as a minimum of
32 hours per week for a minimum of 45 weeks per year. At least 26 hours per week must be
spent providing clinical services to patients. No more than 7 weeks (28 work days) per service
year can be spent away from the approved practice site for vacation, holidays, continuing
education, illness, maternity, or any other reason. Absences of greater than 7 weeks in a 52week service year will extend the service obligation end date.
FULL-TIME STUDENT - A student will be considered full-time if the student meets the
nursing school program's definition of a full-time student.
FUNDING PREFERENCE - Funding preference is defined as the funding of a specific
category or group of approved applicants ahead of other categories or groups of approved
applicants.
HEALTH CARE FACILITY - A health care facility is one of the following:
A) Indian Health Service Health Center - A health care facility (whether operated
directly by the Indian Health Service or operated by a tribe or tribal organization,
contractor or grantee under the Indian Self-Determination Act, as described in 42 Code
of Federal Regulations (CFR) Part 136, Subparts C and H, or by an urban Indian
organization receiving funds under Title V of the Indian Health Care Improvement
Act), which is physically separated from a hospital, and which provides clinical
treatment services on an outpatient basis to persons of Indian or Alaskan Native descent
as described in 42 CFR Section 136.12.
B) Native Hawaiian Health Center - An entity (a) which is organized under the laws of
the State of Hawaii; (b) which provides or arranges for health care services through
practitioners licensed by the State of Hawaii, where licensure requirements are
applicable; (c) which is a public or nonprofit private entity; and (d) in which Native
Hawaiian health practitioners significantly participate in the planning, management,
monitoring, and evaluation of health services. See the Native Hawaiian Health Care
Act of 1988 (P.L. 100-579), as amended by P.L. 102-396.
C) Hospital - Any public or nonprofit private or for profit private entity in a State that is
primarily engaged in providing, by or under the supervision of physicians, to inpatients
(a) diagnostic services and therapeutic services for medical diagnosis, treatment, and
care of injured, disabled, or sick persons, or (b) rehabilitation of injured, disabled, or
sick persons. Hospital-based outpatient services are included under this definition.
D) Federally Qualified Health Center - An entity receiving a grant, or funding from a
grant, or meets the requirements for receiving (but does not receive) a grant under
section 330of the Public Health Service Act, as amended, to provide primary health
services and other related services to a population that is medically underserved.
2009 NSP AIB
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FQHCs include Community Health Centers, Migrant Health Centers, Health Care for
the Homeless Health Centers, Public Housing Primary Health Care Centers and FQHC
Look-Alikes.
E) Rural Health Clinic - An entity which the Centers for Medicare and Medicaid
Services has certified as a rural health clinic under section 1861(aa)(2) of the Social
Security Act. A rural health clinic provides outpatient services to a non-urban area with
an insufficient number of health care practitioners.
F) Nursing Home - An institution (or a distinct part of an institution), certified under
section 1919(a) of the Social Security Act, which is primarily engaged in providing, on
a regular basis, health-related care and service to individuals who because of their
mental or physical condition require care and service (above the level of room and
board) which can be made available to them only through institutional facilities, and is
not primarily for the care and treatment of mental diseases.
G) Home Health Agency - A public agency or private organization, certified under
section 1861(o) of the Social Security Act, which is primarily engaged in providing
skilled nursing care and other therapeutic services.
H) Hospice Program - A public agency or private organization, certified under section
1861(dd)(2) of the Social Security Act, which provides 24-hour care and treatment
services (as needed) to terminally ill individuals and their families. This care is
provided in individuals' homes, on an outpatient basis, and on a short-term inpatient
basis, directly or under arrangements made by the agency or organization.
I) State or Local Public Health Department including a Public Health Clinic within
the Departments - The State, county, parish or district entity in a State that is
responsible for providing population focused health services which include health
promotion, disease prevention and intervention services provided in clinics that are
operated by the health department.
J) Skilled Nursing Facility - An institution (or a distinct part of an institution), certified
under section 1819(a) of the Social Security Act, which is primarily engaged in
providing skilled nursing care and related services to residents requiring medical,
rehabilitation or nursing care and is not primary for the care and treatment of mental
diseases.
K) Ambulatory Surgical Center - An entity in a State that provides surgical services to
individuals on an outpatient basis and is not owned or operated by a hospital.
LEAVE OF ABSENCE - A period of approved absence from a course of study granted to a
student by his or her nursing school for medical, personal, and other reasons. The leave of
absence is usually granted for a period of 1 year or less. When a leave of absence is expected, a
scholar is required to notify the Division of Scholar and Clinician Support, Scholar Support
Branch immediately, in writing, and submit a letter from the school approving the leave of
absence and indicating the start and end dates for the period of the absence. Payment of all
2009 NSP AIB
29
benefits is discontinued when a scholar is on an approved leave of absence, and may be resumed
when the student returns to the course of study for which the scholarship was awarded.
PART-TIME CLINICAL PRACTICE - Part-time clinical practice is defined as a minimum of
16 hours per week and up to a maximum of 31 hours per week, for a minimum of 45 weeks per
year. At least 80% of the hours each week must be spent providing clinical services to patients.
No more than 7 weeks (28 work days) per service year can be spent away from the approved
practice site for vacation, holidays, continuing education, illness, maternity, or any other reason.
Absences of greater than 7 weeks in a 52-week service year will extend the service obligation
end date.
PART-TIME STUDENT - A less than full-time student will be considered part-time if the
student is enrolled on at least a half-time basis (i.e., the student is taking a sufficient number of
credit hours to meet or exceed 50% of the credit hours required by the nursing school program to
be a full-time student).
QUALIFIED APPLICANT - A person who meets all of the eligibility requirements set forth in
this Applicant Information Bulletin.
SCHOOL OF NURSING - The term 'school of nursing' means an accredited collegiate,
associate degree, or diploma school of nursing in a State.
SCHOOL YEAR
All NSP scholarship contracts are for a specific year. Under the NSP, all school years run from
July 1 through June 30. If, for example, a student is in a 24-month program that begins on
August 3, 2009, and he/she signs contracts for 2 school years, the student will receive stipend,
ORC and tuition payments through June 30, 2011. Funding for the extra months of the program
beyond June 30, 2011, would require a request for a third year of scholarship funding, and if
granted, obligates the recipient to 3 full years of service commitment. If a student is in a 24month program that begins on May 3, 2009, and he/she signs contracts for 2 school years, the
student will receive a stipend, ORC and tuition payments from July 1, 2009, through June 30,
2011, or the month the recipient completes the required classes for graduation, whichever comes
first.
STATE - Includes the 50 States, the District of Columbia, the Commonwealth of Puerto Rico,
the Commonwealth of the Northern Marianas, the U.S. Virgin Islands, the Territory of Guam,
the Territory of American Samoa, the Republic of Palau, the Republic of the Marshall Islands,
and the Federated States of Micronesia.
SUSPENSION - Is a temporary status. The basis for a suspension would be a medical condition
or a personal situation that: 1) would make it temporarily impossible to continue the service
commitment or payment of the monetary debt, or 2) would temporarily involve an extreme
hardship to the individual and enforcement of the service or payment commitment would be
against equity and good conscience. All requests for a suspension must be submitted, in writing,
to the Division of Scholar and Clinician Support and be supported by full medical and/or
financial documentation.
2009 NSP AIB
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THE SECRETARY - The Secretary of Health and Human Services, and any other officer or
employee of the U.S. Department of Health and Human Services to whom the authority to
administer the NSP has been delegated.
UNDERGRADUATE NURSING PROGRAM – Any school of nursing program in which the
student will receive a Diploma, Associate, or Baccalaureate degree (see a description of these
programs in Section 1 “Applicant Eligibility.”
GRADUATE NURSING PROGRAM – Any department, division, or other administrative unit
in a college or university which provides primarily or exclusively a program of education in
professional nursing and related subjects leading to a graduate degree in nursing, or to an
equivalent degree, and including advanced training related to such program of education
provided by such school, but only if such program, or such unit, college of university is
accredited.
UNENCUMBERED LICENSE – A license is unencumbered if it is not revoked, suspended, or
made probationary or conditional by a licensing or registering authority in the applicable
jurisdiction as the result of disciplinary action.
WAIVER - Is a permanent status. The basis for a waiver would be a permanent medical
condition or personal situation that: 1) would make it impossible for the individual to serve the
commitment or pay the debt, or 2) would involve an extreme hardship to the individual and
enforcement of the service of payment commitment would be against equity and good
conscience. All requests for a waiver must be submitted in writing to the Division of Scholar and
Clinician Support and be supported by full medical and financial documentation.
2009 NSP AIB
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SECTION III. SUMMARY OF IMPORTANT DEADLINES
ACTIVITIES
Submit NSP Application Online
IMPORTANT DEADLINES
May 14, 2009 at 5:00 p.m. ET
(All applicants)
Submit and Print Receipt - BCRSIS Online Banking Form
May 14, 2009 at 5:00 p.m. ET
(First funding preference applicants only)
Submit All Supporting Documents (see Checklist)
(First funding preference applicants only)
Postmarked by May 14, 2009
Notify applicant of award
September 30, 2009
Notify applicant of selection as alternate
September 30, 2009
Notify applicant of non-selection for a scholarship award
2009 NSP AIB
October 30, 2009
32
SECTION IV. SUPPORTING DOCUMENTS
For first funding preference applicants, all the supporting documents described in this Bulletin,
except as noted on the Checklist (Banking Information), must be mailed to:
Nursing Scholarship Program
c/o HRSA Call Center
12530 Parklawn Drive, Suite 350
Rockville, MD 20852
and must be postmarked by the May 14, 2009 application deadline. Samples of the referenced
forms follow.
All questions should be directed to the HRSA Call Center at: [email protected] or phone 1800-221-9393, weekdays 9:00 a.m. to 5:30 p.m. ET.
If sufficient funds are available to make awards beyond the first funding preference, additional
applicants will be notified and given an opportunity to provide the supporting documentation.
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33
NSP CHECKLIST FOR COMPLETING THE APPLICATION
The first item listed below must be completed by all applicants, regardless of funding preference.
The remaining items must be submitted only by first funding preference applicants. Except as
otherwise noted below, the documents must be received by the NSP or be postmarked by the
May 14, 2009, deadline.
1.
Online Application (submitted electronically by 5:00 p.m. ET on May 14, 2009)- Be sure to submit your
application by the due date.
2.
Scholarship contract - Signed in ink, and dated. Sign on each line for each school year you are requesting
support.
3.
Authorization to Release Information Letter - Be sure to complete and sign the authorization letter.
4.
Verification of Acceptance/Good Standing Report and Data Collection Worksheet – Must be
completed by school official and include school seal or stamp. If there are contingencies to acceptance
noted on the Verification of Acceptance/Good Standing Report, documentation that the contingencies have
been met must be provided.
5.
Proof of Citizenship - Each applicant is required to submit evidence of your U.S. citizenship or status as a
U.S. National (e.g., a copy of a birth certificate, a certificate of citizenship, passport or naturalization
certificate).
6.
Online BCRSIS Banking Information - (submitted electronically by 5:00 p.m. ET on May 14,, 2009).
Submit banking information electronically through BCRSIS.
7.
BCRSIS Receipt of Submission – Be sure to print a copy of the completed “BCRSIS Receipt of
Submission” by 5:00 p.m. ET and submit with supporting documents. If you are unable to print a copy of
the “BCRSIS Receipt of Submission”, please complete the following 2 steps: (1) Contact the HRSA Call
Center to log a help-ticket toll-free at 1-800-221-9393 (TTY: 1-877-897-9910), Monday-Friday (except
Federal Holidays), 9:00 a.m. to 5:30 p.m. ET; and (2) Complete the Banking Update Form found at
https://www.fms.treas.gov/eft/1199a.pdf. The completed form must be received or postmarked by May 14,
2009. Please mail the completed form to: Division of Applications and Awards, Scholarship Branch, 5600
Fishers Lane, Room 8-37, Rockville, MD 20857.
8.
Power-of-Attorney - This document must be submitted if you are submitting an application on behalf of
another person.
9.
Tuition and Fees Schedule for 2009-2010 School Year - A copy of your school’s 2009-2010 tuition/fees
schedule or most recent tuition/fees schedule.
10.
Student Aid Report (SAR) – This is obtained when you submit the Department of Education’s Free
Application for Federal Student Aid (FAFSA). Please note that it takes a minimum of 2 weeks to receive
the official SAR.
11.
Form W-4 – Completed and submitted for appropriate tax deductions by 5:00 p.m. ET on May 14, 2009,
and a copy of the Form W-4 must be received or postmarked by May 14, 2009.
12.
Letter, on business letterhead, from entity to which existing service obligation is owed (if applicable)
indicating the date the service obligation will be complete.
13.
Certification Regarding Debarment, Suspension, Disqualification and Related Matters Form
2009 NSP AIB
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NURSING SCHOLARSHIP PROGRAM
VERIFICATION OF ACCEPTANCE/GOOD STANDING REPORT
DATA COLLECTION WORKSHEET FOR TUITION AND FEES
(For School Use Only)
Date: ________________
This Verification of Acceptance/Good Standing Report certifies that the student identified below has been
accepted for admission in the school of nursing and is enrolled in good standing for the 2009-2010 school year
as indicated.
1.
Name of Student: ______________________________________________________
2.
Student’s Social Security Number: ________________________________________
3.
Nursing Program in which student is accepted/enrolled:
Associate
Diploma
Baccalaureate
Masters
Doctoral
Yes
No
4.
Length of Full-Time Nursing Program (Years Only): _______
5.
Is the student considered Full-Time in the nursing program?
6.
Check year in which the student will be/is enrolled in the nursing program for the 2009-2010 Fall term:
1
st
2
nd
3
4
rd
th
7.
Enter the month and year the applicant first entered or will enter the program for which funding is being
requested. ____ Month
____Year
8.
Date classes start for the Fall Term for 2009-2010 school year:
9.
Date student is expected to graduate: ___________________
mm/yyyy
______________
mm/yyyy
Yes
No
10. Is there a contingency to student’s acceptance?
If YES, please explain: ____________________________________________________
(All contingencies must be met by the start of the Fall 2009-2010 term)
11. NAME OF SCHOOL:
____________________________________________
12. ADDRESS:
____________________________________________
____________________________________________
CITY: ______________STATE:_______ ZIP:________
13. SCHOOL’S EMPLOYER IDENTIFICATION NUMBER:________________________
(Also known as Federal tax ID)
14. CONTACT INFORMATION FOR SCHOOL OF NURSING OFFICIAL COMPLETING THIS FORM:
NAME: ______________________________________ TITLE: ___________________________________
PHONE NUMBER:_____________________________ FAX NUMBER:____________________________
E-MAIL ADDRESS: __________________________________
2009 NSP AIB
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Page 2 of 2 – Name of Student ______________________
Student’s Social Security Number_______________
DATA COLLECTION WORKSHEET FOR TUITION AND FEES
15. Check the nursing program for which the data is submitted (check only one):
Associate
Diploma
Baccalaureate
Masters
Doctoral
16. Is summer school an academic term normally required for all students in the nursing program?
Yes
No
INSTRUCTIONS: Please provide the cost of tuition and fees for school year 2009-2010 for each year of the
nursing program regardless of the number of years the student requires to complete the program. Provide the
resident (in-state) and non-resident (out-of-state) tuition cost that students will be charged. The tuition amount
should reflect the total amount required for school year 2009-2010 for the specified nursing program.
Tuition and fee amounts will be paid directly to the school, on behalf of the scholar. Therefore, it is essential that
you only enter the total amount for eligible fees (see below) that all students in the same program and class year
incur regardless of the source of funding.
TUITION AND REQUIRED FEES COST FOR
SCHOOL YEAR 2009-2010
Student in 1st
Student in 2nd
Student in 3rd
Student in 4th
Year of Program
Year of Program
Year of Program
Year of Program
______________
______________
______________
______________
Resident Tuition
Non-Resident Tuition
______________
______________
______________
______________
All Fees
______________
______________
______________
______________
NOTE: If a student is selected to receive a Nursing Scholarship Program award, the amounts reported above will be
used to determine the amount obligated for tuition and fees under that award, for the duration of the scholarship
award. Failure to provide accurate information may result in insufficient funding. The Scholarship Program’s
ability to pay for increased costs will be subject to the availability of funds.
Certification: I certify that the information provided on this Verification of Acceptance/Good Standing Report and
the Data Collection Worksheet for Tuition and Fees is accurate and complete to the best of my knowledge and
belief. I understand that any willfully false statements made herein may be investigated and may be punishable as a
felony under U.S. Code, Title 18, Section 1001.
_______________________________________
Signature of Nursing School Official
_________________
Date
THIS REPORT MUST HAVE THE SCHOOL’S RAISED SEAL OR STAMP ON IT TO BE ACCEPTED.
MAIL TO:
Nursing Scholarship Program- c/o HRSA Call Center
12530 Parklawn Drive, Suite 350
Rockville, MD 20852
For Questions Call 1-800-221-9393
PUBLIC BURDEN STATEMENT: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information
unless it displays a currently valid OMB control number. The OMB control number for this project is 0915-0301. Public reporting burden for
the applicant for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to
HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14-33, Rockville, MD 20857.
FORM APPROVED
OMB No. 0915-0301
Expires 07/31/2009
NOTE: IF THE SUPPORTING INFORMATION IS NOT POSTMARKED BY THE MAY 14, 2009 DUE DATE OR THERE ARE
DISCREPANCIES BETWEEN THE INFORMATION ON THE ON-LINE APPLICATION AND THE VERIFICATION OF
ACCEPTANCE/GOOD STANDING REPORT, YOUR APPLICATION WILL BE DEEMED INELIGIBLE AND WILL NOT BE
CONSIDERED FOR AN NSP AWARD.
2009 NSP AIB
36
NURSING SCHOLARSHIP PROGRAM
ELIGIBLE AND INELIGIBLE FEES 2009-2010
Eligible Fees
Academic Support Services Fee
Administrative Fee
Building or Facility Fees
Campus Life Fee
Computer Lab Fee
Curriculum Fee
Disability Insurance Fee (Must be required of all students regardless of source of funding)
Education Fee
Health Insurance Fee if a charge to all students (for students only) if it is mandatory that it be purchased through the school
by all students
Health Services Fee and Immunizations
Graduation Fee in last year of program
Laboratory Fees
Library Fee
Malpractice Insurance if it is mandatory that it be purchased through the school by all nursing students
Matriculation Fee
Recreation Fee
Student Activities Fee
Student Services Fee
Technology Fee
University Fee
Ineligible Fees
Accident Insurance
Attorney Fee
Automobiles and Automobile Maintenance Expenses and Accident Insurance
Books (as they are covered by the Other Reasonable Cost payment)
Certification Boards
Class Dues
Counseling Fees
Dental Insurance
Educational Associations
Financial Aid Trust Funds
ID Maintenance
Late Charges
Life Insurance
NCLEX Review
Parking Fee
Penalty Fees
Personal Laundry
Post Office Box Rental
Room and Board Expenses
Refundable Property Deposit
Study Abroad Fees
Student Association and Union Fee
Testing Fees
Transportation Fees
Yearbook
2009 NSP AIB
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HRSA-124 (Revision 12-08) (FRONT)
NURSING SCHOLARSHIP PROGRAM CONTRACT
FOR FULL-TIME STUDENT
SCHOOL YEAR 2009-2010
Section 846(d) of the Public Health Service Act (“Act”), as amended
by Public Law 107- 205 on August 1, 2002, authorizes the Secretary of
Health and Human Services (“Secretary”) to provide applicants selected
to be participants in the Nursing Scholarship Program (“Scholarship
Program”) with scholarship awards. In return for the awards, applicants
must agree to serve for a period of not less than 2 years as nurses in a
health care facility with a critical shortage of nurses.
Pursuant to section 846(d)(4) of the Act, applicants are required to
submit with their application a signed contract stating the terms and
conditions of participation in the Scholarship Program. The Secretary
shall sign only those contracts submitted by applicants who are selected
for participation.
The terms and conditions of participating in the Scholarship Program
for the 2009-2010 school year are set forth below.
Section A - Obligations of the Secretary
Subject to the availability of funds appropriated by the Congress of the
United States for the Nursing Scholarship Program, the Secretary
agrees to:
1. Provide the undersigned applicant (“applicant”) with a
scholarship award for the school year 2009-2010 during which
the applicant:
a. is enrolled, or is accepted for enrollment, as a full-time
student in an accredited (as determined by the Secretary)
school of nursing in one of the several States, the District of
Columbia, the Commonwealth of Puerto Rico, the
Commonwealth of the Northern Marianas, the U.S. Virgin
Islands, the Territory of Guam, the Territory of American
Samoa, the Republic of Palau, the Republic of the
Marshall Islands or the Federated States of Micronesia,
and
b.
is pursuing a course of study in a collegiate, associate degree,
or diploma school of nursing.
The scholarship award may consist of payments, in whole or in part,
for tuition, an amount for all other reasonable educational expenses
incurred by the student, and a monthly stipend for the 12-month period
beginning with the first month of each school year in which the
applicant is a participant in the Scholarship Program. The
disbursement of these scholarship payments may be delayed by the
Secretary pending receipt of verification, satisfactory to the Secretary,
of the applicant’s continued eligibility for scholarship support.
Scholarship support will not extend beyond 4 school years or the
applicant’s completion of the required classes for graduation,
whichever is less.
2. Annually determine the most needy health care facilities with a
critical shortage of nurses.
Section B - Obligations of the Applicant
The applicant agrees to:
1. Accept the scholarship award provided by the Secretary under
Section A.1. of this contract for the school year 2009-2010.
2. Maintain enrollment as a full-time student until completion of the
course of study for which the scholarship award is provided.
3. Notify the Scholarship Program promptly in writing as soon as
one of the following events is anticipated: repeat course
work; a delay in the applicant’s graduation date (e.g., due to a
leave of absence approved by the school); a change from full-time
student status to a less than full-time student status; withdrawal from
courses; a change in school or program; and a withdrawal or
dismissal from school.
4. Maintain an acceptable level of academic standing while enrolled
in the course of study for which the scholarship award is provided.
5. Serve one year of full-time obligated service for each school year
a scholarship award is provided, with a minimum obligation of 2
years of full-time clinical service.
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
HEALTH RESOURCES AND SERVICES ADMINISTRATION
BUREAU OF CLINICIAN RECRUITMENT AND SERVICE
6.
Serve his or her period of obligated service in a healthcare facility
with a critical shortage of nurses identified by the Secretary pursuant to Section A.2. of this contract. The service obligation may
be fulfilled on a full-time or part-time basis. Full-time service is
defined as a minimum of 32 hours per week, for a minimum of 45
weeks per year. Part-time service is defined as a minimum of
16 hours per week up to a maximum of 31 hours per week, for a
minimum of 45 weeks per year. Part-time service is subject to
approval by the Secretary. The applicant must accept an offer of
employment from such healthcare facility within 6-months of the
applicant’s date of graduation.
7. If approved by the Secretary to provide part-time service, extend
the period of obligated service set forth in paragraph 5 of this Section so that the aggregate amount of service performed will equal
the amount of service that would be performed through a period
of full-time service.
8. Commence obligated service in accordance with paragraph 6
above, within 3 months of the date of the applicant’s acceptance
of an offer of employment from such health care facility or within
9 months of the applicant’s date of graduation from nursing
school, whichever occurs first.
9. Undertake service in accord with policies and procedures in
effect at the time the service obligation is required to begin.
10. Permit the U.S. Department of Health and Human Services to collect any debt owed by the applicant, as a result of an overpayment
of scholarship award payments, through the administrative offset of
subsequent scholarship award payments to the applicant under this
Contract, an Optional Contract or an Extension Contract, until the
debt is paid in full. An overpayment of scholarship award payments occurs when scholarship award payments are made:
a) for repeat course work,
b) during any period when the applicant is on an approved leave
of absence from the school,
c) during any period when the applicant is enrolled as a less
than full-time student, or
d) due to administrative error.
11. Comply with Title 2, Code of Federal Regulations, Part 180,
Subpart C (2006), as supplemented by Subpart C of Title 2, Code of
Federal Regulations, Part 376 (2007).
Section C - Breach of Scholarship Contract
1. If the applicant:
a. fails to maintain an acceptable level of academic
standing in the nursing program,
b.
is dismissed from the nursing program for disciplinary
reasons,
c. voluntarily terminates the nursing program before the
completion of such training; or
d. fails to provide health services in accordance with Section B
of this contract,
then the applicant shall be liable to the United States to repay all
funds paid to the applicant, or on the applicant’s behalf, under this
contract, and to pay interest on such amounts at the maximum
legal prevailing rate from the date of the applicant’s default.
2. The amount owed under paragraph 1 of this Section must be paid
within 3 years of the date of the applicant’s default.
Section D -Cancellation, Suspension, and Waiver of Obligation
1. Any service or payment obligation incurred by the applicant
under this contract will be canceled upon the applicant’s death.
2. The Secretary may waive or suspend the applicant’s service or
payment obligation incurred under this contract if:
a.
b.
compliance by the applicant with the obligation is impossible
or
compliance would involve extreme hardship and enforcement of
such obligation would be unconscionable.
(OVER)
requirements, policies and procedures for participating in the
Section E - Contract Extension
1. The applicant may annually request extension of this contract, if the
Scholarship Program; and
request is submitted in accordance with procedures established by
d. The applicant has complied with the procedures for requesting
the Secretary.
continued scholarship support.
2. Subject to the availability of funds appropriated by the Congress of the Section F - Contract Termination
United States for the Scholarship Program, the Secretary may approve 1. The Secretary may terminate this contract with the applicant if,
a request for contract extension if:
not later than 30 days before the end of the school year to which
the contract pertains (i.e., by June 1 of that school year), the
a. the request does not extend the total period of scholarship
applicant:
award beyond 4 school years;
a. submits a written request for such termination and
b. the applicant is otherwise eligible for continued participation
b. repays all amounts paid to, or on behalf of, the applicant
in the Scholarship Program;
under the contract for that school year.
c.
the applicant has demonstrated past compliance with the
The Secretary or his/her authorized representative must sign this contract before it becomes effective
Applicant Name (Please Print)
Applicant Signature
Date
Secretary of Health and Human Services
Date
OPTIONAL CONTRACTS
This Nursing Scholarship Program Contract for the 2009-2010 school year ("2009-2010 Contract") is hereby amended by the Secretary of Health and
Human Services and the applicant to provide the applicant with additional scholarship support for the 2010-2011 school year, under the same terms and
conditions set forth in the 2009-2010 Contract except to the extent that the terms set forth in the 2009-2010 Contract may be subsequently amended by statute
or regulation. Disbursements for the 2010-2011 school year will begin at the start of that school year.
2010-2011
SCHOOL YEAR
Applicant Signature
Secretary Signature
This Nursing Scholarship Program Contract for the 2009-2010 school year ("2009-2010 Contract") is hereby amended by the Secretary of Health and
Human Services and the applicant to provide the applicant with additional scholarship support for the 2011-2012 school year, under the same terms and
conditions set forth in the 2009-2010 Contract except to the extent that the terms set forth in the 2009-2010 Contract may be subsequently amended by statute
or regulation. Disbursements for the 2011-2012 school year will begin at the start of that school year.
2011-2012
SCHOOL YEAR
Applicant Signature
Secretary Signature
This Nursing Scholarship Program Contract for the 2009-2010 school year ("2009-2010 Contract") is hereby amended by the Secretary of Health and
Human Services and the applicant to provide the applicant with additional scholarship support for the 2012-2013 school year, under the same terms and
conditions set forth in the 2009-2010 Contract except to the extent that the terms set forth in the 2009-2010 Contract may be subsequently amended by statute
or regulation. Disbursements for the 2012-2013 school year will begin at the start of that school year.
2012-2013
SCHOOL YEAR
Applicant Signature
Secretary Signature
HRSA-124 (BACK)
(Revision 12-08)
2009 NSP AIB
39
AUTHORIZATION TO RELEASE INFORMATION
I, _____________________________________________________________, hereby authorize:
(Print Name - First, Middle Initial, Last)
1) The school where I am accepted for enrollment/am enrolled/was enrolled while applying for and
participating in the Nursing Scholarship Program to disclose information pertaining to my school
enrollment to the Department of Health and Human Services (DHHS), and/or its contractors.
Information pertaining to my school enrollment includes, but is not limited to, my transcripts and
grades, my academic standing, my enrollment and degree status, my curriculum and examination
requirements for graduation, my tuition and fees, and my leave-of-absence, withdrawal, or dismissal
from school. This information will be used by DHHS to determine my eligibility to continue to
receive scholarship benefits and the amount of those benefits.
2) The entity/entities where I am/was approved to provide service in satisfaction of my Nursing
Scholarship Program obligation to disclose to DHHS, and/or its contractors, information pertaining to
my compliance with the Nursing scholarship service requirements. Such information includes, but is
not limited to, my practice location(s), my practice responsibilities, my work schedule or other
documentation indicating the hours that I worked and the hours I was away from the site, records
relating to my work performance and (if applicable) the circumstances relating to the termination of
my employment at the service location.
3) The DHHS, and/or its contractors, to release my name, address(es) and social security number to see
if I appear on the Excluded Parties List System.
4.
The DHHS, and/or its contractors, to release my name, the professional school I am attending, and
my graduation date to health professions associations and to groups which have the responsibility for
coordinating funds paid to students from Federal and other sources.
5)
The DHHS, and/or its contractors, to release my name, address, Social Security number and other
information necessary to identify me to a credit reporting agency for the purpose of determining my
eligibility to participate in the NSP.
This authorization takes effect on the date I sign this release form. If I do not become a participant, this
authorization shall remain in effect until September 30, 2009. If I become a participant, the above
authorizations shall remain in effect until the date my Nursing scholarship commitment has been fulfilled
or this authorization has been revoked by me in writing.
____________________________________
____________
(Signature of Individual)
(Date)
__________________
(Last 4 of Social Security Number)
RETURN TO:
Nursing Scholarship Program
c/o HRSA Call Center
12530 Parklawn Drive, Suite 350
Rockville, Maryland 20852
2009 NSP AIB
40
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, DISQUALIFICATION AND
RELATED MATTERS
Pursuant to 2 CFR 180.335 (2006) as implemented by 2 CFR 376.10 (2007), an applicant applying to
enter into a covered transaction (which includes an application to participate in this program) is required
to notify the Federal agency office if the applicant knows that he or she:
• Is presently debarred, suspended, excluded, or disqualified from participation in covered
transactions by any Federal agency or department;
•
Within the 3-year period preceding the application, has been convicted of, or had a civil judgment
rendered against him or her for any of the following offenses:
o commission of fraud or a criminal offense in connection with obtaining, attempting to
obtain, or performing a public (Federal, State, or local) transaction or a contract under a
public transaction;
o violation of Federal or State antitrust statutes; or
o commission of embezzlement, theft, forgery, bribery, falsification or destruction of
records, making false statements, tax evasion, receiving stolen property, making false
claims, or obstruction of justice;
•
Is presently indicted or otherwise criminally or civilly charged by a governmental entity (Federal,
State, or local) with the commission of any of the offenses set forth above; or
•
Within a 3-year period preceding the application, has had any public transaction (Federal, State,
or local) terminated for cause or default.
The applicant must sign the certification below which is applicable to his or her situation.
I , _____________________
(Print Name of Applicant)
______,certify that none of the above statements apply to me.
OR
I, ______________________
(Print Name of Applicant)
_________________________________
Signature of Applicant
2009 NSP AIB
_, certify that one or more of the above statements apply to me.
_______________
Date
___________________
Social Security Number
41
| File Type | application/pdf |
| File Title | Nursing Scholarship Program Applicant Information Bulletin - School Year 2009-2010 |
| Author | HRSA |
| File Modified | 2009-04-25 |
| File Created | 2009-04-11 |