LRP Application Form Index

Index of Loan Repayment Application Forms

The table below is an index of the loan repayment application forms and shows the different forms pertinent to each type of application. Unless noted otherwise, the form is completed by the applicant.

Form Number	Current Form	Initial Intramural	Initial Extramural	Renewal Intramural	Renewal Extramural
2674-1	Applicant Information	X	X	X	X
2674-2	Personal Statement	X	X	X	X
2674-3	Recommendations	X	X		X
2674-4	Loan Information Form	X	X
2674-5	IC Recommendation for LRP Funding	X		X
2674-6	Research Activities	X	X	X	X
2674-7	Assessment of Research Activities	X	X	X	X
2674-8	Research Accomplishments			X	X
2674-9	Certifications for Online Applications	X	X	X	X
2674-10	Institutional Contact		X		X
2674-11	Disadvantaged Background Documentation (Applicable only to Clinical LRP for Individuals from Disadvantaged Backgrounds)	X	X
2674-12	NIH Loan Repayment Program Contract	X	X	X	X
2674-13	Recommendation (Completed by Supervisor)	X	X	X	X
2674-13	Recommendation (Completed by 2 additional colleague recommenders)	X	X		X
2674-14	Assessment of Research Accomplishments			X	X
2674-15	Apply Here	X	X	X	X
2674-16	Institutional Information (colleague)	X	X
2674-17	NIH Loan Repayment Programs/ Loan Information Form1 (Completed by applicant and financial institution)	X	X	X	X
2674-18	Citizenship Information		X
2674-19	Funding Information		X		X

1 Form is only completed if the applicant or participant needs to add a loan to their portfolio or consolidate existing loans.