1b Application Program Guidance

Nursing Scholarship Program
Fiscal Year 2012
Application and Program Guidance
March 2012

Application Submission Deadline: May 8, 2012, 5:00pm EST
For Questions, please call 1-800-221-9393 (TTY: 1-877-897-9910), or email
[email protected], Monday through Friday (except Federal holidays) 8:00am
to 8:00 pm EST.
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
Bureau of Clinician Recruitment and Service
5600 Fishers Lane
Rockville, Maryland 20857
Authority:

Section 846(d) of the Public Health Service Act (42 United States Code 297n (d)), as amended.
Future changes in the governing statute, implementing regulations and Program Guidances may
also be applicable to your participation in the Nursing Scholarship Program.

Table of Contents
PRIVACY ACT NOTIFICATION STATEMENT………………………………………………………………………………….3
PROGRAM OVERVIEW
Introduction……………………………………………………………………………………………………………………………4
 What is the Nursing Scholarship Program (NSP)?
 What are the benefits of the NSP?
Eligibility Requirements…………………………………………………………………………………………………………..4
 Am I Eligible?
Funding Awards………………………………………………………………………………………………………………………6
 How does the NSP determine which applicants will receive scholarships?
 How many awards does the NSP expect to give?
Understanding the Contract and Length of the Service Commitment……………………………..………8
 How many years of school does the contract cover?
 Can I request additional scholarship support after I receive my award?
 Can I terminate my NSP contract?
 How long is my service commitment?
Program Requirements…………………………………………………………………………………………………………10
 What are the requirements while I am in school?
 What happens if I have a change in enrollment status?
Tuition, Required Fees, Other Reasonable Costs, and Stipend………………………………………………10
 What costs does the NSP cover?
 What if I have additional funding provided by an alternative source?
Changes in Scholarship Payments…………………………………………………………………………………………13
 What situations impact the NSP’s payment of tuition and/or stipend?
Service Requirements and Eligible Sites under NSP……………………………………………….………………15
 What are the service requirements after graduation?
 What are the types of sites where I can fulfill my service obligation?
 What is a HPSA and how do I locate my facility’s HPSA score?
 Can I leave my NSP-approved Critical Shortage Facility prior to completion of service?
Breaching the Contract…………………………………….…………………………………………………………………..20
 What is a breach of the NSP Contract?
 What happens if I breach the NSP contract?
 What happens if a debt incurred by a breach of contract is not paid?
Suspension and Waiver…………………………………………………………………………………………………………21
 What should I do if I cannot continue my service or payment obligation?
 When would my service obligation be cancelled?
ADDITIONAL MATERIALS
How To Apply………………………………………………………………………………………………………………………..23
Definitions…………………………………………………………………………………………………………………………….27
Frequently Asked Questions………………………………………………………………………………………………….31

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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.
Statutory Authority
Section 846(d) of the Public Health Service Act (42 United States Code 297n (d)), as amended.
Purposes and Uses
The purpose of the Nursing Scholarship Program (NSP) is to provide scholarships to nursing students in
exchange for a minimum 2 year full-time service commitment (or part-time equivalent), at an eligible
health care facility with a critical shortage of nurses. The information an applicant provides will be used
to evaluate eligibility for participating in the NSP. In addition, information from other sources will be
considered (e.g., credit bureau reports).
A participant’s contract, application, required supplemental forms, supporting documentation,
correspondences and related data are maintained in a system of records to be used within the U.S.
Department of Health and Human Services to monitor NSP-related activities. The information may also
be disclosed outside the Department, as permitted by the Privacy Act and Freedom of Information Act,
to the Congress, the National Archives, the Government Accountability Office, and pursuant to court
order and various routine uses (see http://www.hrsa.gov/about/privacyact/09150037.html.
Effects of Nondisclosure
Disclosure of the information sought is voluntary; however, if not submitted, except for the replies to
questions related to Race/Ethnicity of the online application, an application will be considered
incomplete and therefore 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 and expires 9/30/2012. The public
reporting burden for this collection is estimated to average 5 hours 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.
Discrimination Prohibited
In accordance with applicable Federal laws, the U.S. Department of Health and Human Services is
prohibited from discrimination on the basis of race, color, national origin, sex, age, religion or disability.

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PROGRAM OVERVIEW
INRODUCTION
What is the Nursing Scholarship Program?
The purpose of the Nursing Scholarship Program (NSP) is to provide scholarships to nursing
students in exchange for a minimum 2-year full-time service commitment (or part-time
equivalent), at an eligible health care facility with a critical shortage of nurses. Scholarships are
awarded competitively and consist of payment for tuition, required school fees, Other
Reasonable Costs (as defined on page 11) and a monthly support stipend.
Up to fifty percent of NSP funds will be made available for nurse practitioners (NPs) to address
key issues pertaining to the expanding need for health care.
What are the benefits of the NSP?
(1) Service: NSP participants will have the opportunity to increase access to care by
delivering nursing services in eligible health care facilities with a critical shortage of
nurses.
(2) Scholarship: NSP provides the following for up to four school years:
a. Funds to support nursing school tuition and fees;
b. An annual payment for Other Reasonable Costs to cover expenses for books, clinical
supplies, and instruments; and
c. Monthly stipends to cover living expenses.
ELIGIBILITY REQUIREMENTS
Am I eligible?
To be eligible for a scholarship, an NSP applicant must:
(1) Be a U.S. citizen (either U.S. born or naturalized), U.S. national, or a Lawful Permanent
Resident.
(2) Be enrolled or accepted for enrollment as a full or part-time student in an accredited
nursing degree program at one of the following:
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
A COLLEGIATE SCHOOL OF NURSING: A department, division, or the 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
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

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professional nursing and allied subjects leading to a diploma or to an equivalent
evidence of completion and is an accredited program.
Accredited Program. The NSP considers a nursing program to be accredited if it is
accredited by a national or regional nurse education accrediting agency or state
approval agency recognized by the Secretary of the U.S. Department of Education.
Currently, these agencies include but are not limited to the Commission on Collegiate
Nursing Education; the National League for Nursing Accrediting Commission; Kansas
State Board of Nursing; Maryland Board of Nursing; Missouri State Board of Nursing;
North Dakota Board of Nursing; and New York State Board of Regents, State Education
Department, Office of the Professions (Nursing Education). For a complete list of
agencies recognized by the Secretary of the U.S. Department of Education, please visit:
http://ope.ed.gov/accreditation/Agencies.aspx

Please note: Students enrolled in Licensed Practical Nurse programs, self-paced study
programs (on-line), and bridge/dual-degree programs that are not RN-to-BSN programs are not
eligible for a scholarship award.

(3) Be enrolled in or accepted for enrollment in a school of nursing (as outlined above)
located in a state, the District of Columbia, or a U.S. Territory.
Located in a State, the District of Columbia, or a U.S. Territory. The schools and
educational programs for which scholarship support is requested must be in one of 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, or the Federated States of Micronesia. A student attending a school
outside of these areas is not eligible for the Nursing Scholarship Program, even though
the student may be a citizen/national/lawful permanent resident of the United States.
(4) Begin the nursing degree program on or before September 30, 2012.
(5) Submit a complete application and signed contract.
An applicant will be deemed ineligible if the applicant:
(1) Has any judgment liens against his or her property arising from a debt owed to the
United States;
(2) Has a breach of a prior service obligation;
(3) Is excluded, debarred, suspended, or disqualified by a Federal Agency; OR
(4) Has an existing service obligation. An applicant who is already obligated to a Federal,
State, or other entity for professional practice or service after academic training is not
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eligible for an NSP award. An exception may be made if the entity to which the
obligation is owed 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. An NSP scholarship participant who subsequently enters into another service
commitment and is not immediately available after completion of the participant’s
degree to fulfill his/her NSP service commitment will be subject to the breach-ofcontract provisions described on page 20.
EXCEPTION: Individuals in a Reserve component of the Armed Forces including the National
Guard are eligible to participate in the NSP. Reservists should understand the following:
 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, will exceed 35 work days per service year, the participant should
request a suspension. The NSP service obligation end date will be extended to compensate for the
break in NSP service.
 If the critical shortage facility where the reservist is serving at the time of his/her deployment is
unable to reemploy that reservist, the reservist will be expected to complete his/her NSP service
obligation at another eligible critical shortage facility. The reservist must contact NSP to request a
transfer and receive approval, in accordance with the transfer policy (see page 20, “Can I leave my
NSP-approved Critical Shortage Facility prior to completion of service?’).
 The Uniformed Services Employment and Reemployment Rights Act (USERRA) of 1994, affords
service members protection from employers not willing to reemploy them upon return from a
deployment. Please visit the Department of Labor website,
http://www.dol.gov/compliance/laws/comp-userra.htm for more information.

Please be advised that a credit check and excluded parties list system check will be performed
as part of the application approval process.
FUNDING AWARDS
How does the NSP determine which applicants will receive scholarships?
Among eligible applicants, the NSP determines scholarship awardees utilizing funding
preferences and selection factors.
Funding Preferences
There is a funding preference for applicants of greatest financial need. An applicant’s financial
need is determined based on the applicant’s Expected Family Contribution (EFC), which is
provided on the Student Aid Report (SAR) generated through the Free Application for Federal
Student Aid (FAFSA). Applicants with an EFC between $0 and $5,550 will be considered as
having the greatest financial need.
Among qualified applicants with the greatest financial need (i.e. applicants with an EFC
between $0 and $5,550):

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(1) First Funding Preference will be given to qualified applicants who are enrolled or
accepted for enrollment in an accredited undergraduate nursing program or Master’s
nurse practitioner program as full-time students.
(2) Second Funding Preference will be given to qualified applicants who are enrolled or
accepted for enrollment in an accredited graduate nursing program other than a
Master’s nurse practitioner program (e.g., Doctor of Nursing Practice programs,
programs for certified nurse midwives, certified registered nurse anesthetists, or clinical
nurse specialists), as full-time students.
(3) Third Funding Preference will be given to qualified applicants who are enrolled or
accepted for enrollment in an accredited undergraduate or graduate nursing program as
part-time students.
To the extent that funds remain available, all other applicants will be considered in the order of
decreasing financial need.
Selection Factors
The following selection factors will be considered when determining scholarship awardees:
(1) A history of not honoring a prior legal obligation. An NSP applicant who has a history of
not honoring a prior legal obligation, as evidenced by one or more of the following
factors, may not be selected:
a. Default on a prior service obligation to the Federal government, a State or local
government, or other entity, even if the applicant subsequently satisfied that
obligation through service, monetary payment, or other means.
b. Default on any Federal payment obligations (e.g., student loans, Federal income tax
liabilities, mortgages, etc.) or non-Federal payment obligations (e.g., court-ordered
child support payments); OR
c. Write off of any Federal or non-Federal debt as uncollectible.
(2) Academic performance. Demonstrates the ability to excel and maintain an acceptable
level of academic standing in school.
(3) Essay questions. Demonstrates a thorough commitment to a career in nursing;
interest/motivation in providing care to underserved communities; and relevant work
experience and/or activities (i.e., community service, research, and internships) that
have prepared the applicant to work with underserved populations.
(4) Resume/Curriculum Vitae. Summarizes educational qualifications, work experience,
and volunteer/community service in chronological order.
(5) Recommendation letters. Provides a detailed description of the applicant’s
performance in school; education/work achievements; community/civic or other nonacademic achievements; ability to work and communicate constructively with others
from diverse backgrounds; and interest and motivation to serve underserved
populations through work experience, course work, special projects, research, etc.
How many awards does the NSP expect to give?
The NSP for the 2012-2013 school year is expected to be highly competitive. The program
anticipates more applicants for scholarship awards than there are funds available. It is expected
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that approximately 350 awards will be made for the 2012 – 2013 school year. In the past, NSP
funds have only allowed for funding of individuals in the first funding preference. Below is a
table with previous years’ award history.
Award History
Fiscal Year

FY 2011
FY 2010
FY 2009

# of Eligible
Applications
Received
2,922
3,812
425

# of Initial
Awards
Made
395
458
189

# of
Continuations
17
18
15

Once an applicant has been selected for an award, the applicant will be provided with
information for logging in to the BCRS Customer Service Portal. This web-based system will
allow NSP participants to communicate with the NSP and to manage several customer service
inquiries, such as contact information changes. The Customer Service Portal is available at
https://programportal.hrsa.gov/.
UNDERSTANDING THE CONTRACT AND LENGTH OF THE SERVICE COMMITMENT
How many years of school does the contract cover?
The NSP award and contract is for the 2012-2013 school year (July 1, 2012 – June 30, 2013) and
any additional school years (Optional Contracts) requested by the applicant and agreed to by
the Secretary or his/her designee as indicated on the executed contracts. Support will be
provided during the school years agreed to in the executed contracts (not to exceed 4 years),
based on the cost of the initial school of record (i.e., the school attended at the time the initial
contract is executed). If an NSP participant signs a contract for only 1 year of support, the 20122013 school year, his/her scholarship support will end on June 30, 2013, and a two-year service
commitment will be incurred (See “How long is my service commitment?” on page 9 for more
details).
Can I request additional scholarship support after I receive my award?
Additional scholarship support will only be provided for the same nursing degree that the NSP
participant’s original contract funded. To request additional scholarship support for the 20132014 school year or any subsequent school years, the NSP participant must submit a signed
contract for that school year and a report verifying that he/she is still in an acceptable level of
academic standing. The participant may also request optional contracts for subsequent school
years through graduation for a maximum of 4 school years of support. The NSP will notify the
participant when this submission is due.
The granting of continuation awards depends upon the availability of funds for the NSP and is
contingent upon the participant’s:

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(1) Continued eligibility to participate in the NSP (acceptable level of academic standing,
not repeating coursework, etc.). Please be advised that a credit check will be conducted
as part of the eligibility process;
(2) Compliance with policies and procedures established by the NSP for requesting
continued support; AND
(3) Past compliance with program policies and requirements.
Participants requesting continued support must be able to financially support themselves until
the scholarship benefit payment schedule can be reinstated. If a continuation award is granted,
the first payment may not be received until mid-November but will include stipends retroactive
to July 1 and the annual Other Reasonable Costs (ORC) payment.
Can I terminate my NSP contract?
The Secretary of Health and Human Services or his/her designee may terminate an NSP
contract for a school year if the participant, on or before June 1st 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 participant for that school year. If a scholarship
participant does not meet these requirements, he or she will incur a minimum 2-year service
commitment for the full or partial year of support received, as set forth in the “Program
Requirements” Section of this Guidance.
How long is my service commitment?
All participants incur, at a minimum, a 2-year full-time service obligation (or part-time
equivalent) and may have a longer service obligation, as set forth below.
Participants who sign “Full-Time Student” contracts incur an obligation to provide one year of
full-time service for each full or partial school year of support received beyond two years as set
forth in the table below. 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. If
a participant receives support for one year or less, there is still an obligation to serve two years.
Years of Scholarship Support

Years of Service Obligation

1 Full-Time School Year (2012-2013)

2 Years Full-Time

2 Full- Time School Years (2012-2014)

2 Years Full-Time

3 Full- Time School Years (2012-2015)

3 Years Full-Time

4 Full- Time School Years (2012-2016)

4 Years Full-Time

Participants who sign “Part-Time Student” contracts will have their part-time enrollment
aggregated to determine its full-time equivalent.

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PROGRAM REQUIREMENTS
What are the requirements while I am in school?
(1)
(2)

(3)

Maintain Enrollment. The NSP participant must maintain enrollment in the nursing
program until the program is complete.
Maintain an Acceptable Level of Academic Standing. A scholarship participant must be
in an acceptable level of academic standing, or the level at which a student retains
eligibility to continue attending school under the school’s standards and practices, for
the duration of the academic year. Applicants on academic probation will not be
considered as in an acceptable level of academic standing by the NSP.
Notify NSP of Any Changes in Enrollment Status. A participant is required to notify the
NSP through the Customer Service Portal as soon as one of the following events is
anticipated:
a. Repeat course work for which the NSP has already made payments;
b. A change in the applicant’s graduation date;
c. A leave of absence approved by the school;
d. Withdrawal or dismissal from school;
e. 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 for participants who sign “Part-Time Student” Contracts).
f. Voluntary withdrawal from courses during an academic term; OR
g. A transfer to another school or program.

These events could have an adverse impact on a participant’s receipt of NSP payments.
What happens if I have a change in enrollment status?
A change in enrollment status can result in a reduction or discontinuation of benefits (See
“Changes in Scholarship Payment” on page 13). A participant is required to notify the NSP
promptly through the Customer Service Portal as soon as one of the events listed above is
anticipated. If a change in enrollment status has already occurred, the participant must submit
a letter from the school verifying that the change has occurred through the Customer Service
Portal.
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 continuing eligibility and status.
TUITION, REQUIRED FEES, OTHER REASONABLE COSTS, AND STIPEND
All NSP payments made to NSP participants, including those made to schools on their behalf,
are taxable (see page 12 for more information). The first payment for new NSP awardees will be
made no later than November 2012 and will include stipend payments retroactive to July 1st
and the annual payment for Other Reasonable Costs.
What costs does the NSP cover?
(1) Tuition and Required Fees
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a. Tuition and required fees will be paid directly to the nursing school. The nursing
school is required to submit an invoice to the NSP for payment of tuition and fees for
each term. Any fees on the invoice that are included in the Other Reasonable Costs
(discussed below) will not be approved for payment to the nursing school.
b. Summer sessions. NSP will only pay tuition and fees for required courses in summer
school sessions when (1) summer session is an academic term normally required by
the school for all students in the same program and (2) the summer session is in
progress during the participant’s contract period.
c. Repeated coursework. The NSP does not pay tuition and fees for repeated
coursework for which the NSP has previously made a payment. If the repeated
course work does not delay the participant’s graduation date, the scholarship
payments may continue except for any costs relating to the repeated course work
(e.g., cost of the repeated course, overload fees). The decision to continue
scholarship payments while a participant is repeating coursework will be made at
the discretion of the NSP. Participants who must repeat coursework should
immediately contact the NSP.
d. Increases in tuition or required fees. Payment for any increases in tuition or
required fees that are reported by the school after the award has been made is not
guaranteed and will be subject to the availability of funds.
e. Attending more than one school. For participants enrolled in programs which
require taking classes at more than one school/campus, please be advised that
payments will only be made to other institutions which have degree program
agreements with the nursing institution as indicated on the NSP application and only
for courses required as part of the degree program.
f. The NSP will pay for ONLY the courses that are required for graduation. The NSP
will not pay for additional courses beyond those required for graduation. Also, the
NSP will not pay for tuition costs unrelated to the degree/program, such as
membership dues for student societies/associations, loan processing fees, penalty or
late fees, and other similar expenses.
g. Transfers to other academic institutions are strongly discouraged. Transfers in
academic institutions are strongly discouraged once the applicant has been accepted
into the NSP. Transfers will be considered only for exceptional circumstances and
must be approved by the NSP in advance to ensure continued eligibility for funding.
Scholarship awards are based on the cost of attendance at the initial school of
record for all school year contracts executed during the FY 2012 application cycle. If
a transfer is approved, the NSP will not cover any increase in tuition and/or fees for
the new institution; the participant will be responsible for the difference.
(2) Other Reasonable Costs (ORC)
a. The ORC is an additional, annual payment provided directly to each NSP participant
to assist in the payment of books, clinical supplies/instruments, and uniforms. This
information is obtained directly from the nursing program. ORC payments will vary
from student to student depending on the student’s program and graduation date.
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b. The ORC payment will be reduced proportionately for students who plan to attend
less than a full school year (e.g., December graduates) and for part-time students.
(3) Stipend Amount
a. During the 2012-2013 school year, the NSP will pay each full-time student a monthly
amount of $1,289.00 (before Federal taxes). A part-time student will receive a
proportionately reduced stipend amount.
b. The stipend payments may be delayed or placed on hold if requested NSP
documents are not received. Stipend payments may also be stopped if a student is
repeating coursework that has already been paid for by the NSP. See “Changes in
Scholarship Payments” on page 13 for more information.
c. Stipend payments will stop the month the nursing course work is completed or
when the contract ends, whichever comes first.
Receipt of the stipend payment does not mean that the NSP participant is employed by the
Federal Government or participates in any of the benefits available to Federal employees.

NSP TAX INFORMATION
The entire NSP award is taxable. While NSP does not withhold Federal, State or local income taxes from
an NSP participant’s tuition and fees, the participant is responsible for taxes owed on the value of the
entire award including tuition and fees. It is the participant’s responsibility to ensure that federal
income tax is paid on the remainder of the award.
NSP withholds Federal income taxes owed on the stipend payments and ORC based on information
provided on the W-4, Employee’s Withholding Allowance Certificate by the participant. Any participant
who wants additional funds withheld from the stipend amount to cover the income tax on his or her
tuition and fees should indicate the additional amount to be deducted on the appropriate line on the
W-4. State and/or local taxes are not withheld from stipend and ORC payments.
Each year, participants will receive a 1099-Miscellaneous Income form for amounts paid for tuition and
fees and a W-2-Wage and Tax Statement form for amounts paid for stipends and ORC.
NSP participants should consult their local tax authority regarding applicable federal, state or local taxes
for which they may be liable.

What if I have additional funding provided by an alternative source?
(1) Financial Aid Received Before Notice of Award.
Grants and Scholarships. If tuition and fees for the school year have been paid by
another source of financial aid (e.g., Pell Grant, state grants or other scholarships)
before the student received notice of the NSP award, then the school may return
payments to the funding source and submit an invoice to the NSP for payment.

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Loans. If a new NSP participant has taken out a student loan to cover the cost of tuition
and fees for their summer and/or fall 2012 semester(s) while waiting for notice of an
NSP award, the student’s academic institution should supply an itemized invoice to the
NSP showing the amount of tuition and fees paid for with that student loan. The NSP
will pay that amount to the academic institution to cover the tuition costs covered by
the loan. After the fall 2012 semester, the NSP will not pay tuition and fee costs covered
by any student loans.
(2) Financial Aid Received After Notice of Award. If a student receives financial aid to pay
tuition and fees from sources other than NSP after he or she has received notice of the
NSP award, the school will be instructed not to submit an invoice to the NSP for costs
that have already been covered by the other source of financial aid. If the other source
of financial aid covers the full cost of tuition and fees, the school should 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.
CHANGES IN SCHOLARSHIP PAYMENTS
What situations impact the NSP’s payment of tuition and/or stipend?
(1) Changes in Enrollment Status. A change in enrollment status can result in a
discontinuation of benefits. A participant is required to promptly notify the NSP through
the Customer Service Portal as soon as one of the events listed below is anticipated. If a
change in enrollment status has already occurred, the participant must submit a letter
from the school verifying the status change through the Customer Service Portal.
a. Repeat course work for which the NSP has already made payments. The NSP may
continue payments for stipends and all other non-repeated course work,
provided that the participant continues to meet the NSP requirements;
b. A change in the participant’s graduation date;
c. A leave of absence approved by the school. All payments will be discontinued;
d. Withdrawal or dismissal from school. All payments will be discontinued;
e. A change from full-time student status to a less than full-time student status for
a participant who signs a “Full-Time Student” Contract may result in a
discontinuation of benefits. An exception may be made if the participant is in his
or her final academic term. In such instances, a participant with a student status
change may receive scholarship support as long as the participant maintains
enrollment and an acceptable level of academic standing and does not change
the graduation date.
f. Voluntary withdrawal from courses during an academic term; OR
g. A transfer to another school or program (See below).
(2) 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 NSP to ensure continued
eligibility for funding and will be considered only for exceptional circumstances.
Scholarship awards are based on the cost of attendance at the initial school of record
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for all school year contracts executed during the FY 2012 application cycle. If a transfer
is approved, the NSP will not cover any increase in tuition and/or fees for the new
institution; the participant will be responsible for the difference.
(3) Delinquent Federal and State Debt. Under the Treasury Offset Program, the U.S.
Treasury Department is authorized to offset a student’s NSP 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.
(4) NSP Overpayments. NSP payments received by a participant, including payments made
to a school on the participant’s behalf, during the periods while the participant 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
contact the NSP through the Customer Service Portal to make arrangements to
promptly return all overpayments and 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/or
referral of the overpayments to the Department of Justice for enforced collection. For
participants 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 participant (including stipends, ORC payments, and, if necessary,
tuition payments) until the overpayment owed is paid in full. Administrative offset is not
a repayment option for NSP participants who wish to terminate a contract.
(5) Resumption of Benefits. To resume benefits discontinued under existing scholarship
contracts, NSP participants must submit documentation from their school official
confirming that they are now eligible to receive scholarship support (e.g., not repeating
course work, returned from a leave of absence, resumed full-time student status, etc.).
Requests for the resumption of scholarship benefits should be sent to the NSP. They will
be considered on a case-by-case basis by the NSP to determine the participant’s
eligibility to receive continuing funds. For participants who have not repaid
overpayments previously received, the resumption of scholarship benefits will be
subject to the administrative offset described in the “NSP Overpayments” Section
above. For participants 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.

14

(6) Veteran Benefits. Educational benefits from the Department of Veterans Affairs (G.I.
Bill) generally continue along with NSP funds, if awarded, since Veteran benefits were
earned by prior active duty in a uniformed service. However, Scholarship benefits may
be reduced for participants receiving funding under the Post 9/11 G.I. Bill.
Questions or concerns regarding changes in scholarship payments should be directed to the
Customer Service Portal.
SERVICE REQUIREMENTS AND ELIGIBLE SITES UNDER NSP
What are the service requirements after graduation?
(1) Obtain a license. Prior to commencing service at a Critical Shortage Facility (CSF), NSP
participants must be permanently licensed within 6 months of graduation to practice as
a registered nurse (or if appropriate, as an advanced practice nurse) in the State where
they will be serving.
a. Credit towards fulfillment of the scholarship service commitment will not be given in
the absence of a current, unencumbered permanent license in the State of service.
b. 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.
c. Service credit will NOT be given until the NSP has received documentation that all
licensure and certification requirements have been met. Documents should be
uploaded to the Customer Service Portal.
d. Responsibility for obtaining the required State license (and national certification
exam, if applicable) prior to the service start date rests with the NSP participant.
e. NSP participants are expected to take the appropriate licensure/certification exams
at the earliest possible date.
f. If the participant is unsuccessful in obtaining a license or passing the certification
exam(s) within 6 months of his or her graduation date, the participant should
immediately contact the NSP in writing at the address above to request a
suspension. See the “Suspension and Waiver” section in this Guidance.
(2) Obtain a Position at a Critical Shortage Facility
NSP participants 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.
Participants will have up to 3 months following the date of the acceptance of such job
offer to commence full-time (or if approved by the Secretary, part-time) clinical services
at the facility.
Participants should contact the NSP 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 ensure a participant’s compliance with statutory requirements
related to the service obligation (See “What are the types of sites where I can fulfill my
service obligation?” on page 17).

15

Participants may be recommended for default of their service obligation for failure to
(1) accept an offer of employment from an NSP-approved facility within 6 months of
their date of graduation or (2) commence full-time (or if approved by the Secretary,
part-time) clinical services at the facility within 3 months following the date of the
acceptance of the job offer. Participants who default on their NSP service obligation
incur the damages described in the “Breaching the Contract” section on page 20.
(3) Perform Full-Time or Part-Time Clinical Service
Participants may satisfy their service obligations on either a full-time or, with written
approval from the Secretary or his/her designee, a part-time basis.
a. Full-Time clinical practice is defined as a minimum of 32 hours per week. At least 26
hours per week must be spent providing clinical services, or direct patient care, to
patients. The remaining 6 hours may be spent on administrative or other non-clinical
activities.
b. Part-Time clinical practice is defined as a minimum of 16 hours per week and up to a
maximum of 31 hours per week. Participants wishing to serve part-time must first
obtain approval from the Secretary or his/her designee and must extend their
service obligation so that the aggregate amount of service performed will equal the
amount of a full-time service obligation. At least 80% of the hours each week must
be spent providing clinical services, or direct patient care, to patients. For example, a
nurse scheduled to work 20 hours per week must spend at least 16 hours per week
providing clinical services.
c. Absences
Please note that the information provided below pertains to compliance with the
NSP service obligation and is not a guarantee that a service site will allow any
particular amount of leave.
No more than 35 work days per service year can be spent away from the approved
NSP site for vacation, holidays, continuing professional education, illness, or any
other reason. If a participant has circumstances due to a medical or personal
emergency that will result in an extended period of absence, he/she will need to
request a suspension of the NSP service commitment. The NSP cannot guarantee
that a suspension request will be approved. If a suspension is requested and
approved, the participant’s service commitment end date will be extended
accordingly.
(4) Verify Service. Every NSP participant who has completed school and is providing clinical
nursing services must verify their service every six (6) months through the Customer
Service Portal. In this process, an appropriate official at the NSP-approved CSF must
certify the participant’s compliance or noncompliance with the full-time or part-time
service requirement during each 6-month period. The service verification process will
also record the time spent away from the CSF.

16

Participants who fail to complete and submit their 6-month service verification through
the Customer Service Portal on time may jeopardize receiving service credit and may
also be recommended for default. Participants must download and submit the form via
the Customer Service Portal. Any participant who cannot complete the form through
the portal should contact the NSP immediately through the Customer Service Portal, by
phone (1-800-221-9393), or email ([email protected]).
What are the types of sites where I can fulfill my service obligation?
NSP participants are required to serve for a minimum of 2 years at a health care facility with a
critical shortage of nurses (Critical Shortage Facility) and will be expected to serve at a Tier 1
Critical Shortage Facility. A Critical Shortage Facility is defined to be:
Critical Shortage Facility (CSF) – a health care facility located in, designated as,
or serving a primary medical care or mental health Health Professional Shortage
Area (HPSA).
Health care facilities include:
a. Critical Access Hospital (CAH). A facility that is (a) located in a State that has
established with the Centers for Medicare and Medicaid Services (CMS) a Medicare rural
hospital flexibility program; (b) designated by the State as a CAH; (c) certified by the
CMS as a CAH; and (d) in compliance with all applicable CAH conditions of participation.
For more information, please visit:
http://www.cms.hhs.gov/Certificationandcomplianc/04_CAHs.asp.
b. Disproportionate Share Hospital (DSH). A hospital that has a disproportionately large
share of low-income patients and receives an augmented payment from the State under
Medicaid or a payment adjustment from Medicare. Hospital-based outpatient services
are included under this definition. For more information, please visit:
http://www.cms.hhs.gov/AcuteInpatientPPS/05_dsh.asp#TopOfPage.
c. Public Hospital. Any hospital that is owned by a government (Federal, State, or Local)
and receives government funding and is primarily engaged in providing, by or under the
supervision of physicians, to inpatients: (a) diagnostic 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 (FQHC). FQHCs include: (1) nonprofit entities that
receive a grant, or funding from a grant, under section 330 of the Public Health Service
Act to provide primary health services and other related services to a population that is
medically underserved; (2) FQHC “Look-Alikes” which are nonprofit entities that are
certified by the Secretary of HHS as meeting the requirements for receiving a grant
under section 330 of the Public Health Service Act but are not grantees; and (3)
outpatient health programs or facilities operated by a tribe or tribal organization under
the Indian Self-Determination Act or by an urban Indian organization receiving funds
17

e.

f.

g.

h.

i.

j.
k.

l.

under Title V of the Indian Health Care Improvement Act. FQHCs include Community
Health Centers, Migrant Health Centers, Health Care for the Homeless Health Centers,
and Public Housing Primary Care Health Centers. For more information, please visit:
http://findahealthcenter.hrsa.gov.
Indian Health Service Health Center. A health care facility (whether operated directly
by the Indian Health Service or 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 Heath Care Improvement Act) that is physically separated
from a hospital, and which provides clinical treatment services on an outpatient basis to
person of Indian or Alaskan Native descent as described in 42 CFR Section 136.12. For
more information, please visit: http://www.ihs.gov.
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. For more information, please see the
Native Hawaiian Health Care Act of 1988 (Public Law 100-579), as amended by Public
Law 102-396, and http://healthfinder.gov/orgs/HR3600.htm.
Rural Health Clinic. An entity that 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. For more information, please visit:
http://www.cms.hhs.gov/center/rural.asp.
Skilled Nursing Facility (SNF). An institution (or a distinct part of an institution),
certified under section 1819(a) of the Social Security Act, that is primarily engaged in
providing skilled nursing care and related services to residents requiring medical,
rehabilitation, or nursing care and is not primarily for the care and treatment of mental
diseases. For more information, please visit: http://www.cms.hhs.gov/center/snf.asp.
State or Local Public Health or Human Services Department. 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 or other health care facilities that are operated by the Department.
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.
Home Health Agency. An agency or organization, certified under section 1861(o) of the
Social Security Act that is primarily engaged in providing skilled nursing care and other
therapeutic services. For more information, please visit:
http://www.cms.hhs.gov/center/hha.asp.
Hospice Program. An agency or organization, certified under section 1861(dd)(2) of the
Social Security Act, that provides 24-hour care and treatment services (as needed) to
terminally ill individuals and bereavement counseling for their immediate family
members. This care is provided in individuals’ homes, on an outpatient basis, and on a
18

short-term inpatient basis, directly or under arrangements made by the agency or
organization.
m. Non-Disproportionate Share Hospital. An institution in a State that is primarily engaged
in providing care, by or under the supervision of physicians, to inpatients: (a) diagnostic
and therapeutic services for medical diagnosis, treatment, and care of injured, disabled,
or sick persons, of (b) rehabilitation of injured, disabled, or sick persons. Hospital-based
outpatient services are included under this definition.
n. Nursing Home. An institution (or a distinct part of an institution), certified under
section 1919(a) of the Social Security Act, that 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) that
can be made available to them only through institutional facilities, and is not primarily
for the care and treatment of mental diseases. For more information, please visit:
http://www.medicare.gov/Nursing/Overview.asp.
Ineligible facilities include, but are not limited to:
(1) Free-standing clinics that do not qualify as a facility above;
(2) Renal dialysis centers;
(3) Private practice offices;
(4) Assisted living facilities; and
(5) Clinics in prisons and correctional facilities.
If a participant is not sure whether a facility fits into one of the categories above, please contact
the facility’s business office or human resources department.
NSP participants must provide full-time (or if approved, part-time) clinical service in a CSF.
Participants are expected to serve in Tier 1 of the CSFs (See below). NSP participants who must
relocate to accept a position in a different geographic area will not receive a relocation
incentive or reimbursement.
Critical Shortage Facilities
Critical Access Hospital; Disproportionate Share Hospital;
Federally Qualified Health Center; Indian Health Service
Health Center; Public Hospital; Native Hawaiian Health
Center; Rural Health Clinic; Skilled Nursing Facility; State or
Local Public Health or Human Services Department

Ambulatory Surgical Center; Nursing Home; Home Health

Primary Care or
Mental Health
HPSA Score 14
or above
Primary Care or
Mental Health
HPSA Score
between 10 – 13
Primary Care or
Mental Health
HPSA Score
between 0 – 9

Tier 1

Primary Care or

Tier 4

Tier 2

Tier 3

19

Agency; Hospice Program; and Non-Disproportionate Share Mental Health
Hospital
HPSA Score
between 0-25
What is a HPSA and how do I locate a facility’s HPSA score?
Health Professional Shortage Areas (HPSAs) are designated by the Health Resources and
Services Administration (HRSA) as having shortages of primary medical care, dental or mental
health providers and may be geographic, population, or institutional. NSP will only be using
primary medical care and mental health HPSA designations and scores. For more information
on HPSA designations, please visit http://bhpr.hrsa.gov/shortage/.
Participants should consult the HPSA websites listed below:
 http://datawarehouse.hrsa.gov/GeoAdvisor/ShortageDesignationAdvisor.aspx: Enter
the facility’s address to see if the facility is located in a HPSA. Please note that once the
results are generated, the facility MUST be located in a primary medical care or mental
health HPSA. More specifically, “Yes” must appear beside “In a Primary Care (or Mental
Health) Health Professional Shortage Area”. The primary care/mental health HPSA
score(s) will appear beneath the respective designation(s).
 http://hpsafind.hrsa.gov: Find HPSAs by State, county, and discipline (select only
primary medical care or mental health).
A HPSA score or HPSA designation status may change on the HPSA websites over time. A
facility may be deemed as a Tier 1 CSF at the time the NSP participant begins nursing school but
may become a Tier 3 CSF by the time the participant completes nursing school. If a facility has
more than one designation with different scores, NSP will use the highest score.
Can I leave my NSP-approved Critical Shortage Facility prior to completion of service?
The NSP expects that a participant will fulfill his or her obligation at the NSP-approved CSF;
however, the NSP does understand that circumstances may arise that require a participant to
leave the initial facility and complete service at another NSP-approved CSF. If a participant feels
he or she can no longer continue working at the approved facility, the participant should
contact the NSP. All transfers must be approved by the NSP. A transfer request should be
submitted before the participant leaves his or her site. Leaving the assigned site without prior
written approval may result in a default recommendation.
BREACHING THE CONTRACT
What is a breach of the NSP Contract?
A participant is in breach of the NSP contract if he or she:
(1)
(2)
(3)
(4)

Fails to maintain an acceptable level of academic standing in the nursing program;
Is dismissed from the nursing program for disciplinary reasons;
Voluntarily terminates or withdraws from the nursing program; or
Fails to begin or complete the service obligation as specified in the participant’s NSP
contract.
20

What happens if I breach the NSP Contract?
The participant will be liable to the Federal Government to repay all funds paid to the
participant, or on the participant’s behalf, under the NSP and 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. Please note that
participants who default on their NSP contract will be ineligible to participate in federal loan
repayment programs, including the Nursing Education Loan Repayment Program.
What happens if a debt incurred by a breach of contract is not paid?
Failure to repay the NSP debt within 3 years will result in delinquency and 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 U.S. Department of Justice for enforced collection.
(3) Administrative offset. Federal and/or State payments due to the participant (e.g., an
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.
SUSPENSION & WAIVER
What should I do if I cannot continue my service or payment obligation?
The Secretary of Health and Human Services may, under certain circumstances, suspend (put
“on hold”) or waive (excuse) the NSP service or payment obligation. A request for a suspension
or waiver must be submitted through the Customer Service Portal. Additional supporting
documentation will be required following submission of the request.
(1)

Suspension. This mechanism provides temporary relief to an NSP participant if he/she
has short-term (not permanent) circumstances that currently make compliance with
the obligation impossible or would involve an extreme hardship such that
enforcement of the obligation would be unconscionable. Periods of approved
suspension will extend a participant’s NSP service obligation end date.
The major categories of service suspensions are set forth below.
a. Medical or Personal Hardship – A suspension may be granted for up to one year,
if the participant provides independent medical documentation of a physical or
mental health disability, or personal hardship, including a terminal illness of an
21

immediate family member, which results in the participant’s temporary inability
to perform the NSP service obligation. Upon receipt of the suspension request,
the NSP will notify the participant of instructions for submitting supporting
documentation.
b. Parental (Maternity/Paternity/Adoption Leave)–Participants must notify the
NSP of pending parental leave and provide appropriate documentation. Parental
leave of 12 weeks or less will be automatically approved, if properly
documented. If the participant’s parental leave will exceed 12 weeks during that
service year, a suspension may be granted by the NSP based on documented
medical need or if additional parental leave time is permitted under State law.
c. Call to Active Duty in the Armed Forces – Participants who are also military
reservists and are called to active duty will be granted a suspension, for up to
one year, beginning on the activation date described in the reservist’s call to
active duty order. In addition to the written request for a suspension, a copy of
the order to active duty must be submitted to NSP. The suspension will be
extended if the applicable Armed Forces entity continues the period of active
duty. The period of active military duty will not be credited toward the NSP
service obligation.
(2)

Waiver. A waiver permanently relieves the participant of all or part of the NSP
obligation. A waiver will be granted only if the participant demonstrates that
compliance with his/her obligation (a) is permanently impossible or (b) would involve
an extreme hardship such that enforcement of the obligation would be
unconscionable. A request must be submitted in writing to the NSP and must specify
the reason(s) the waiver is being sought. The participant will be contacted directly by
the NSP regarding the medical and financial documentation necessary to process the
waiver request. Please note that waivers are not routinely granted, and require a
demonstration of compelling circumstances.

When would my service obligation be cancelled?
A participant’s obligation will be cancelled only in the unfortunate event of death. No liability
will be transferred to the participant’s heirs.

22

HOW TO APPLY
APPLICATION AND PROGRAM GUIDANCE
Please read the Application and Program Guidance in its entirety before proceeding with the
online application. This Guidance explains in detail the contractual obligations of NSP
participants and the Secretary of Health and Human Services or his/her designee. Be sure you
have a complete understanding of the obligation to serve for a minimum of 2 years at a Critical
Shortage Facility and the financial consequences of failing to perform that obligation.
Applicants should keep a copy of the application package for their records.
APPLICATION DEADLINE
The online application and all supporting document must be submitted to the BCRS Program
Portal at https://programportal.hrsa.gov/ by 5:00 p.m. EST on May 8, 2012. Applicants are
strongly encouraged to upload all supporting documents in PDF format to expedite processing
of their application.
A complete application package consists of:
(1) A complete online NSP application through https://programportal.hrsa.gov/;
(2) All required supporting documentation (PDF format preferred);
AND if applicable,
(3) A letter on official letterhead from the entity to which the applicant’s existing service
obligation is owed, indicating there is no potential conflict in fulfilling the service
commitment to the NSP and that the NSP service commitment will be served first.
The following supporting documents are required of each applicant:










Completed Authorization to Release Information;
Proof of U.S. Citizenship, U.S. national or Lawful Permanent Resident (Acceptable
documents include: copy of birth certificate, certificate of citizenship or naturalization,
U.S. passport ID page, or Green Card);
Completed Verification of Acceptance/Good Standing Report;
Copy of Student Aid Report;
Completed Academic Recommendation Letter;
Completed Non-Academic Recommendation Letter;
Completed Essay Questions;
Resume/Curriculum Vitae; and
Copy of Academic Transcript(s) (Transcripts may be official or unofficial. However,
course grades must be included.).

Applicants are responsible for submitting a complete application package. Application packages
will be initially reviewed to determine completeness. Application packages deemed incomplete
(e.g., missing, illegible, or incomplete application materials) as of the May 8, 2012 deadline will
not be considered for funding. It is required that the information in your online application
23

match your supporting documents. Erroneous information and/or illegible documentation
could result in your application receiving an inaccurate ranking and not being considered for
funding.
Supporting Documentation
All supporting documentation must be uploaded by May 8, 2012. PDF file uploads are strongly
encouraged to ensure uploaded documents can be reviewed.
(1) Authorization to Release Information Form
This form authorizes the Department of Health and Human Services (DHHS), and/or its
contractors, to release information that identifies the applicant for purposes of coordinating
financial aid at schools and checking whether the applicant appears on the Excluded Parties
List System. It also authorizes the applicant’s school and future service entity to release
information to DHHS and/or its contractors.
(2) Documentation of Status as a U.S. Citizen, U.S. National, or Lawful Permanent Resident
Applicants must provide proof of U.S. citizenship or status as a U.S. National or Lawful
Permanent Resident. Acceptable documents include: a copy of a birth certificate, certificate
of citizenship or naturalization, U.S. Passport ID page, or Green Card. A driver’s license
and/or social security card are not valid proof of citizenship.
(3) Completed Verification of Acceptance/Enrollment Verification Form
The NSP uses the Verification of Acceptance and Enrollment Verification Forms to confirm
the student’s enrollment and status, the start date for the 2012-2013 academic year,
expected date of graduation, grade point average, institution’s name and address, and the
official contact person for the school of nursing.
(4) Student Aid Report
Applicants must provide a complete copy of their official Student Aid Report (SAR) which
summarizes all the information provided on the FAFSA. The SAR will contain the applicant’s
Expected Family Contribution (EFC), the number used in determining eligibility for federal
student aid. The EFC should appear in the upper portion of a paper or electronic SAR in
addition to a SAR ‘expiration’ or ‘valid through’ date. The NSP will deem partial or expired
SAR submissions as incomplete. Applicants can request a copy of their official SAR from the
Department of Education by calling 1‑800‑4‑FED‑AID (1‑800‑433‑3243) or via email at
[email protected].
(5) Completed Academic Recommendation Letter
Applicants must obtain a recommendation letter from a non-relative academic official such
as a department chair, faculty advisor, or a faculty member of their current academic
nursing program (or most recent academic program if the applicant has not begun the
nursing program).
The academic official’s recommendation letter must contain the student’s first initial and
last name and the last four digits of the social security number. The recommender must
describe his or her relationship and length of time acquainted with the applicant. The
recommendation letter should address the three discussion points found in the instructions
in “School Year 2012-2013 Application: Supporting Documents.” The letter must be on the
24

institution’s letterhead and must have the evaluator’s name printed, title, address (unless
already on the letterhead), and signature.
(6) Completed Non-Academic Recommendation Letter
The non-academic letter is used to assess the applicant’s compatibility to serve populations
of greatest need. The evaluator must complete the letter on official letterhead if
representing an organization.
The non-academic recommendation letter must contain the student’s first initial and last
name and the last four digits of the social security number. The evaluator must describe his
or her relationship and length of time acquainted with the applicant. The evaluator may not
be a relative of the applicant, or be the same individual who completed the Academic
Recommendation letter. The letter should address the discussion points found in the
instructions in “School Year 2012-2013 Application: Supporting Documents.”
(7) Completed Essay Questions
The applicant must provide typed responses to the three essay questions listed below, one
page per essay. Each response must be limited to 2,500 characters or less (approximately ½
page). The applicant must provide the first initial and last name and the last four digits of
the social security number at the top of each document.
Essay 1: How will you contribute to the mission of the Nursing Scholarship
Program in providing care to underserved communities?
Essay 2: What defines an underserved community? What experiences have
you had that have prepared you to work with underserved populations?
Essay 3: Please discuss your commitment to pursue a career in nursing.

(8) Resume/Curriculum Vitae (CV)
Applicants must provide a resume/CV that summarizes their educational qualifications,
work experiences, and volunteer/community service in chronological order. The resume/CV
must also include the location (city/state) where the experience took place.
(9) Academic Transcripts
Applicants must submit official or unofficial transcripts from all post-secondary academic
institutions/programs attended, including their current school. If the applicant is not
currently or has not previously been enrolled in a post-secondary academic
institution/program, a complete high school transcript should be submitted. The uploaded
transcript must be legible and include the applicant’s school name, courses taken, grades
received for each course, and cumulative Grade Point Average.
Application Status
(1) The deadline for submitting an online application and supporting documentation is 5:00pm,
EST, May 8, 2012.

25

(2) Applicants will receive a receipt of submission notice once the application has been
successfully submitted online.
(3) The application review process will take approximately three to four months. Applicants
selected for an NSP award will be notified by email. Applicants may opt to accept or decline
the NSP award. In order to be awarded, applicants selected for an award must sign the NSP
contract, complete the online banking form for direct deposit, the Enrollment Verification
Form, and the W-4 form.
Awards are subject to the availability of funds. Applicants selected for an award will receive
notice no later than August 31, 2012. Applicants not selected for an award will be notified no
later than September 30, 2012.

26

DEFINITIONS
(1) ACCEPTABLE LEVEL OF ACADEMIC STANDING –The level at which a student retains
eligibility to continue attending school under the school’s standards and practices.
Applicants on academic probation will not be considered as in an acceptable level of
academic standing by the NSP.
(2) ADMINISTRATIVE OFFSET – Administrative offset is the withholding of funds payable by
the United States to, or held by the United States for, a person to satisfy a debt. For NSP
participants who received overpayments which have not been repaid, the NSP will
withhold scholarship funds payable to, or on behalf of, the participant (including stipends,
ORC payments, and, if necessary, tuition payments) until the overpayment owed is paid in
full. Administrative offset is not a repayment option for NSP participants who wish to
terminate a contract.
(3) CONTRACT – A written contract under Section 846(d) of the Public Health Service Act, as
amended, for an academic 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 academic year.
(4) DEFAULT OF SERVICE OBLIGATION – Failure for any reason to begin or complete a
contractual service obligation.
(5) ELIGIBLE REQUIRED FEES – Fees that may be covered by NSP if required by a participant’s
school, include:


Academic Support
Services Fee



Education Fee



Matriculation Fee



Administrative Fee



Graduation Fee in last year of
program



Processing Fee



Facility Fee





Recreation Fee



Campus Life Fee



Health Insurance (Must be
required of all students
regardless of source of funding)
Health Services Fee and
Immunizations



Student Activities Fee



Computer Lab Fee



Laboratory Fees



Student Services Fee



Curriculum Fee



Library Fee



Technology Fee



Disability Insurance
(Must be required of all
students regardless of
source of funding)



Malpractice Insurance if it is
mandatory that it be purchased
through the school by all nursing
students



University Fee

27

(6) EXCLUDED PARTIES LIST SYSTEM - A world wide web site, www.epls.gov, maintained by
the General Services Administration for the purpose of disseminating information on
parties that are excluded from receiving federal contracts, subcontracts, and federal
financial and non-financial assistance and benefits, pursuant to E.O. 12549, E.O. 12689,
and implementing regulations.
(7) EXPECTED FAMILY CONTRIBUTION – The Expected Family Contribution (EFC) is the
amount of money your family is expected to contribute to your college education for one
year, as determined by the Department of Education in your Student Aid Report.
(8) FULL-TIME CLINICAL PRACTICE – Full-time practice is defined as the provision of nursing
services for a minimum of 32 hours per week. At least 26 hours per week, of the minimum
32 hours per week, must be spent providing clinical services (direct patient care) to
patients. No more than 35 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 35 work days in a 52-week service year will
extend the service obligation end date or result in a breach of contract, as determined by
the NSP.
(9) 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.
(10) 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 or university is
accredited.
(11) INELIGIBLE FEES –Ineligible Fees include:


Accident Insurance



Educational
Associations



Personal Laundry



Attorney Fee



Financial Aid Trust
Funds



Post Office Box Rental



Automobiles and Related
Expenses



ID Maintenance



Refundable Property
Deposit



Books (books are covered
by the Other Reasonable
Cost payment)



Late Charges



Room, Board, and Meal
Plan Expenses



Certification Boards



Life Insurance



Student Association and
Union Fee



Class Dues



NCLEX Review



Study Abroad Fees

28



Counseling Fees



Parking Fee



Testing Fee



Dental Insurance



Penalty Fee



Transportation Fee

(12) INITIAL SCHOOL OF RECORD - The school indicated on the NSP application and attended
at the time the initial contract is executed.
(13) 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 participant is required to notify the NSP immediately through the Customer
Service Portal 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 benefits is
discontinued when a participant 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.
(14) LOCATED IN A STATE, THE DISTRICT OF COLUMBIA, OR A TERRITORY – 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.
(15) PART-TIME CLINICAL PRACTICE – Part-time practice is defined as provision of nursing
services for a minimum of 16 hours per week (up to a maximum of 31 hours per week). At
least 80% of the hours each week must be spent providing clinical services (direct patient
care) to patients. No more than 35 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 35 days in a 52-week service year will extend
the service obligation end date or result in a breach of contract, as determined by the
NSP.
(16) 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).
(17) 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 full-time 24month program that begins on August 3, 2012, and he/she signs contracts for 2 school
years, the student will receive stipend, ORC and tuition payments from July 1, 2012
through June 30, 2014. Funding for the extra months of the program beyond June 30,
2014, would require a request for a third year of scholarship funding, and if granted,
obligates the participant to 3 years of full-time service. If a student is in a 24-month
29

program that begins on May 3, 2012, and he/she signs contracts for 2 school years, the
student will receive stipend, ORC and tuition payments from July 1, 2012, through June
30, 2014, or the month the participant completes the required classes for graduation,
whichever comes first.
(18) SUSPENSION – A temporary status. A suspension of the service or payment obligation will
be granted if compliance with the obligation by the participant (1) is temporarily
impossible or (2) would involve a temporary extreme hardship such that enforcement of
the obligation would be unconscionable. All requests for a suspension must be submitted,
in writing, to the Division of Program Operations and be supported by full medical and/or
financial documentation.
(19) 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.
(20) UNDERGRADUATE NURSING PROGRAM – Any school of nursing program where
graduates will be authorized to sit for the National Council Licensure Examination–
Registered Nurse (NCLEX-RN) (i.e., where students will receive a Diploma, Associate, or
Baccalaureate degree). See Section 801 of the Public Health Service Act for a full and
complete definition of these terms. The educational programs in the school of nursing
must be accredited by a national nursing accrediting agency or state approval agency
recognized by the Secretary of the U.S. Department of Education.
(21) 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.
(22) WAIVER – A permanent status. A waiver of the service or payment obligation will only be
granted if compliance with the obligation by the participant (1) is permanently impossible
or (2) would involve a permanent extreme hardship such that enforcement of the
obligation would be unconscionable. All requests for a waiver must be submitted via the
Customer Service Portal and be supported by full medical and financial documentation.

30

FREQUENTLY ASKED QUESTIONS
1. How do I apply to the Nursing Scholarship Program?
The application deadline for the 2012-2013 academic year is 5 pm EST, May 8, 2012. Those
interested in applying to the Nursing Scholarship Program should read the Application &
Program Guidance. To apply for the Nursing Scholarship Program, complete the online
application and submit the required Supporting Documentation. Please read the “How to
Apply Section” for instructions on completing the application and the supporting
documentation.
2. What if I change my mind about going into nursing after I have accepted the Nursing
Scholarship?
Accepting a Nursing Scholarship is a serious commitment to serve as a registered nurse in a
facility with a critical shortage of nurses. If you accept the scholarship and change your
mind about nursing before you have completed nursing school or your service commitment,
you have breached your contract with the U.S. Government and must pay back all monies
paid to you directly and to the school on your behalf, with interest. The amount owed,
including interest, must be paid within 3 years of the date of your default. Please note that
participants who default on their NSP contract are ineligible to participate in federal loan
repayment programs, including the Nursing Education Loan Repayment Program.
For more information, see “Breaching the Contract.”
3. What is an eligible health facility where Nursing Scholarship Program participants can
fulfill the service obligation?
NSP participants are expected to serve at a Tier 1 Critical Shortage Facility.
Type of Facility

Tier 1

Critical Access Hospital; Disproportionate Share
Hospital; Federally Qualified Health Center; Indian
Health Service Health Center; Public Hospital; Native
Hawaiian Health Center; Rural Health Clinic; Skilled
Nursing Facility; State or Local Public Health or
Human Services Department

Critical Shortage Facility
HPSA Score
Primary Care or Mental
Health HPSA Score 14 or
above

NSP participants are responsible for finding their own employment site and confirming its
eligibility with the Program. The NSP reserves the right of final approval to ensure a
participant’s compliance with statutory requirements related to the service obligation.
For more information, see “Service Requirements and Eligible Sites under NSP?”

31

4. Are there any sites where I could be employed as a nurse that would not fulfill the
Nursing Scholarship service obligation?
Ineligible facilities include, but are not limited to:
Renal Dialysis Centers; Private Practice Offices; Assisted Living Facilities; Clinics in Prisons
and Correctional Facilities; and Free Standing Clinics that do not qualify as one of the
facilities listed in the Application and Program Guidance under “Service Requirements and
Eligible Sites under NSP.”
For more information, see “Service Requirements and Eligible Sites Under NSP.”
5. What type of nursing degree program must I be accepted or enrolled in to apply for the
Nursing Scholarship Program?
NSP participants may be enrolled or accepted for enrollment in an accredited associate,
collegiate (baccalaureate or graduate level), or diploma school of nursing. See Section 801
of the Public Health Service Act for a full and complete definition of these terms. The
educational programs in the school of nursing must be accredited by a national nursing
accrediting agency or state approval agency recognized by the Secretary of the U.S.
Department of Education.
Students enrolled in LPN programs, bridge/dual-degree programs that are not RN to BSN
programs, and self-paced study programs are not eligible to apply.
For information on Nursing Scholarship Program eligibility requirements, see “Eligibility
Requirements.”
6. How many hours must I work at a health care facility with a critical shortage of nurses to
be considered full-time?
Full-time employment is considered to be no less than 32 hours of nursing services per
week. At least 26 hours of the minimum 32 hours per week must be spent providing clinical
services (direct patient care) to patients.
Participants wishing to serve part-time must obtain prior approval from the NSP and must
extend the service obligation to equal the full-time commitment.
For more information, see “Understanding the Contract and Length of the Service
Commitment.”
7. When does the Nursing Scholarship service obligation begin?
Nursing participants have up to 6 months from the date of graduation to (1) obtain a
nursing license and (2) accept an offer of employment from an NSP approved facility.
Participants have up to 3 months following the day of their acceptance of such job offer to
commence full-time (or if approved part-time) clinical services at a Critical Shortage Facility.
32

For more information, see “Service Requirements and Eligible Sites Under NSP.”
8. How much is the Nursing Scholarship Program monthly stipend and when is the payment
made?
For the 2012-2013 academic year the monthly stipend will be $1,289. The stipend is
disbursed by the end of each month; payments are not considered late until the 15th of the
following month. The first stipend payment is issued in November and includes a lump sum
payment for all months of the Fall term (July through October).
For more information, see “Tuition, Required Fees, Other Reasonable Costs, and Stipend.”
9. Is the entire Nursing Scholarship taxable?
All Nursing Scholarship Program payments made to and on behalf of the participant (tuition,
fees, Other Reasonable Costs, and stipend) are considered taxable income.
For more information, see “Tuition, Required Fees, Other Reasonable Costs, and Stipend.”
10. If I am selected to receive a Nursing Scholarship, when will I receive tuition payment?
Payment of tuition and fees are made directly to the school on the participant’s behalf.
The Notice of Award Letter issued by the NSP to the participant serves as authorization to
the school to bill the Nursing Scholarship Program directly for tuition and required fees.
It is the participant’s responsibility to take the Notice of Award Letter to the appropriate
school officials. It takes approximately 6 weeks from date of receipt of the invoice by the
Nursing Scholarship Program for the school to receive payment. For more information,
see “Tuition, Required Fees, Other Reasonable Costs, and Stipend.”
11. If I am selected to receive a Nursing Scholarship, will the program cover tuition and fees if
my program started prior to July 1, 2012?
Yes, the Nursing Scholarship Program will pay tuition and required fees for summer sessions
when (1) summer school is an academic term normally required by the school for all
students in the same program and (2) the summer session is in progress during the
participant’s contract period.
For more information, see “Tuition, Required Fees, Other Reasonable Costs, and Stipend.”
12. How are Nursing Scholarship stipend and other reasonable cost payments issued?
Nursing Scholarship stipend and other reasonable cost payments are transferred
electronically to each participant’s financial institution through direct deposit. Direct
deposit is mandatory.
For more information, see “Tuition, Required Fees, Other Reasonable Costs, and Stipend.”

33

13. What happens if tuition has been paid by another source of financial aid before the
participant receives notice of the Nursing Scholarship?
Tuition and fees are paid directly to the educational institution that the scholarship
participant is attending.
If tuition and fees for the initial Summer and/or Fall term of the academic year have been
paid by another scholarship or a grant (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.
If a scholarship participant has taken out a student loan to cover the cost of tuition and fees
for their initial summer and/or fall semester(s) while waiting for notice of an NSP award, the
student should supply an itemized invoice to the NSP showing the amount of tuition and
fees paid for with the student loan. The NSP will then pay that amount to the academic
institution.
For more information, see “Tuition, Required Fees, Other Reasonable Costs, and Stipend.”
14. Does the Nursing Scholarship cover additional books or materials a participant is required
to purchase during the school year?
During the fall of the school year, the Nursing Scholarship Program makes a single "other
reasonable cost" payment to the participant. This payment is to assist with covering
expenses for required materials such as books, clinical supplies/instruments, and uniforms
during that school year. If additional expenses for books and other materials arise, those
expenses are not covered by the Nursing Scholarship Program. The participant is
responsible for paying those expenses.
15. Is health insurance coverage included in the fees paid for by the Nursing Scholarship
Program?
If health insurance is required and purchase through the school is mandatory, the cost can
be included in the fees paid by the Nursing Scholarship Program to the school. Insurance
for family members is not covered.
If the required insurance is purchased through any other source, then the school will not be
allowed to submit the costs for the insurance fee.
16. Can the rules change after an individual selected to receive the Nursing Scholarship has
accepted the scholarship?
NSP participants may be subject to changes in the statute, regulations, and/or policies of
the Nursing Scholarship Program that occur after they have received their awards.
17. What happens if a Nursing Scholarship Program participant takes a leave of absence
and/or repeats course work while attending the nursing program?
The Nursing Scholarship Program will discontinue the payment of all benefits during a leave
of absence approved by the school (for personal, medical or other reasons). If the
34

participant is repeating course work for which the NSP has already paid, the NSP will not
pay for that repeated course work but may maintain payments for stipends and all other
non-repeated course work provided that the participant continues to meet the NSP
requirements.
For more information, see “Changes in Scholarship Payment.”
18. What happens if the Nursing Scholarship Program runs out of money or is discontinued?
When a scholarship is awarded, funds are obligated (set aside) for the number of school
years of support requested by the participant and agreed to by the Secretary of the U.S.
Department of Health and Human Services, as indicated by the signed contract(s).
If the participant did not sign contracts through the date of graduation, he/she will be given
priority for continued funding when the existing scholarship support ends. Continuation
funding will be subject to the availability of future funding and the continued existence of
the NSP.
For more information, see “Understanding the Contract and Length of the Service
Commitment.”
19. When can an NSP participant start applying for positions to fulfill the service
commitment?
Participants have up to six months from the date of graduation to obtain a nursing license
and accept an offer of employment from an NSP-approved Critical Shortage Facility.
Participants have up to three months following the day of their acceptance of such a job
offer to commence full-time (or, if approved, part-time) work providing clinical services at
the Critical Shortage Facility.
20. Who pays the salary of an NSP participant fulfilling the service commitment?
The health care facility that employs the NSP participant pays the participant’s salary. Each
NSP participant negotiates his/her own salary and benefits packages with the Critical
Shortage Facility where he/she is employed after graduation. There is no "typical" salary.
Salaries vary by employing facility and location.
21. What is the Expected Family Contribution (EFC) and what if mine needs to be updated?
The EFC (Expected Family Contribution) is part of the Student Aid Report (SAR) that you
receive when you complete the Free Application for Federal Student Aid (FAFSA).
The EFC measures a student's expected family contribution in terms of the ability to pay for
educational costs. It is used to determine eligibility for Federal student aid. The Nursing
Scholarship Program has a funding preference for applicants of greatest financial need,
defined as qualified applicants with an EFC between $0 and $5,550.

35

The Nursing Scholarship Program uses the EFC listed on the Student Aid Report. If your EFC
has changed due to special circumstances, the Student Aid Report must be corrected. Call
1-800-433-3243 to speak with the Federal Student Aid Information Center about your
situation and obtain help updating your FAFSA. If your EFC changes before the NSP
application cycle closes, you must notify the NSP. The NSP will reconsider your application
based on this change.
22. What does the Nursing Scholarship Program mean when it says participants must make
"at least a two-year service commitment”?
Individuals who receive the Nursing Scholarship are required to serve, at a minimum, a twoyear full-time service obligation (or its part-time equivalent). NSP participants who receive
less than 2 years of scholarship support will still owe the equivalent of 2 years of full-time
service. The service obligation is extended by one year for each full-time year of Nursing
Scholarship support received beyond two years.
For more information, see “Understanding the Contract and Length of the Service
Commitment.”
The Nursing Scholarship Program hopes that participants will remain at their service sites
and continue serving those in need even after the service commitment is fulfilled.
Participants who have satisfactorily completed their service commitment and are working
at eligible public or nonprofit private facilities may apply to the Nursing Education Loan
Repayment program to obtain funds to repay a portion of the outstanding balance on
qualifying education loans.
23. What are the computer requirements for the online portion of the Nursing Scholarship
Program application?
The NSP recommends the following browsers when completing the online application:
Internet Explorer 8, Firefox, Chrome 6, or Safari 5.
24. Are students accepted for enrollment or enrolled in bridge/dual degree programs eligible
for the Nursing Scholarship Program?
Students enrolled in an RN to BSN bridge program are eligible for the NSP. Students
enrolled in any other bridge program or dual degree program are not eligible to apply to the
NSP. This includes any combined associates/bachelors program or combined
bachelors/masters program.
For complete eligibility information, see “Eligibility Requirements.”
25. Where do I send my Nursing Scholarship Program supporting documentation?
Please upload your NSP supporting documents to the NSP Online Application:
https://programportal.hrsa.gov/. Applicants are strongly encouraged to upload all
36

supporting documents in PDF format to expedite processing of their application. Materials
must be received by the application deadline (EST 5:00 p.m., May 8, 2012).
26. How may I check the status of my Nursing Scholarship Application?
Applicants will receive a receipt of submission notice once the application has been
successfully submitted online. Status and confirmation of receipt will be provided for
uploaded documents. Individuals selected for awards will be notified by e-mail no later
than August 31, 2012. Individuals not selected for an NSP award will be notified by e-mail
no later than September 30, 2012.
27. Can a Nursing Scholarship Program participant transfer schools and still receive NSP
support?
Transferring to another school or changing programs is strongly discouraged once the
applicant has been accepted into the NSP. Transferring to another school or changing
programs will be considered only for exceptional circumstances and must be approved in
advance to ensure continued eligibility for funding.
28. Can I make changes to my banking information after it has been submitted?
No, only the NSP staff can enter any relevant changes to the online banking information
once it has been submitted and a "Receipt of Submission" is received by the applicant.
However, applicants can request a change to their banking information by completing the
Banking Update Form, and faxing the completed form to the appropriate program staff to 1855-444-6032.
Please note: Only applicants who are selected for an NSP scholarship will be requested to
submit banking information.

37

NURSING SCHOLARSHIP PROGRAM
School Year 2012-2013 Forms

UPLOAD FORMS TO ONLINE APPLICATION
https://programportal.hrsa.gov

For Questions, please call 1-800-221-9393 (TTY: 1-877-897-9910), Monday through Friday
(except Federal holidays) 8:00am to 8:00 pm EST, or email [email protected].

OMB No. 0915-0301 Expiration: 9/30/2012
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. Disclosure of information sought is voluntary; however, if not
submitted, except for questions related to Race/Ethnicity on the online application, an application will be
considered incomplete and therefore will not be considered for an award. The information applicants supply
will be maintained in a system of records and subject to disclosure as set forth under the Privacy Act
Notification Statement in the NSP Application and Program Guidance. The public reporting burden for this
collection is estimated to average 5 hours 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.

Nursing Scholarship Program
U.S. Department of Health and Human Services

Health Resources and Services Administration

NURSING SCHOLARSHIP PROGRAM

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, academic
standing, enrollment and degree status, curriculum and examination requirements for graduation, tuition
and fees, 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), practice responsibilities, 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.

This authorization takes effect on the date that I sign this release form. If I do not become a participant, this
authorization shall remain in effect until September 30, 2012. If I become a participant, the above authorizations
shall remain in effect until the date my Nursing Scholarship commitment has been fulfilled. These authorizations
may be revoked by me in writing at any time.

_________________________________
(Signature of Individual)

____________
(Date)

(Last 4 Digits of Social Security Number)

Must be received by 5pm EST May 8, 2012

Please upload to the NSP Portal: https://programportal.hrsa.gov/

2
OMB No. 0915-0301 Expiration: 9/30/2012

Nursing Scholarship Program
U.S. Department of Health and Human Services

Health Resources and Services Administration

VERIFICATION OF ACCEPTANCE/GOOD STANDING REPORT
This Verification of Acceptance/Good Standing Report certifies that the student identified below has been accepted for admission
or is enrolled in good standing for the 2012-2013 academic year as indicated. (To be completed by a school official only.)

1. Student’s Name (Last, First, Middle)

2. Student’s Social Security Number (Last 4 digits)

__________________________________________

____________________________________________

3. Nursing program the student is admitted to/enrolled in:
Associate _____

Baccalaureate _____

Masters ______

Diploma _____

Doctoral _____

4. When will/did the student enter the nursing program for which funding is being requested: (mm/yy): _____
5. Is the student in good academic standing?

Yes

No

6. Is the student considered Full-Time or Part Time in the nursing program? Full-Time _____

Part-Time _____

7. Length of the full-time nursing program (years and/or months):
8. Date professional nursing classes begin for the 2012-2013 academic year (mm/yy):
9. Nursing program end date (Completion of required classes for graduation) (mm/yy):
10. Anticipated date of graduation (mm/yy):
11. Student’s total cumulative Grade Point !verage (GP!):
12. Is there a contingency to the student’s acceptance to the program? Examples include the student needing to
repeat a course or the student receiving an “Incomplete” status for a course.
Yes
No
If YES, please explain: ________________________________________________________________________

(All contingencies must be met by the start of the Fall 2012-2013 term.)
Nursing Program Accreditation (The NSP will only fund students attending fully accredited institutions)
Name of National or Regional Accreditation Organization:
Accreditation Expiration / Renewal Date: (mm/yy):
____________
Is accreditation provisional?
Yes
No
School Information

Nursing School Official Contact Information

Name of School:

Name & Title:

Address:

Phone Number:

City:

State:

Zip Code:

Fax:

E-mail Address:

By signing my name below, I certify that the information provided on this Verification of Acceptance/Good Standing Report is accurate and complete to the

best of my knowledge and belief. I understand that any willfully false information may be punishable as a felony under U.S. Code, Title 18, Section 1001.

Signature of Nursing School Official:

Date
Must be received by 5pm EST May 8, 2012

Please upload to the NSP Portal: https://programportal.hrsa.gov/

3
OMB No. 0915-0301 Expiration: 9/30/2012

Nursing Scholarship Program
U.S. Department of Health and Human Services

Health Resources and Services Administration

ESSAY QUESTIONS

Each response should be limited to 2,500 characters or less (approximately ½ page), one page
per essay. We recommend that you use a standard word processing tool (e.g., Microsoft Word,
Word Perfect) to respond to the questions. The applicant must provide the first initial and last
name and the last four digits of the social security number at the top of each document.

Essay 1: How will you contribute to the mission of the Nursing Scholarship Program in providing
care to underserved communities?

Essay 2: What defines an underserved community? What experiences have you had that have
prepared you to work with underserved populations?

Essay 3: Please discuss your commitment to pursue a career in nursing.

Must be received by 5pm EST May 8, 2012

Please upload to the NSP Portal: https://programportal.hrsa.gov/

4
OMB No. 0915-0301 Expiration: 9/30/2012

Nursing Scholarship Program
U.S. Department of Health and Human Services
Health Resources and Services Administration

NURSING SCHOLARSHIP PROGRAM
!C!DEMIC OFFICI!L’S RECOMMEND!TION LETTER - INSTRUCTIONS
If the applicant is currently enrolled in the nursing program, the letter should be from a non-relative
academic official - the applicant’s Department Chair, Faculty advisor or a Faculty member of that
academic program who is familiar with the student. If the applicant has not begun the nursing program
associated with the scholarship, the letter should be from the Department Chair, Faculty advisor, or a
Faculty member of the applicant’s most recent academic program who is familiar with the applicant; The
letter must be based on the academic official’s observations or knowledge of the applicant, and should
not be submitted by the same individual submitting the non-academic official recommendation letter.

The letter should be on the institution’s letterhead and include the following:








Student’s first initial and last name;
Last 4 Digits of Student’s Social Security Number;
Evaluator’s Name (Printed);
Title;
Address (unless already on letterhead);
Signature;
! description of the academic official’s relationship to the applicant and the length of time the
official has known the applicant;

AND

 A discussion of the following points:
1. The applicant’s education/work achievements;

2. The applicant’s ability to work and communicate constructively with other people; and,

3. The official’s assessment of the applicant’s particular characteristics, interest and motivation
to serve populations of greatest need in health professional shortage areas. This
assessment should include the official’s knowledge of the applicant’s work experiences,
pertinent course work, special projects, research, or other activities that demonstrate an
interest in and commitment to serving underserved populations.

Must be received by 5pm EST May 8, 2012

Please upload to the NSP Portal: https://programportal.hrsa.gov/

5
OMB No. 0915-0301 Expiration: 9/30/2012

Nursing Scholarship Program
U.S. Department of Health and Human Services
Health Resources and Services Administration

NURSING SCHOLARSHIP PROGRAM
NON-!C!DEMIC OFFICI!L’S RECOMMEND!TION LETTER - INSTRUCTIONS
The Non-Academic Recommendation Letter should be from a non-relative who is familiar with the
applicant’s professional, community and/or civic activities, especially those related to underserved
communities. The evaluator can be an employer or previous employer, community leader, colleague, or
anyone who has knowledge of the applicant’s interest and motivation to provide care to underserved
communities. The letter should not be submitted by the same individual submitting the academic
official recommendation letter.
The letter should include the following:








Student’s first initial and last name;
Last 4 Digits of Student’s Social Security Number;
Evaluator’s Name (Printed);
Title or Organization;
Address (unless already on letterhead);
Signature;
A description of the evaluator’s relationship to the applicant and the length of time the
evaluator has known the applicant;

AND
 A discussion of the following points:
1. The applicant’s community/civic or other non-academic achievements;

2. The applicant’s ability to work and communicate constructively with other people; and,

3. The evaluator’s assessment of the applicant’s particular characteristics, interest and
motivation to serve populations of greatest need in health professional shortage areas. This
assessment should include the evaluator’s knowledge of the applicant’s work experiences,
pertinent course work, special projects, research, or other activities that demonstrate an
interest and commitment to serving underserved populations.

If the letter is from an individual representing a particular organization or institution, the letter should
be on official letterhead.

Must be received by 5pm EST May 8, 2012

Please upload to the NSP Portal: https://programportal.hrsa.gov/

6
OMB No. 0915-0301 Expiration: 9/30/2012