Form 1 S2S LRP - Receipt of Exceptional Financial Need Scholars

The National Health Service Corps Scholarship Program, Students to Service Loan Repayment Program, and the Native Hawaiian Health Scholarship Program

S2S 3 Exceptional Financial Need

S2S LRP - Receipt of Exceptional Financial Need Scholarship

OMB: 0915-0146

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Bureau of Clinician Recruitment and Service

U.S. Department of Health and Human Services

Health Resources and Services Administration





National Health Service Corps Students to Service Loan Repayment Program

Verification of Exceptional Financial Need (EFN)

(For School Use Only – Must be completed by a Financial Aid Official)



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Name of Student (First, Middle initial, last) Last 4 Digits of the Applicant’s SSN




The Financial Aid Officer identified below certifies that the above-named student


  • has received

  • has not received



a scholarship for students of Exceptional Financial Need (EFN) under section 758 of the Public Health Service Act and qualify for a funding priority (applicable to medical students only).



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Signature Printed Name Date


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Title Phone Email


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Name of School

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorLtoohey
File Modified0000-00-00
File Created2021-01-22

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