Participant Forms - Minnesota Loan Forgiveness and Repayment Program
| For application forms, see main Loan Forgiveness and Repayment Programs page. |
- Allied Health Care Faculty Loan Forgiveness Program
- Dentist Loan Forgiveness Program
- Nurse Loan Forgiveness Program
- Nurse Faculty Loan Forgiveness Program
- Rural Midlevel Practitioner Loan Forgiveness Program
- Rural Pharmacist Loan Forgiveness Program
- Rural Physician Loan Forgiveness Program
- Rural Veterinarian Loan Forgiveness Program
- Urban Physician Loan Forgiveness Program
- Minnesota State Loan Repayment Program
Allied Health Care Faculty Loan Forgiveness Program
Affidavit of Practice Form must be completed annually as evidence of service obligation (Fillable Word: 35KB/1 page or PDF: 20KB/1 page).
Payment Verification Form must be completed annually to confirm funds have been applied to loans.
Dentist Loan Forgiveness Program
Affidavit of Practice Form must be completed annually as evidence of service obligation (Fillable Word: 36KB/1 page or PDF: 21KB/1 page).
Payment Verification Form must be completed annually to confirm funds have been applied to loans.
Nurse Loan Forgiveness Program
Affidavit of Practice Form must be completed annually as evidence of service obligation (Fillable Word: 35KB/1 page or PDF: 20KB/1 page).
Payment Verification Form must be completed annually to confirm funds have been applied to loans.
Nurse Faculty Loan Forgiveness Program
Affidavit of Practice Form must be completed annually as evidence of service obligation (Fillable Word: 36KB/1 page or PDF: 21KB/1 page).
Payment Verification Form must be completed annually to confirm funds have been applied to loans.
Rural Midlevel Practitioner Loan Forgiveness Program
Affidavit of Practice Form must be completed annually as evidence of service obligation (Fillable Word: 35KB/1 page or PDF: 21KB/1 page).
Payment Verification Form must be completed annually to confirm funds have been applied to loans.
Rural Pharmacist Loan Forgiveness Program
Affidavit of Practice Form must be completed annually as evidence of service obligation (Fillable Word: 35KB/1 page or PDF: 12KB/1 page).
Payment Verification Form must be completed annually to confirm funds have been applied to loans.
Rural Physician Loan Forgiveness Program
Affidavit of Practice Form must be completed annually as evidence of service obligation (Fillable Word: 35KB/1 page or PDF: 12KB/1 page).
Payment Verification Form must be completed annually to confirm funds have been applied to loans.
Rural Veterinarian Forgiveness Program
Affidavit of Practice Form must be completed annually as evidence of service obligation (Fillable Word: 35KB/1 page or PDF: 15KB/1 page).
Payment Verification Form must be completed annually to confirm funds have been applied to loans.
Urban Physician Loan Forgiveness Program
Affidavit of Practice Form must be completed annually as evidence of service obligation (Fillable Word: 35KB/1 page or PDF: 21KB/1 page).
Payment Verification Form must be completed annually to confirm funds have been applied to loans.
Minnesota State Loan Repayment Program
Affidavit of Practice Form must be completed annually as evidence of service obligation:
- Affidavit of Practice - Part-time (Fillable Word: 35KB/1 page or PDF: 27KB/1 page).
- Affidavit of Practice - Full-time (Fillable Word: 35KB/1 page or PDF: 27KB/1 page).
Payment Verification Form must be completed annually to confirm funds have been applied to loans.
| All programs: Payment Verification Form must be completed annually to confirm funds have been applied to loans. | |
| Fillable Word: 87KB/1pg (complete online and email to mohamed.samaha@state.mn.us) | or print and complete |
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