Minnesota Health Care Loan Forgiveness Forms

The forms listed here are for awardees and current participants only. Please do not complete and/or submit these forms unless instructed to do so by the Program Administrator.

If you have any question, please contact us at: health.loanforgiveness@state.mn.us

Forms for the eligible professions:

• Qualified Loan Form
• Verification Form


• Advanced Practice Provider Confirmation of Practice
• Advanced Practice Provider Verification of Employment


• Allied Health Care Faculty Confirmation of Practice
• Allied Health Care Faculty Verification of Employment


• Dentist Confirmation of Practice
• Dentist Verification of Employment


• Long Term Care Nurses Confirmation of Practice
• Long Term Care Nurses Verification of Employment


• Nurse Faculty Confirmation of Practice
• Nurse Faculty Verification of Employment


• Rural Dental Therapists/Advanced Dental Therapist Confirmation of Practice
• Rural Dental Therapists/Advanced Dental Therapist Verification of Employment


• Rural Mental Health Professional Confirmation of Practice
• Rural Mental Health Professional Verification of Employment


• Rural Pharmacist Confirmation of Practice
• Rural Pharmacist Verification of Employment


• Rural Physician Confirmation of Practice
• Rural Physician Verification of Employment


• Rural Public Health Nurse Confirmation of Practice
• Rural Public Health Nurse Verification of Employment


• Urban Mental Health Professional Confirmation of Practice
• Urban Mental Health Professional Verification of Employment


• Urban Physician Confirmation of Practice
• Urban Physician Verification of Employment


• Urban Advanced Practice Provider Confirmation of Practice (Psychiatric Nurse Practitioner Only)
• Urban Advanced Practice Provider Verification of Employment (Psychiatric Nurse Practitioner Only)