Application Instructions

Please read the instructions and eligibility requirements carefully before completing the application.

Service Period Requirement:

The provider must serve for at least 12 consecutive months at an approved practice site to qualify for an annual loan repayment award. The first service period begins on the first day of the month in which the application is received.

Annual Award Amounts:

If the loan balance is less than the applicable maximum annual award amount (as shown below) times 4, then the annual amounts will be prorated to retire the balance over a period of four years (contingent upon continued annual grant funding).  Awards will also be prorated to the extent the provider is only providing a part-time service. Otherwise, the maximum annual award amounts are as follows:

• Physicians: $30,000/year or $120,000/total 
• Dentists: $30,000/year or $120,000/total 
• Physician Assistants: $15,000/year or $60,000/total
• Nurse Practitioners: $15,000/year or $60,000/total

The purpose of the St. David’s Foundation Public Health Corps Loan Repayment Program is to recruit and retain qualified primary care and behavioral health providers at eligible safety net sites located in the five-county area served by the Foundation. If you are selected for enrollment into the program, loan repayment funds will be reserved for annual disbursement at the end of each of the four years of service, contingent upon continued annual grant funding. We will mail the appropriate documents to you toward the end of each year of service, for your employer’s verification of your service and for your lender’s verification of loan information.

We will notify you by postal mail and e-mail regarding the disposition of your application.

Eligibilty Requirements: 

1. All providers must be a U.S. citizen or permanent legal resident (or otherwise be legally authorized to work in the United States), practice an approved practice specialty, and agree to provide four years of service at an approved practice site (outpatient primary care or behavioral health facility) NOTE: Funding under this program is currently only provided for the first year of service. Provider will be released from this agreement if grant funding is not continued for subsequent years of service.
2. Physicians must have a current unrestricted license from the Texas Medical Board and be board certified or eligible to take the exam from an American Specialty Board that is a member of the American Board of Medical Specialties or the Bureau of Osteopathic Speciists.
3. Dentists must have an unrestricted license from the Texas State Board of Dental Examiners.
4. Physician Assistants must be certified by the National Commission on Certification of Physician Assistants (NCCPA) or be eligible to take the exam offered by the NCCPA and work under the direction of a physician in the area of primary care and/or behavioral health.
5. Nurse Practitioners must be licensed as a Nurse Practitioner in the area of primary care and/or behavioral health or be eligible to take the exam offered by a national certifying body recognized by the Texas Board of Nursing and work under the direction of a physician in the area of primary care and/or behavioral health.

To be eligible for repayment, an education loan must:

• Be evidenced by a promissory note to pay for the cost of attendance for the provider’s undergraduate or graduate education at an accredited institution in the United States.  Loans made during residency are not eligible.  If the loan has been consolidated with other loans, the applicant must provide documentation of the portion of the consolidated debt that was originated to pay for the cost of attendance for the provider.
• Not have an existing service obligation and must not be subject to repayment through another student loan repayment or loan forgiveness program.

Priority and Preference:

If the number of qualified applicants exceeds available funding, priority will be given to physicians and dentists. Preference will be given for:

• New hires and/or providers who completed training within the past 2 years
• Bilingual providers (with preference for languages of the underserved populations, such as Spanish and Vietnamese)

Practice Site Requirements:

All clinical sites must be either tax-exempt under section 501(c) (3) of the Internal Revenue Code (e.g. primary care clinic, FQHC as defined below), a local mental health authority, or a governmental/public health facility (e.g. outpatient clinic, state psychiatric hospital). Sites must be located in: Bastrop, Caldwell, Hays, Travis, or Williamson County and have a primary focus on serving the underserved, including Medicaid, CHIP, Medicare, and other low-income under-insured or uninsured populations. All sites that are eligible to participate in National Health Service Corps (NHSC) programs must have submitted an NHSC site application and be approved for participation in that program. The following are listed in order of priority:

1. St. David’s Foundation-funded grant partner sites that are not Federally Qualified Health Centers (FQHCs)
2. St. David’s Foundation-funded grant partner sites that are FQHCs
3. FQHCs and other nonprofit primary care and/or behavioral health sites that are not St. David’s Foundation grant partners

Section A: Employer  Information

Section B: Employment Verification

Full-time clinical practice is defined as a minimum of 32.5 hours/ week. Awards for part-time service (minimun 20hours/week) will be proro-rated accordingly. DO NOT INCLUDE ON-CALL TIME: 

Section C: Certification

I represent, warrant, and certify the following:

1.       I am a U.S. citizen or a Legal Permanent Resident (or am otherwise legally authorized to work in the United States) and hold a full license, with no restrictions, to practice my profession in the State of Texas.

2.       I meet all program eligibility requirements, including the requirement that I am not currently fulfilling another obligation to provide medical services as part of a scholarship agreement, a student loan agreement, another student loan repayment agreement, or an employment agreement.

3.       I agree to provide four years of continuous service as a provider at the eligible clinical site described in Part C of this application, with the understanding that I will be released from this agreement if grant funding is not continued beyond current year funding.

4.       By my signature below, I authorize my employer to release information regarding my employment to TDA and I authorize TDA to share my application information (including any student loan records submitted by either myself or my lender relating to this program) with the St. David’s Foundation, with the understanding that TDA and/or the St. David’s Foundation (and any of their respective agents) may contact me in the future regarding my participation in this program and may use this information for purposes of reporting, auditing, and evaluating the impact of this program.

5.       The information contained in all parts of this application is true and correct to the best of my knowledge.

6.       I understand that (A) upon acceptance of the application, all information submitted with the application becomes subject to disclosure under the Texas Public Information Act (Texas Government Code Section 552.001 et seq.), unless an exception under the Texas Public Information Act is applicable and (B) the loan repayment awards are disbursed annually following my completion of 12 months of continuous eligible service and are contingent upon continued grant funding.