Complete the form below in its entirety and submit to the Rick Davila prior to the close of the announcement along with a copy of your current loan statement reflecting the lending institution name, address and the balance of all outstanding student loans. Name: Occupation: Full-Time Part-Time Care Line: Department: Current Performance Rating: Outstanding Excellent Fully Less than Fully Successful Successful Have you previously received SLRP Yes No If yes, what is the total amount you were Funding: awarded? _____________ Are you currently serving a service Yes No If yes, when is the service agreement’s agreement? expiration date? ____/____/____ Are you a current participant in the Yes No Educational Debt Reduction Program (EDRP)? Current Outstanding Loan Balance: $______________ I have attached a copy of my loan statement reflecting the following: current Name of Address Current Loan Balance Lending of Institution Lender I understand that if approved for the Student Loan Repayment Program: 1) I am obligated to 3 years of service to the Department of Veterans Affairs, 2) I must maintain a minimum performance level of fully successful or better; and 3) I must have no adverse performance or conduct action pending. If I fail to fulfill this obligation, repayment of all funds received will be required. Signature Date Supervisor Recommendation Supervisors are required to recommend their employee for participation in the Student Loan Repayment Program. These recommendations will be used to make the final selection of recipients and should be individually tailored to the employee applying. Recommendations must include the following information: Justification for need of SLRP to retain this highly qualified employee. Verification that this organization would experience difficulty filling this position should this highly qualified employee leave. Supervisor’s Recommendation:
Complete the form below in its entirety and submit to the Rick Davila prior to the close of the announcement along with a copy of your current loan statement reflecting the lending institution name, address and the balance of all outstanding student loans. Name: Occupation: Full-Time Part-Time Care Line: Department: Current Performance Rating: Outstanding Excellent Fully Successful Less than Fully Successful Have you previously received SLRP Funding: Yes No If yes, what is the total amount you were awarded? _____________ Are you currently serving a service agreement? Yes No If yes, when is the service agreement’s expiration date? ____/____/____ Are you a current participant in the Educational Debt Reduction Program (EDRP)? Yes No Current Outstanding Loan Balance: $______________ I have attached a copy of my current loan statement reflecting the following: Name of Lending Institution Address of Lender Current Loan Balance I understand that if approved for the Student Loan Repayment Program: 1) I am obligated to 3 years of service to the Department of Veterans Affairs, 2) I must maintain a minimum performance level of fully successful or better; and 3) I must have no adverse performance or conduct action pending. If I fail to fulfill this obligation, repayment of all funds received will be required. Signature Date Supervisor Recommendation Supervisors are required to recommend their employee for participation in the Student Loan Repayment Program. These recommendations will be used to make the final selection of recipients and should be individually tailored to the employee applying. Recommendations must include the following information: Justification for need of SLRP to retain this highly qualified employee. Verification that this organization would experience difficulty filling this position should this highly qualified employee leave. Supervisor’s Recommendation:
SLRP_Application_2012.docx