2 FY 2017 NHSC S2S LRP Additional Letter of Recommendation

Bureau of Health Workforce

U.S. Department of Health and Human Services Health Resources and Services Administration

OMB Number: 0915-0146

Expiration Date: XX/XX/20XX

National Health Service Corps Students to Service Loan Repayment Program

Additional Letter of Recommendation – Instructions

This letter should be from individuals who are familiar with the applicant and his/her academic, professional, community, and/or civic activities, particularly those related to primary care and underserved communities. A recommender can be a current or former employer, community leader, colleague, or anyone who has knowledge of the applicant’s interest and commitment to a career in primary care and service to underserved populations and communities.

All recommendations must be submitted by the recommender through the application portal. To complete and submit the letter of recommendation, please click on the link you received via email and submit the recommendation. The letter must have a handwritten signature and/or be on letterhead from the recommender’s organization/institution, if appropriate, and include the following:

1) Applicant’s first, middle initial and last name;

2) Last four digits of the applicant’s Social Security Number (if known);

3) Applicant’s anticipated specialty (if known);

4) Recommender’s Name (printed) and Title;

5) Recommender’s Address (unless already on letterhead);

6) Handwritten Signature;

7) A description of the recommender’s relationship to the applicant and length of time he/she has known the applicant; and

8) A discussion of the following items:

a. The applicant’s academic, professional, community, and/or civic achievements;

b. The applicant’s ability to work and communicate effectively with patients and colleagues;

c. An assessment of the applicant’s particular characteristics, interests, and motivations to serve populations in underserved communities; and

d. An assessment of the applicant’s work experiences, course work, special projects, research, or other activities that demonstrate an interest in and commitment to serving underserved populations and communities.

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 0915–0146. Public reporting burden for this collection of information is estimated to average 0.5 hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N39, Rockville, MD 20857.