DEPARTMENT OF VETERANS AFFAIRS



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-TimePart-TimeCare Line: Department:Current Performance Rating:OutstandingExcellentFully SuccessfulLess than Fully SuccessfulHave you previously received SLRP Funding: Yes NoIf yes, what is the total amount you were awarded? _____________ Are you currently serving under a service agreement? Yes NoIf yes, when is the service agreement’s expiration date? ____/____/____ Are you a current participant in the Educational Debt Reduction Program (EDRP)? Yes NoCurrent Outstanding Loan Balance:$______________I have attached a copy of my current loan statement reflecting the following:Name of Lending InstitutionAddress of LenderCurrent Loan BalanceI 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.SignatureDateSupervisor RecommendationSupervisors 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:Supervisor SignatureDate ................
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