11-351

us-hi-regs-official-43ff23de0174034d827dfbc853303482866ec8fa5860d578237c77d1ebf33fa311-351Regulation

DEPARTMENT OF 	HEALTH
Adoption 	of 	Chapter 	351
Hawaii 	Administrative 	Rules
May 	22, 	1992
1. 	Chapter 	351 	of 	Title 	11, 	Hawaii 	Administrative
Rules, 	entitled 	"Nursing 	Student 	Loan 	Program" 	is
adopted 	to 	read 	as 	follows:
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§11-351-1
§11-351-2
§11-351-3
§11-351-4
§11-351-5
§11-351-6
§11-351-7
§11-351-8
§11-351-9
§11-351-10
§11-351-11
§11-351-12
§11-351-13
HAWAI 1 I 	ADMINISTRATIVE 	RULES
TITLE 	11
DEPARTMENT OF 	HEALTH
CHAPTER 	351
NURSING 	STUDENT 	LOAN 	PROGRAM
Purpose
Definitions
Loan management
Loan 	funds
Purpose 	of 	loans
Eligibility 	requirements
Application 	procedures
Loan 	advisory 	committee
§11-351-2
Disapproval 	of 	loan 	applications
Notification 	of 	approval 	or 	disapproval
Maximum 	loan 	amount; 	loan 	terms 	and
restrictions
Repayment
Default
§11-351-1 	Purpose. 	The 	purpose 	of 	this 	chapter
is 	to 	adopt 	rules 	governing 	implementation 	of 	the
Nursing 	Student 	Loan 	program 	authorized 	by 	chapter 	321,
Hawai I i 	Revised 	Statutes. 	[Eff: 	JUN 	25 1992 	J 	(Auth:
§ § 3 21-2 4 , 	3 21-2 5, 	3 21-2 6) 	(Imp: 	§§ 3 21-2 4 , 	3 21-2 5 , 	3 21-
2 6)
§11-351-2 	Definitions. 	As 	used 	in 	this 	chapter,
unless 	a 	different 	meaning 	clearly 	appears 	in
the 	context;
11 Department 11 	means 	the 	department 	of 	health 	of 	the
State 	of 	Hawai'i;
11 Director 11 	means 	the 	director 	of 	health 	of 	the
State 	of Hawai 1 i 	or 	a 	duly 	authorized 	designate;
11 Loan 11 	mean 	a 	financial 	obligation 	owed 	to 	the
department 	by 	students 	who 	borrow money 	to 	pursue 	a
nursing 	career;
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§11-351-2
"Loan 	advisory 	committee" 	means 	the 	committee
formed 	by 	the 	director 	to 	advise 	the 	director 	on
the 	making 	of 	loans. 	Members 	of 	the 	loan 	advisory
committee may 	include 	officers 	and 	staff 	of 	the
department, 	representatives 	from 	the 	Hawai'i 	Nurses'
Association, 	the 	Hawai'i 	chapter 	of 	the 	American
Organization 	of 	Nurse 	Executives, 	the 	University 	of
Hawai'i, 	Hawai'i 	Loa 	College, 	and 	the 	community
colleges;
"Loan 	reserve 	fund" 	means 	moneys 	available 	to
grant 	loans 	to 	eligible 	applicants;
"Nursing 	student" 	means 	a 	student 	registered 	in 	an
accredited 	specialized nursing 	educational 	program 	as 	a
full-time 	student 	as 	defined 	by 	an 	accredited 	degree-
granting 	university, 	college 	or 	nursing 	institution 	in
Hawai'i;
"NCLEX" 	means 	the 	licensing 	examination 	for 	the
licensure 	of 	nurses 	which 	is 	administered 	in 	the 	State
in 	February 	and July 	of 	each 	year;
"State" 	means 	the 	state 	of 	Hawai'i;
"Work" 	means 	employment 	for 	a 	minimum of 	seventy-
two 	hours 	per 	consecutive 	two-week period. 	Exceptions
will 	be made 	for 	time 	taken 	off 	for 	temporary 	disability
insurance/workers 	compensation, 	pregnancy 	(limited 	to
three 	months), 	involuntary military 	duty, 	and 	personal
leave 	limited 	to 	six months. 	[Eff: 	JUN 	?51992 	]
(Auth: 	§§321-24, 	321-25, 	321-26) 	(Imp: 	§°§321-24, 	321-
25, 	321-26)
§11-351-3 	Loan management. 	The 	operation 	and
implementation 	of 	the 	loan 	program 	shall 	be 	conducted 	in
accordance 	with 	the 	remaining 	sections 	of 	this 	chapter
and 	a 	loan 	fund 	management 	procedural 	guide. 	A copy 	of
the 	loan 	fund 	management 	procedural 	guide 	used 	by 	the
administrator 	shall 	be 	at 	the 	department's 	building 	in
its 	most 	current 	form 	and 	available 	for 	inspection
during 	normal 	business 	hours. 	[Eff: 	JUN 251992 	]
(Auth: 	§§ 321-24, 	321-25, 	321-26) 	(Imp: 	§§321-24, 	321-
25, 	321-26)
§11-351-4 	Loan 	funds. 	(a) 	The 	fund 	is
implemented 	on 	the 	basis 	of 	an 	initial 	legislative
appropriation 	of 	$250,000.
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§11-351-6
(b) 	The 	fund 	may 	also 	accept 	donations 	from 	any
legitimate 	source, 	including 	federal 	and 	private 	grants
and 	gifts 	from 	private 	foundations 	or 	endowment 	organi-
zations. 	Donations 	will 	be 	received 	by 	the 	director 	for
deposit 	in 	the 	fund.
(c) 	All 	interest 	and 	fees 	collected by 	the
department 	shall 	be 	deposited 	in 	the 	fund 	to 	cover the
administrative 	costs 	associated with 	operating 	the 	fund.
All 	payments 	received 	on 	account 	of 	principal 	shall 	be
credited 	to 	the 	fund 	to maintain 	a 	proper 	reserve 	to
guarantee 	sufficient 	loans.
(d) 	All 	funds 	in 	the 	student 	nursing 	loan 	program
shall 	lapse 	into 	the 	general 	fund 	at 	the 	close 	of
business 	on June 	30, 	2000. 	[Eff: 	JUN 25 1992 	J 	(Auth:
§ §3 21-2 4 , 	3 21-2 5, 	3 21-2 6) 	(Imp: 	§§ 3 21-2 4 , 	3 21-2 5, 	3 21-
2 6)
§11-351-5 	Purpose 	of 	loans. 	(a) 	The 	department
shall 	provide 	low 	interest 	loans 	to 	students 	who 	are
studying 	to 	become 	licensed 	registered 	nurses 	or nurse
practitioners 	and who 	intend 	to work 	in 	the 	State. 	The
loan 	amount 	shall 	be 	used 	for:
(1) 	Payment 	of 	tuition; 	and
(2) 	Other 	necessary 	financial 	assistance 	in
connection with 	obtaining 	a 	degree 	or
certificate 	from 	an 	accredited 	degree-
granting 	university, 	college 	or 	nursing
(b)
funds" 	to
§§ 321-24,
26)
institution 	in Hawai'i.
The 	department may 	grant 	loans 	as 	"matching
secure 	grants. 	[Eff: 	_Ul~I 	?f:i 199? 	J 	(Auth:
321-25, 	321-26) 	(Imp: 	~3'21"-'"24, '"321-25, 	321-
§11-351-6 	Eligibility 	requirements.
Consideration 	for 	loans 	under 	this 	chapter 	shall 	be
extended 	only 	to 	applicants 	who meet 	the 	following
minimum 	requirements:
(1) 	The 	applicant 	is 	or 	plans 	to 	be 	a 	student
pursuing 	a 	career 	as 	a 	registered 	nurse;
(2) 	The 	applicant 	has 	been 	accepted 	and 	is
classified as 	a 	full-time 	nursing 	student by
the 	applicant's 	respective 	school;
(3) 	The 	applicant 	has 	been 	a 	Hawai'i 	resident 	for
at 	least 	one 	year 	prior to 	the 	date 	the
applicant 	applies 	for 	a 	loan;
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§11-351-6
(4) 	The 	applicant 	has 	not 	previously 	graduated
from 	a 	similar nursing 	program 	and 	is 	not
repeating 	any 	nursing-related 	courses; 	and
(5) 	The 	applicant 	intends 	to 	become 	licensed 	and
obtain 	employment 	as 	a 	registered 	nurse
immediately upon 	graduation 	and work 	in
Hawai'i 	for 	a 	minimum of 	three 	years.
[Eff: 	'JUN 251992 	J 	(Auth: 	§§321-24, 	321-
2 5 , 	3 21- 2 6 ) 	( Imp : 	§§ 3 2 1- 2 4 , 	3 2 1- 2 5 , 	3 2 1- 2 6 )
§11-351-7
persons 	applying
application 	form
request.
Application 	procedures. 	(a) 	All
for 	loans 	shall 	utilize 	the 	loan
provided by 	the 	department 	upon
(b) 	The 	application 	form 	shall 	be 	submitted 	to 	the
department 	at 	least 	ninety 	days 	prior 	to 	the 	start 	of
the 	upcoming 	academic 	semester.
(c) 	Applicants 	are 	required 	to 	submit 	a 	written
confirmation 	from 	an 	accredited degree-granting
university, 	college, 	or 	nursing 	institution 	in 	Hawai'i
confirming 	the 	applicant 	is 	either 	a 	current 	student 	or
will 	be 	commencing 	studies 	in 	the 	upcoming 	academic
semester.
(d) 	In 	the 	event 	that 	no 	accredited 	specialized
nursing 	educational 	programs 	are 	available 	in 	Hawai'i,
the 	director, 	in 	consultation with 	the 	loan 	advisory
committee, 	shall 	give 	consideration 	for 	loan 	approval 	to
fund 	training 	at 	an 	accredited 	degree-granting 	or
certificate-granting university, 	college, 	or 	nursing
institution 	outside 	the 	State 	of Hawai'i.
(e) 	Applicants 	shall 	submit 	official 	copies 	of
their 	college 	transcripts 	to 	the 	department. 	(First
term 	college 	students 	shall 	provide 	high 	school
transcripts.)
(f) 	Applicants 	shall 	submit 	a 	written 	essay 	on 	the
applicant's 	personal 	and 	professional 	goals 	using 	the
form 	provided by 	the 	department.
(g) 	Applicants 	shall 	make 	a 	commitment, 	in 	a
written 	notarized 	form 	provided by 	the 	department, 	to
work 	as 	a 	registered 	nurse 	in Hawai'i 	for 	a 	minimum 	of
three 	years 	immediately 	following 	obtaining 	a 	license
under 	chapter 	457, 	Hawai'i 	Revised 	Statutes.
(h) 	At 	the 	discretion 	of 	the 	loan 	advisory
committee, 	applicants 	may 	be 	subject 	to 	a 	credit
verification 	and 	will 	be 	notified 	of 	this 	credit
verification 	check when 	applying 	for 	the 	loan.
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§11-351-9
(i) 	The 	"Nursing 	Student 	Loan 	Program General
Application 	Information 	and 	Instructions" 	comprised
of 	the 	Application 	for 	student Nursing 	student 	Loan
Application 	and 	the 	Notice 	of 	Intent, 	all 	dated
9/17/91, 	located 	at 	the 	end 	of 	this 	chapter, 	are made
a 	part 	of 	this 	section.
(j) 	Only 	loan 	applications 	meeting 	all 	the
requirements 	of 	this 	section 	shall 	be 	considered
complete 	and 	eligible 	for 	review pursuant 	to 	this
chapter. 	It 	shall 	be 	solely the 	applicant's
responsibility 	to 	submit 	a 	completed 	loan 	application.
Incomplete 	loan 	apP,lications 	shall 	not 	be 	eligible 	for
review. 	[Eff: 	JUN 25 1992 	] 	(Auth: 	§§321-24, 	321-25,
321-26) 	(Imp: 	§§321-24, 	321-25, 	321-26)
§11-321-8 	Loan 	advisory 	committee. 	(a) 	All
completed 	loan 	applications 	shall 	be 	reviewed 	by 	the
loan 	advisory 	committee.
(b) 	The 	loan 	advisory 	committee will 	meet 	on 	a
semiannual 	basis, 	or 	as 	determined 	by 	the 	committee, 	to
review 	loan 	applications.
(c) 	The. 	loan 	advisory 	committee 	recommendations
will 	be 	guided 	by 	the 	nature 	of 	studies, 	the 	applicant's
past 	academic 	performance, 	and 	the 	assurance 	that 	the
applicant 	will 	pursue work 	as 	a 	licensed 	registered
nurse, 	or 	secondly, 	a 	career 	as 	a 	nurse 	practitioner 	in
Hawai'i 	upon 	graduation. 	Should 	there 	be 	a 	limit 	in 	the
amount 	of 	funds 	available, 	the 	applicant's 	financial
need will 	also 	be 	considered.
(d) 	The 	loan 	advisory 	committee 	shall 	submit 	the
completed 	loan 	applications 	and 	its 	recommendations 	to
the 	director 	for 	final 	approval 	or 	disapproval.
[Eff: 	JUN 25 1992 	] 	(Auth: 	§§321-24, 	321-25, 	321-26)
(Imp: 	s§ 321-24, 	321-25, 	321-26)
§11-351-9 	Disapproval 	of 	loan 	applications. 	The
director may 	disapprove 	the 	loan 	application 	for 	any 	of
the 	following 	reasons:
(1) 	Applicant 	cannot meet 	certain 	practical 	credit
requirements 	established by 	the 	loan 	advisory 	committee;
(2) 	Applicant's moral 	character 	is 	questionable 	as
determined 	by 	the 	loan 	advisory 	committee; 	or
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§ 11-351-9
(3) 	Applicant 	fails 	to meet 	other 	criteria 	deemed
necessary 	by 	the 	loan 	advisory 	committee 	in 	justifying
or 	granting 	a 	loan.
[Eff: 	.IUN 	251992 	J 	(Auth: 	§§ 321-24, 	321-25, 	321-26)
(Imp: 	§s 3'21-24, 	321-25, 	321-2 6)
§11-351-10 	Notification 	of 	approval 	or 	disapproval
(a) 	Applicants 	will 	be 	notified 	in writing 	of 	their
approval 	or 	disapproval 	for 	the 	loan 	request 	at 	least
thirty days 	prior 	to 	the 	upcoming 	academic 	semester.
(b) 	For 	approved 	applicants, 	warrants 	will 	be
issued 	directly 	to 	the 	recipient 	at 	least 	ten 	days 	prior
to 	the 	start 	of 	the upcoming 	academic 	semester.
[Eff: 	JUN 251992 	] 	(Auth: 	§§ 321-24, 	321-25, 	321-26)
(Imp: 	§ § 3 21-2 4 , 	3 21-2 5, 	3 21-2 6)
§11-351-11 	Maximum 	loan 	amount; 	loan 	terms 	and
restrictions. 	(a) 	The maximum 	individual 	loan 	amount
shall 	not 	exceed 	$10,000 	per 	recipient 	for 	any 	one
academic 	year.
(b) 	The 	director 	shall 	determine 	the 	extent 	and
kinds 	of 	security 	required 	for 	each 	loan, 	if 	any.
(c) 	No 	loan 	shall 	be 	granted 	for 	a 	period
exceeding 	five 	years. 	The 	following 	guidelines 	shall 	be
used 	by 	the 	department 	in 	establishing 	loan 	terms:
(1) 	All 	loans 	shall 	be made 	before 	June 	30, 	1995.
(2) 	All 	repayments 	of 	loans 	shall 	be 	made 	before
the 	close 	of 	business 	on June 	30, 	2000, 	at
which 	time 	the 	funds 	from 	the 	nursing 	student
loan 	program 	shall 	lapse 	into 	the 	general
fund.
(d) 	Each 	loan 	shall 	bear 	a 	simple 	interest 	rate
not 	to 	exceed 	five 	per 	cent 	per year.
(e) 	Loans 	shall 	be 	granted 	for 	the 	entire 	period
required 	to 	complete 	studies, 	up 	to 	a 	maximum 	of 	five
years. 	Allocations 	will 	be made 	each 	semester/quarter
to 	the 	loan 	beneficiary upon 	submission 	of:
(1) 	Transcripts 	from 	the 	previous 	academic
semester 	indicating 	that 	the 	loan 	recipient
has 	a 	minimum grade 	point 	average 	of 	2.0 	(on 	a
4.0 	scale);
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§ 11-351-12
(2) 	A copy 	of 	the 	recipient's 	registration 	for
courses 	for 	the 	upcoming 	academic 	semester/
quarter; 	and
(3) 	Letter 	from 	the 	school 	of 	nursing 	confirming
the 	recipient's 	enrollment, 	as 	requested 	by
the 	director.
(f) 	Should the 	recipient 	determine 	that 	the 	loan
amount 	will 	need 	to 	be 	increased 	after 	the 	original 	loan
amount 	is 	awarded, 	the 	recipient 	shall 	submit 	a 	request
for 	additional 	funds 	in writing 	to 	the 	loan 	advisory
committee 	along with 	justification 	for 	the 	increase
(e.g., 	increased 	tuition). 	The 	increased 	amount, 	if
approved 	by 	the 	director, 	will 	be 	applied 	to 	the
upcoming 	academic 	semester. 	[ Eff: 	IUN 2i::; 100? 	J
(Auth: 	§§321-24, 	321-25, 	321-26) 	(Dup: 	§"'§ 3':z'I-24, 	321-
25, 	321-26)
§11-351-12 	Repayment. 	(a) 	Repayment 	of 	the 	loan
shall 	commence 	twelve months 	after 	the 	recipient 	has
graduated, 	been 	licensed, 	and 	has 	obtained 	employment 	as
a 	registered 	nurse 	in Hawai'i.
(b) 	Loan 	recipients 	shall 	have 	their 	outstanding
repayment 	obligation 	reduced by 	twenty 	percent 	per 	year
for 	each 	year 	they work as 	a 	registered 	nurse 	in
Hawai'i. 	Recipients 	shall 	submit 	a 	letter 	from 	the
recipient's 	employer by January 	31 	of 	each 	year, 	or 	as
requested 	by 	the 	director, 	to 	confirm the 	recepient 	is
employed 	full-time 	as 	a 	licensed 	registered 	nurse
directly 	providing 	or 	supervising 	clinical 	care with 	an
institution 	or 	organization 	in Hawai'i.
(c) 	Recipients who 	meet 	the 	criteria 	in 	sub-
section 	(h) 	of 	this 	section may 	defer 	repayment 	of 	the
outstanding 	loan 	amount 	each year 	they 	are 	employed 	as 	a
licensed 	registered 	nurse 	directly 	providing 	or
supervising 	clinical 	care 	with 	an 	institution 	or
organization 	in Hawai'i. 	If 	the 	recipient 	requires 	time
off 	from 	work 	due 	to 	temporary 	disability 	insurance/
workers' 	compensation, 	pregnancy 	(limited 	to 	three
months), 	personal 	emergency 	(limited 	to 	six months), 	or
involuntary military 	duty, 	the 	repayment 	period will 	be
deferred 	and 	added 	to 	the 	end 	of 	the 	loan 	repayment
period.
(d) 	Repayment 	of 	loans 	shall 	commence 	immediately
under 	the 	following 	conditions. 	The 	recipient:
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§11-351-12
(1) 	Withdraws 	from 	nursing 	studies 	prior 	to
graduation;
(2) 	Graduates 	but 	does 	not 	seek employment;
(3) 	Graduates 	and 	becomes 	employed 	in 	the 	State 	in
a 	profession 	other than 	as 	a 	registered 	nurse;
or
(4) 	Graduates 	and 	becomes 	employed 	in 	any 	field
outside 	of 	the 	State.
(e) 	Repayment 	of 	the 	loan 	amount 	or 	any 	portion
thereof 	which 	has 	been 	allocated 	to 	the 	recipient 	for
the upcoming 	semester/quarter but which has 	not 	been
expended 	shall 	be 	returned 	immediately to 	the 	depart-
ment. 	Loan 	amounts 	are 	assumed 	to 	be unexpended, 	unless
the 	recipient 	provides 	proof 	that 	it 	has 	been 	spent
(e.g., 	receipts).
(f) 	Repayment 	of 	the 	loan 	amount 	which 	has 	been
disbursed 	to 	the 	recipient 	and 	expended 	shall 	be made 	on
a 	quarterly 	basis, 	according 	to 	the 	repayment 	schedule
specified 	by 	the 	department. 	There 	are 	no 	penalties 	for
early 	repayment 	of 	the 	loan.
(g) 	Repayment 	which 	is 	fifteen 	calendar days 	past
the due 	date 	will 	be 	assessed 	a 	late 	payment 	penalty 	of
two percent 	simple 	interest.
(h) 	Repayments may 	be 	deferred 	under 	any 	of 	the
following 	conditions:
(1) 	The 	recipient 	provides 	written 	confirmation
that 	the 	recipient 	has 	resumed 	nursing 	studies
on 	a 	full-time 	basis 	for 	which 	the 	loan was
originally approved;
(2) 	The 	recipient 	takes 	and 	passes 	the 	next
scheduled NCLEX 	and 	obtains 	employment 	as 	a
licensed 	registered 	nurse 	directly 	providing
or 	supervising 	clinical 	care 	with 	an
institution 	or 	organization 	in 	Hawai'i 	within
ninety 	days 	of 	taking 	the 	examination; 	or
(3) 	The 	recipient 	provides 	written 	confirmation
that 	the 	recipient 	has 	become 	employed 	as 	a
registered 	nurse 	directly 	providing 	or
supervising 	clinical 	care 	in 	an 	institution 	or
organization 	in 	the 	State 	of 	Hawai'i.
(i) 	Deferral 	of 	loan 	repayments 	is 	subject 	to
approval 	by 	the 	director. 	[Eff: 	.JUN 251992 	] 	(Auth:
§§321-24, 	321-25, 	321-26) 	(Imp: 	§S321-24, 	321-25, 	321-
26)
351-8
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§ 11-351-13
§11-351-13 	Default. 	Loans 	that 	are 	three
installments 	in 	arrears 	shall 	be 	considered 	in default.
The 	recipient 	shall 	also 	be 	considered 	to 	be 	in 	default
for 	failure 	to 	comply with 	any 	term 	or 	condition 	of 	the
loan 	authorization 	or 	agreement. 	If 	the 	recipient 	is 	in
default, 	the 	whole 	of 	the 	loan, 	at 	the 	option 	of 	the
director, 	shall 	become 	due 	and 	payable. 	Any 	expense
incurred 	by 	the 	department 	for 	recovering 	of moneys
shall 	be 	borne 	by 	the 	recipient. 	[Eff: 	. ll IN ? 5 1092 	J
(Auth: 	§§321-24, 	321-25, 	321-26) 	(Imp: 	'"§"§'3tl-2~, 	321-
25, 	321-26)
351-9
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DEPARTMENT OF HEALTH
Chapter 	351, 	Hawaii 	Administrative Rules, 	on 	the 	Summary
Page 	dated May 	22, 	1992, 	was 	adopted 	on 	1992,
following 	public 	hearings 	held 	on May 	4 	- 	13, 	1992, 	after
public 	notice was 	given 	in Hawaii 	Tribune-Herald 	on 	April 	3,
1992, 	West 	Hawaii 	Today 	on April 	3, 	1992, 	Maui 	News 	on April
3, 	1992, 	The 	Garden 	Island 	on 	April 	8, 	1992, 	and 	the 	Honolulu
Star-Bulletin 	on 	April 	12, 	1992.
The 	adoption 	of 	chapter 	351 	shall 	take 	effect 	ten 	days
after 	filing 	with 	the 	Office 	of the 	L' 	utenant 	Governor.
APPROVED AS 	TO 	FORM:
Deputy 	Attrney General
State 	of 	Hawaii
J
Dr 	or
DJpirtment 	of 	Health
APPROVED:
JOHN WAIHEE
Governor
State 	of Hawaii
Dated:
JUN 	15 1992
Filed
l 	51
Complete printed PDF page 11
Department 	of 	Health
State 	of 	Hawai'i
APPLICATION FOR
NURSING 	STUDENT LOAN PROGRAM
Please 	Print 	of 	Type
Section 	I: 	PERSONAL DATA
Name _________________________________ _
(Last) 	(First) 	(Middle)
Address ________________________________ _
(City)
Phone 	(
(State) 	(Zip Code)
) ____ _ 	Social 	Security Ho.
If 	you 	are 	NOT 	a 	U.S. 	citizen, 	are 	you 	eligible 	for 	employment 	in
the 	u.s.? 	0 	Yes O 	Ro
Name 	and 	address 	of 	nearest 	relative NOT 	residing with you
Name ________________ Relationship __________ _
Address _________________ _ 	Phone
Please provide 	one personal 	and one professional 	reference
Personal 	Reference 	(Do NOT 	list 	a 	relative)
Name ________________ Relationship __________ _
Address __________________ _ Phone
Professional 	Reference 	(Do 	NOT 	list 	a 	supervisor)
Name ________________ Relationship __________ _
Address __________________ _ Phone
I:tOB: 9/17 /91 I 1 551
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APPLICATION FOR NURSING 	STUDENT LOAN PROGRAM
Section 	II: 	EDUCATIONAL 	INFORMATION
IA11E UD 	LOCATIOI 	YEllS 	DE&JlEE/
SCHOOLS ATTEIDED 	ATTIDED 	tlAJOJt 	DIPLOtlA
BISH SCHOOL
COLLE&E
OTHER. SCHOOLill&
Name 	of 	Nursing 	School 	Attending________________ _
Status: 	D
D
D
Accepted 	into 	Hursing 	Progra•
Rot 	accepted 	into 	Rursing 	Progra•
Pending 	(explain)__.______________ _
Enrolllment 	Date ________________________ _
Anticipated 	Graduation Date 	__________________ _
Grade 	Point 	Average 	(based 	on 	4.0 	scale)
Degree 	Pursued. _________________________ _
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APPLICATION FOR NURSING 	STUDENT LOAN 	PROGRAM
Section 	III: 	EMPLOYMENT 	INFORMATION
Please 	begin with your most 	recent 	employment
E•ployer 	Phone 	Ho. 	( 	)
Address
Haae 	and 	Title 	of 	Supervisor
Your 	Title
Fro• 	To 	□ Full 	Tiae 	OPart 	Tiae
Eaployer 	Phone 	Ho. 	( 	)
Address
Haae 	and 	Title 	of 	Supervisor
Your 	Title
l'ro• 	To 	□ Full 	Tiae 	OPart 	Tiae
Eaployer 	Phone 	Ho. 	( 	)
Address
Haae 	and 	Title 	of 	Supervisor
Your 	Title
Fro• 	To 	□ Full 	Tiae 	QPart 	Tiae
Eaployer 	Phone 	Ho. 	( 	)
Address
Haae 	and 	Title 	of 	Supervisor
Your 	Title
l'ro• 	To 	□ Full 	Tiae 	0Part 	Tiae
Page 	3 	l 	551
Complete printed PDF page 14
APPLICATION FOR NURSING 	STUDENT LOAN PROGRAM
Section 	IV: 	FINANCIAL 	INFORMATION
For what 	funding 	you 	are 	applying? 	(Maximum 	$10,000 	per year)
□ 	Tuition
D 	Expenses
D 	Tuition and 	Expenses
Please 	complete 	the 	following 	information
Total 	annual 	gross 	income
Total 	monthly 	expenses
$ ________ _
$ ________ _
Please 	summarize your monthly 	financial 	needs 	and 	expenses 	on
the 	reverse 	side 	of 	this 	page
Indicate 	entire 	loan amount 	requested by 	semester 	or quarter
Other 	Total
Se•ester/Quarter 	Tuition 	Ezpenses 	Ezpenses
TOTAL
Other 	financial 	assistance 	information
TYPE 	J.SSISTABCE
I:RSTITUTIOI 	ASSISTABCE 	APPLIED 	FOR 	:RECEIVI:RG
Page 	4 l 	55 l
Complete printed PDF page 15
APPLICATION FOR NURSING 	STUDENT LOAN PROGRAM
Section V: 	STATEMENT OF 	PERSONAL AND 	PROFESSIONAL GOALS
Discuss 	your 	reasons 	for 	applying 	for 	this 	loan. 	Include
information 	on your 	background; 	school 	and 	community 	activities
in which you 	have 	participated; 	awards 	and 	special 	recognition
you 	have 	received; 	your 	hobbies 	and 	interests; 	the 	reasons 	you
have 	for 	becoming 	a 	nurse; 	and your 	future 	career 	goals. 	Attach
additional 	page(s) 	if 	necessary.
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APPLICATION FOR 	NURSING 	STUDENT LOAN PROGRAM
Section VI: 	SIGNATURE
I 	certify 	that 	the 	information 	provided 	in 	this 	application 	is
truthful.
I 	have 	read 	the 	Nursing 	Student 	Loan 	Program General 	Application
Information 	and 	Instructions 	and 	understand 	and 	accept 	the
employment/repayment 	obligations 	associated with 	participating
in 	this 	loan 	program.
Applicants 	Signature 	Date
The 	following 	shall 	be 	submitted 	together:
1. 	Completed application
2. 	Statement 	of 	Personal 	and 	Professional 	Goals
3. 	Copies 	of 	all 	high 	school 	and college 	transcripts
4. 	Verification of 	grade point 	average
5. 	Norarized Letter 	of 	Intent 	to work as 	a 	registered
nurse with an 	institution or organization providing
direct 	clinical 	care 	in Hawai'i 	for 	a 	minimum of 	three
year 	after 	obtaining a 	license under 	chapter 	457, 	the
Hawai'i 	Revised 	Statutes
Application and 	required attachments 	shall 	be 	submitted 	to:
Department 	of 	Health
State 	of 	Hawai•i
Division of 	Community Hospitals
1270 	Queen Emma 	Street, 	Suite 	1200
ATTN: 	NURSING 	STUDENT LOAN PROGRAM
Honolulu, 	Hawaii 	96813
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APPLICATION 	FOR NURSING 	STUDENT 	LOAN APPLICATION
NOTICE 	OF 	INTENT
Name
---------------------------------
Social 	Security 	Number
Total 	Repayment 	(Amount 	Requesting) 	Obligation$---------
I 	agree 	to 	work 	as 	a 	registered 	nurse 	or 	as 	a 	nurse
practitioner with 	an 	institution 	or 	organization 	providing
direct 	clinical 	care 	in Hawai'i 	for 	a 	minimum 	of 	three 	years 	of
obtaining 	a 	license 	pursuant 	to 	chapter 	457 	of 	the 	Hawai'i
Revised 	Statutes.
I,---------,-----""""""""-------,------' 	certify 	that 	I 	am 	a
student 	registered 	in 	a 	full-time, 	accredited 	specialized
nursing 	educational 	program 	as 	defined 	by 	an 	accredited 	degree-
granting 	university, 	college 	or 	nursing 	institution 	in 	Hawai'i
or 	the 	mainland 	and 	meet 	the 	eligibility 	requirements 	to 	obtain
a 	loan 	under 	the 	Nursing 	Student 	Loan 	Program. 	I 	have 	read 	and
agree 	to 	comply with 	the 	terms 	outlined 	in 	the 	Nursing 	student
Loan 	Program General 	Application 	Information 	and 	Instructions.
I 	understand 	that 	if 	awarded 	a 	loan, 	the 	loan 	amount 	will 	be
paid 	to 	me 	each 	semester upon 	submission 	of 	the 	following:
1. 	Transcripts 	from 	the 	previous 	academic 	semester 	indicating
a 	minimum GPA 	of 	2.0 	(based 	on 	a 	4.0 	scale).
2. 	A letter 	from 	the 	school 	of 	nursing 	confirming 	successful
completion 	of 	the 	previous 	semester.
I 	understand 	that 	upon 	graduation, 	I 	must 	obtain 	employment 	as
a 	registered 	nurse 	or a 	nurse 	practitioner 	in Hawai'i 	for 	a
minimum 	of 	three 	years 	immediately 	following 	obtaining 	a
license 	under 	chapter 	457, 	Hawai'i 	Revised 	Statutes. 	I
understand 	that 	for 	each 	full 	year 	{12 	months) 	of 	continuous
employment 	as 	outlined 	above, 	twenty 	per 	cent 	of my 	total
repayment 	obligation 	will 	be 	forgiven. 	To 	cancel 	the 	entire
obligation 	shall 	require 	five 	years 	of 	employment.
I 	understand 	that 	any 	leaves 	of 	absence 	will 	cause
fulfillment 	date 	of my 	obligation 	to 	be 	adjusted.
understand 	that 	the 	repayment 	obligation amount 	is
immediately upon 	any 	of 	the 	following 	conditions:
the
I 	also
due
1. 	I 	withdraw 	from 	nursing 	studies 	prior to 	graduation 	or
convert 	to 	part-time 	status.
2. 	I 	graduate 	but 	do 	not 	seek 	employment.
!JOH 9 I 17 /91 ! Page 	7
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Complete printed PDF page 18
APPLICATION 	FOR NURSING 	STUDENT 	LOAN APPLICATION
NOTICE 	OF 	INTENT 	(CONTINUED)
3. 	I 	graduate 	and 	become 	licensed 	but 	I 	become 	employed 	in
the 	State 	in 	a 	profession 	other 	than 	as 	a 	registered
nurse.
4. 	I 	graduate 	and 	become 	employed 	in 	any 	field 	outside 	the
State 	of 	Hawai'i.
(Name)
(Signature) 	(Date)
Subscribed 	and 	sworn 	to 	before me 	this
_____ day 	of __________ ,199_.
Notary 	Public, 	State 	of 	Hawai'i
My 	commission 	expires: _________ _
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STATE 	OF HAWAI'I
DEPARTMENT OF HEALTH
NURSING STUDENT 	LOAN PROGRAM
GENERAL APPLICATION 	INFORMATION AND 	INSTRUCTIONS
OVERVIEW
Nursing 	students 	may 	receive 	financial 	assistance
through 	a 	restricted 	loan 	program 	as 	they pursue 	an
accredited 	specialized 	nursing 	education program with
an 	accredited 	degree-granting 	university, 	college, 	or
nursing 	institution 	in 	the 	State 	of Hawai'i. 	In 	the
event 	that 	no 	accredited 	specialized nursing 	educational
programs 	are 	available 	in 	the 	State 	of Hawai'i,
consideration 	for 	loan 	approval 	with 	an 	accredited
degree-granting 	or 	certificate-granting university,
college, 	or 	nursing 	institution 	outside 	the 	State 	of
Hawai'i 	may 	be 	given. 	The 	program will 	run 	from
July 	1, 	1991 	to 	June 	30, 	1995, 	or until 	all 	available
funds 	are 	expended, 	whichever 	comes 	first. 	Loan
recipients 	are 	expected 	to 	repay 	their 	loans 	by
June 	30, 	2000.
The 	Department 	of Health, 	State 	of 	Hawai'i, 	provides
services 	and 	opportunities 	to 	take 	part 	in 	its 	programs
and 	activities 	without 	regard 	to 	race, 	color, 	national
origin, 	age, 	disability, 	or 	sexual 	orientation.
FUNDING AVAILABLE
Funding 	under 	this 	loan 	program 	is 	limited 	to 	a 	maximum
of 	$10,000 	per 	student 	per 	academic 	year, 	not 	to 	exceed
five 	years.
Low 	interest 	loans 	are 	available 	to 	persons 	who 	are
studying to 	become 	licensed 	registered 	nurses 	and who
intend 	to 	work 	in Hawai'i. 	The 	loan 	amounts 	shall 	be
used 	for: 	•
1. 	Payment 	of 	tuition.
2. 	Other 	necessary 	financial 	assistance 	in
connection with 	obtaining a 	degree 	or
certificate 	from 	an 	accredited 	degree-granting
university, 	college, 	or 	nursing 	institution 	in
Hawai'i.
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Complete printed PDF page 20
Nursing 	Student 	Loan 	Program
General 	Application 	Information
and 	Instructions
3. 	"Matching 	funds" 	to 	secure 	grants 	from 	other
sources.
MINIMUM SELECTION CRITERIA
Applicants 	shall:
1. 	Be 	a 	student 	pursuing 	a 	career 	as 	a 	registered
nurse.
2. 	Have 	been 	accepted 	and 	classified 	as 	a 	full-time
nursing 	student 	by 	the 	applicant's 	respective 	school.
3. 	Have 	been 	a 	Hawai'i 	resident 	for 	at 	least 	one 	year
prior 	to 	the 	date 	the 	applicant 	applies 	for 	a 	loan.
4. 	Have 	not 	previously graduated 	from 	a 	similar 	nursing
program 	and 	is 	not 	repeating 	any 	nursing-related
courses.
5. 	Intend 	to 	become 	licensed 	and 	obtain 	employment 	as 	a
registered 	nurse 	directly 	providing 	or 	supervising
clinical 	care 	immediately upon 	graduation 	and 	work 	in
Hawai'i 	for 	a 	minimum 	of 	three 	years.
APPLICATION 	PROCESS
Applicants 	shall 	submit:
1. 	Completed 	"Application 	for 	Nursing 	Student 	Loan
Program."
2. 	A confirmation 	from 	an 	accredited 	degree-granting
university, 	college, 	or 	nursing 	institution 	confirming
that 	the 	applicant 	is 	~ither 	a 	current 	student 	or 	will
be 	commencing 	studies 	in 	the 	upcoming 	academic 	semester.
3.. 	Official 	copies 	of 	college 	transcripts. 	Applicants
who 	have 	not 	previously 	attended 	college 	shall 	submit
high 	school 	transcripts.
4. 	A written 	essay 	on 	the 	applicant's 	personal 	and
professional 	goals 	using 	the 	form 	provided by 	the
department.
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Nursing 	Student 	Loan 	Program
General 	Application 	Information
and 	Instructions
5. 	A written 	notarized 	form 	provided 	by 	the 	department,
which 	indicates 	the 	applicant 	intends 	to 	work 	as 	a
registered 	nurse 	in Hawai'i 	for 	a 	minimum 	of 	three 	years
immediately 	following 	obtaining a 	license 	under 	chapter
457, 	Hawai'i 	Revised 	Statutes.
At 	the 	discretion 	of 	the 	Loan Advisory Committee,
applicants 	may 	be 	subject 	to 	a 	credit verification 	and
will 	be 	notified 	of 	this 	check when 	applying 	for 	the
loan.
Applications 	and 	required 	attachments 	listed 	above 	shall
be 	submitted 	together 	to:
Department 	of Health
State 	of Hawai'i
Division 	of 	Community 	Hospitals
1270 	Queen 	Emma 	Street, 	Suite 	1200
ATTN: 	NURSING 	STUDENT 	LOAN 	PROGRAM
Honolulu, 	Hawai'i 	96813
Applications 	may 	be 	obtained 	from 	the 	Office 	of 	the
Director 	of 	the 	Department 	of 	Health 	at 	1250 	Punchbowl
street, 	3rd 	Floor. 	Applicants 	may 	also 	call 	586-3991 	to
receive 	a 	packet 	by mail.
Incomplete 	application 	packets 	will 	not 	be 	processed.
Applications 	for 	financial 	assistance 	will 	be 	accepted
prior 	to 	the 	beginning 	of 	each 	Fall/Spring 	semester
(quarter 	system 	as 	appropriate). 	students 	shall 	apply
for 	total 	funds 	required 	to 	complete 	studies. 	students
will 	only be 	awarded 	one 	loan. 	If 	additional 	funds 	are
needed, 	students 	may 	submit 	a 	written 	request 	to 	the
Loan 	Advisory 	Committee 	to 	increase 	the 	loan 	amount.
The 	request 	should 	inc~ude 	the 	reasons 	and 	purpose 	of
the 	increase. 	Granting 	of 	the 	request 	will 	be 	at 	the
discretion 	of 	the 	director 	of 	health. 	The 	new 	amount
approved 	cannot 	exceed 	$10,000.
Upon 	receipt 	of 	complete 	application 	materials, 	a
personal 	interview may 	be 	scheduled with 	the 	Loan
Advisory 	Committee.
Applicants 	will 	be 	notified 	by mail 	of 	their 	acceptance
or 	denial 	into 	the 	program.
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Nursing 	Student 	Loan 	Program
General 	Application 	Information
and 	Instructions
SELECTION 	PROCESS
In 	addition 	to 	the minimum 	selection 	criteria,
additional 	criteria may 	include:
1. 	Completeness 	of 	application packet
2. 	Personal 	Statement
3. 	Grade 	Point 	Average
4. 	Personal 	Interview
The 	department may 	disapprove 	the 	loan 	for 	any 	of 	the
following 	reasons:
1. 	The 	applicant 	cannot meet 	certain personal 	credit
requirements 	established by 	the 	Loan Advisory 	Committee.
2. 	The 	applicant's moral 	character 	is 	questionable 	as
determined 	by 	the 	Loan 	Advisory 	Committee.
3. 	The 	applicant 	fails 	to 	meet 	other 	criteria 	deemed
necessary 	by 	the 	Loan Advisory 	Committee 	in 	justifying
or 	granting 	a 	loan.
Funds 	will 	be 	disbursed 	on 	a 	semester/quarter basis.
Allocations 	will 	be made 	each 	semester/quarter to 	the
loan 	beneficiary 	upon 	submission 	of:
1. 	Transcripts 	from 	the 	previous 	academic 	semester
indicating 	that 	the 	loan 	recipient 	has 	a 	minimum 	GPA 	of
2.0 	(on 	a 	4.0 	scale).
2. 	Letter 	from 	the 	school 	of 	nursing 	confirming 	the
recipient's 	successful 	completion 	of 	the 	previous
semester.
REPAYMENT 	OBLIGATION
Funding 	received 	through 	this 	program 	shall 	be 	repaid.
By 	accepting 	this 	funding, 	the 	recipient 	agrees 	to
become 	employed 	full-time 	as 	a 	licensed 	registered 	nurse
or 	directly 	providing 	or 	supervising 	clinical 	care 	with
an 	institution 	or 	organization 	in Hawai'i 	for 	a 	minimum
of 	three 	years. 	The 	recipient 	shall 	begin 	employment
within 	ninety 	days 	of 	taking 	the 	NCLEX.
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Nursing 	student 	Loan 	Program
General 	Application 	Information
and 	Instructions
For 	each 	twelve 	months 	of 	continuous 	service 	as 	noted
above, 	20 	per 	cent 	of 	the 	obligation will 	be 	"forgiven"
or 	cancelled. 	After working the 	required 	three 	years,
sixty 	per 	cent 	of 	the 	obligation will 	be 	forgiven. 	To
forgive 	the 	entire 	obligation through 	employment 	shall
require 	five 	years. 	There 	will 	be 	no 	credit 	given 	for
partial 	years 	worked. 	If 	the 	recipient 	requires 	time
off 	from 	work due 	to 	temporary 	disability 	insurance/
workers 	compensation, 	personal 	emergency 	(limited 	to 	six
months), 	or 	involuntary military 	duty, 	the 	repayment
period will 	be 	deferred 	and 	added 	to 	the 	end 	of 	the 	loan
repayment 	period.
Repayments 	of 	loans 	shall 	commence 	immediately under 	any
of 	the 	following 	conditions:
1. 	The 	recipient 	withdraws 	from 	nursing 	studies 	prior
to 	graduation 	or 	converts 	to 	part-time 	status.
2. 	The 	recipient 	graduates 	but 	does 	seek 	employment.
3. 	The 	recipient 	graduates 	but 	is 	employed 	in 	the 	State
in 	a 	profession 	other 	than 	as 	a 	registered 	nurse.
4. 	The 	recipient 	graduates 	and 	becomes 	employed 	in 	any
field 	outside 	the 	State 	of Hawai'i.
Interest will 	start 	from 	the 	time 	employment 	ends 	or 	is
reduced. 	Each 	loan 	shall 	bear 	a 	simple 	interest 	rate
not 	to 	exceed 	five 	per 	cent 	per year. 	If 	a 	recipient
fails 	to 	meet 	repayment 	obligations, 	the 	recipient's
credit 	rating may 	be 	affected 	and 	the 	Department 	of
Health 	reserves 	the 	right 	to 	take 	legal 	action 	as
necessary 	to 	recover 	funds.
OTHER 	INFORMATION
Funds 	will 	be 	disbursed 	to 	the 	recipient 	after 	they 	have
signed 	a 	Letter 	of Understanding, 	which 	reiterates 	their
obligations 	under 	this 	program.
The 	recipient 	will 	be 	responsible 	for 	having 	their
school's 	Registrar 	complete 	and 	return 	a 	confirmation 	of
full-time 	enrollment, 	major 	and GPA 	each 	semester.
Page 	5
l 	55 l
Complete printed PDF page 24

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