TCWD Residency Incentive Program Application
The Residency Incentive Program offers $105,000 to primary care residents in a 3-year residency and $140,000 to those in a 4-year residency program, in exchange for an equal length commitment to serve in a rural area or with an underserved population in Tennessee.
Are you eligible to apply to this program?
Must be a current primary care resident (FM, IM, Med/Peds, Peds, OBGYN, Psych). Must be in good standing with your residency program. Must be a U.S. citizen or permanent resident. Residents in their last year of residency must submit an application before December 31st to be considered for this program.
Taxable Income:
Awarded recipients of this incentive will receive $8750 each quarter until the maximum funds have been reached (maximum funds equal to length of residency program). Recipients must complete a W-9 tax form. TCWD incentive funds are considered taxable income. Each year recipients will receive a 1099 tax form to use for their tax purposes.
Please review the following map for minimum criteria requirements for TCWD practice site consideration post-residency. Please note all practice sites must be individually approved by TCWD and deemed appropriate for this program. If you have questions, reach out to TCWD@tha.com
By signing below, you confirm that you have reviewed the above information and understand the eligibility for this program, program funds are taxable income, and that sites must be approved by TCWD for the service commitment post-residency.
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Personal Inforamtion
Name
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First Name
Last Name
Email
*
Please use personal email, not school or employment.
Phone Number
*
Please enter a valid phone number.
Home Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Medical School
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Medical School Graduation
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Month
-
Day
Year
Date
Are you currently involved with any type service obligations such as National Health Service Corps or a Federal/State Loan Repayment Program?
Yes
No
Residency Information
Residency Program
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Residency Program Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Care Specialty
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Please Select
Family Medicine
Internal Medicine
Pediatrics
IM/Peds
OBGYN
Psychiatry
Current PGY Level
PGY1
PGY2
PGY3
PGY4
Anticipated Graduation Date
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Month
-
Day
Year
Date
Program Coordinator's Name
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Program Coordinator's Email
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example@example.com
Service Commitment
Please note you do not need to know your future employment to apply for this program.
Is there a county or area of TN that you are interested in for employment post-residency:
Is there a specific health system or type of practice site you are most interested in:
ex: rural health, urban undeserved, FQHC, free/charitable, or specific health system employer
Have you already accepted an employment opportunity post-residency?
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Yes
No
If yes, please tell us about your employer: name, location, your position/role, and start date.
How did you hear about this program?
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Previously Awarded Recipient
Residency Program Director/Coordinator
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Social Media: Facebook, LinkedIn, Twitter, Instagram
Other
Documentation
Please upload the following documents:
CV
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Personal Statement
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Upload a personal statement which explains your connection and commitment to practice in a medically underserved area of Tennessee, as well as what type of practice you prefer. Why are you interested in participating in TCWD's Residency Incentive Program? Do you have any examples of your experiences and commitment to providing care to medically underserved populations? Also, be sure to address any gaps or extensions taken in medical school or residency.
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Letter of Support from Program Director
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Please upload a letter of support from your program director. Letter should be in pdf format, on program letterhead, and address your current standing in the program, your suitability for the incentive and your commitment to rural and medically underserved populations.
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USLME/COMLEX Scores
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You do not need to have STEP 3 completed to apply for this program. STEP 3 submission is required by the end of PGY2. You may also upload an unrestricted Tennessee Medical License certificate.
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Medical School Transcript
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Please upload a copy of your medical school transcripts.
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