Give Back, Get Back Education Loan Repayment Program Application

Give Back, Get Back Education Loan Repayment Program Application

2025 - 2026 Application
General Information

The Hawaiʻi Public Health Institute is pleased to announce the Give Back, Get Back Education Loan Repayment Program (GB>GB), funded by the Hawaiʻi State Department of Health (DOH). GB>GB provides qualified educational loan repayment to professionals for the purpose of workforce retention within the public health sector in Hawaiʻi. The objective of the program is to strengthen Hawaii's public health workforce by incentivizing employee retention, minimizing workforce shortages, and allowing recipients to continue working and living in Hawaiʻi strengthening the expertise of the workforce.

Eligibility Criteria:

To qualify for GB>GB, applicants must have completed a minimum of one (1) year working full-time in the public health workforce within Hawaiʻi and have student loan debt.

Applicants must be a United States citizen or lawful permanent resident, no judgement lien against their property for a debt to the U.S. government, and not be excluded, debarred, suspended, or disqualified by a Federal agency.

Awarded participants will be selected by the GB>GB Review Committee.

All applicants who are selected for the GB>GB program and choose to participate are obligated to commit a minimum of two (2) years of full-time service at a public health organization (government or non-government) in the state of Hawaiʻi.

Funding maximum amount will be $25,000.00 paid directly to the debt lender in quarterly installments.

Funding for the program is currently capped at $1,200,000.00 for the first year. Subsequent funding is subject to additional funds appropriated by the state legislature. 25% of the allocated funds are reserved for employees working at the Hawaiʻi State Department of Health.

All applications will be date and time stamped. Priority will be given to those serving rural communities and their debt-to-income ratio.

Please note: It is not guaranteed that all eligible and approved applicants will be awarded the maximum $25,000.00 amount.

Instructions for Applying:

The following documents must be submitted for an application package to be considered complete:
- Completed Application, including all parts.
- Completed Employment Verification Form, signed by the applicant and supervisor. Form can be found on www.hiphi.org/givebackgetback.
- Educational Debt Reporting Information, Part F of the application.
- Copy (copies) of current lender statements, dated within one month of application submission, for each loan to be included in the loan repayment request. The lender statement must include the applicant's name, current balance, account number, and the mailing address of the lender.
  - If the current lender is not an educational lender (i.e. if you have refinanced your educational debt with a commercial lender), include your original educational debt documentation from the lending or educational institution.
- Copy of a valid government-issued photo identification (such as passport or driver's license).
If you have any questions regarding the application, application process or your eligibility for the GB>GB program, please email HIPHI at studentloan@hiphi.org with the subject line: GB>GB Question(s) or via telephone at (808) 591-6508 x 28.

Please refer to the application instructions before you begin. Complete each part of the application form. Make sure all supporting documents are attached and submitted with your application.
Part A: Personal Information
Legal Name (should match name on your lender statement and Identification)*

Last NameMiddle NameFirst Name
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Part B: Qualifications and Eligibility
1. Are you a United States citizen or lawful permanent resident?*

YesNo
2. Have you applied for and received any federal loan forgiveness program? Such as the Hawaiʻi Healthcare Education Loan Repayment, Public Service Loan Forgiveness Program, Substance Use Disorder Treatment and Recovery Loan Repayment Program, and Faculty Loan Repayment Program?*

NoYes, please explain below
If yes, please explain which program(s) you have applied and received federal loan forgiveness from.
Part C: Employment Information

Applicants eligible to receive loan forgiveness must be working in the public health sector in Hawai'i for at least one (1) year. Awardees are required to commit a minimum of two (2) years working in the public health field in the state of Hawai'i upon receiving repayment.
Examples of approved employment sites:
- Government or non-government entities
- Clinics/Community Health Centers (funding for population-level staff, not direct patient care)
- Environmental Agencies
- Health Insurance Companies (roles such as Patient Navigator, Health Educator, Community Health Worker/Community Health Outreach Worker)
- Hospitals (funding for population-level health staff, not direct patient care)
- Human Services Providers (including faith-based organizations, food banks, transportation services)
- Laboratories
- Mental Health Organizations
- Nursing Homes
- Public health community-based organizations
- Public Safety Agencies
- State or local health department
Please complete the Give Back, Get Back Employment Verification Form and attach it below to be considered. This form can be found under the "Instructions for Applying" tab.
Upload your Give Back, Get Back Employment Verification Form here.*

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Part D: Ties to Hawaiʻi

Please check all that apply to you.
Born in HawaiʻiAttended high school in HawaiʻiAttended college in HawaiʻiAttended Graduate or Professional education in HawaiʻiReceived clinical training in HawaiʻiWork(ed) in HawaiʻiHave family in HawaiʻiOwn a home in HawaiʻiPerform outreach activities in Hawaiʻi
Part E: Questionnaire (Optional)
Where did you hear about the GB>GB program?

Work (employer/coworker)Family member, friend, or acquaintanceHIPHI listservs and/or social media accountsDOH listservAHEC conferenceOther source
Part F: Educational Debt Information
Directions:
- List the source and amounts of outstanding educational loans used to finance your education. All spaces on this form must be completed even if the information appears on the lender statements that you will be submitting. Any missing information will make the entire application incomplete and it will not be reviewed.
- You must submit evidence of the educational debts listed below. If your loans have been consolidated, submit proof of consolidation. If your loans have been refinanced via a commercial lender, provide evidence of original educational loan debt.
- Current lender statements need to be dated within 30 days of submission, and MUST include the current balance, account number, and the address to which payment is submitted. Online printouts are acceptable if they include all the required information.
1. Lender Name:*
Name of company
1. Lender address (send payments to):*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
1. Account number*
1. Current loan balance*
Example: $XX,XXX.XX
1. Additional Notes (if needed):
2. Lender Name:
Name of company
2. Lender address (send payments to):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
2. Account number
2. Current loan balance
Example: $XX,XXX.XX
2. Additional Notes (if needed):
3. Lender Name:
Name of company
3. Lender address (send payments to):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
3. Account number
3. Current loan balance
Example: $XX,XXX.XX
3. Additional Notes (if needed):
Copy (copies) of current lender statement. Please combine your statement(s) into one file and upload.*

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Copy of government-issued identification (driver's license or passport)*

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Part G: Applicant Certification
Certification & Committment

I certify that I am the person herein named subscribing to this application; that I have read the complete application, know the full content thereof, and declare under penalty of perjury, that all the information contained herein, and evidence or other credentials submitted herewith are true and correct and I am willing to sign a written agreement to commit a minimum of two (2) years of working full-time in the public health sector in Hawaiʻi upon receiving award.

Authorization

I authorize representatives of the Hawaiʻi Public Health Institute (HIPHI) to contact educational institutions I attended, institutions holding any of the listed educational loans, and employers to verify the accuracy of the information contained in this application.

Program Conditions

I understand that I am not allowed to receive loan repayment from an additional source that requires a commitment that may conflict with GB>GB (such as the Public Service Loan Forgiveness Program or the Hawaiʻi Healthcare Education Loan Repayment Program during my participation in the GB>GB. I understand that HIPHI staff will periodically contact my employer to verify employment.

Indemnification

I agree to defend, indemnify, and hold HIPHI harmless and its affiliated entities and each of their officers, directors, partners, members, employees, and agents, from and against any and all third-party claims, causes of action, liabilities, damages, judgments, settlements, costs and expenses, (including reasonable attorneys' fees), arising or resulting from or caused by the investigation of my background in connection with my application to become a participant of GB>GB.
Applicant Name (Print):*

First NameLast Name
Applicant Signature*

Clear
Should be Empty:

Give Back, Get Back Education Loan Repayment Program Application

Part A: Personal Information

Part B: Qualifications and Eligibility

Part C: Employment Information

Part D: Ties to Hawaiʻi

Part E: Questionnaire (Optional)

Part F: Educational Debt Information

Part G: Applicant Certification