Below, list your school, post-graduate or professional program, and residency program (if applicable), and graduation or completion date of the degree required for your employment. Please list schools and degrees from most to least advanced.
Attention SHARP-1 Applicants: All eligible SHARP-1 employer sites must be located in federally designated Health Professional Shortage Areas (HPSAs). This is because of the level of federal funding in SHARP-1. The SHARP-1 does not require a minimum HPSA score.
Know that SHARP-1 only provides education loan repayment- SHARP makes quarterly payments directly to the lender/loan holder. Payments are exempt from federal income tax withholding.
Please select below an occupation from one of the two tiers of SHARP occupations. REQUIRED
Complete the information requested below for the primary practice site at which you intend to fulfill your SHARP service obligation. A practice site is a location at which you will provide medical, dental or behavioral health services to residents of a Health Shortage Area. The employer is the health care system or organization that owns the practice site. *If you are not already hired at a SHARP-eligible site, simply skip this page.
Site representative (person) or employer contact, if known:
Site representative (person) or employer contact if known:
• You must list all education loans or conditional service agreements for which you have a remaining balance whether or not they entail a service obligation.
• Include only those loans incurred to finance your undergraduate or graduate education and training that led to the professional degree necessary for the position through which you will fulfill your SHARP service obligation.
• If you have consolidated or refinanced any eligible loan with a non-education loan, no portion of the consolidated/refinanced loan is eligible for loan repayment and must not be listed below or included in your practitioner application lender verifications.
• Please list the information about all of your current education loans/service obligations in the "Current Loans" section.
• List all original education loans that have been consolidated in the "Original loans that have been consolidated" section.
(If you have more loans than available lines below, please complete this additional overflow loan form.)
If you are selected for participation in Alaska's SHARP Program:
I certify via my electronic signature below that all information and data contained in the here-attached SHARP Practitioner General Application, and in any other document(s) that I submit at any time, are accurate and can be substantiated by records review.
These documents and/or data include but are not limited to: work experience, education, practitioner background, occupational licensure, and any other concurrent service obligation(s).
I hereby certify, under penalty of revocation of my Alaska SHARP MOA service contract and other potential penalties, that to the best of my ability all submitted data are true. If selected for participation in Alaska's SHARP Program, and upon signature of a contract, I here commit to working at my employer's facility for the entire two-year (24-month) contract period.
Please go through all tabs to ensure that you have included all relevant and correct information. When you click SUBMIT, it will officially submit your final SHARP application: