S2S LRP - Letters of Recommendation

OMB No.: 0915-0146
Expiration Date: XX/XX/20XX
Bureau of Health Workforce
U.S. Department of Health and Human Services
Health Resources and Services Administration

National Health Service Corps
Students to Service Loan Repayment Program
Preceptor Letter of Recommendation –
Instructions
This letter may be from a primary care preceptor or another individual who has worked with the applicant in
a primary care setting and can discuss the applicant’s interest and commitment to a career in primary care
and service to underserved populations and communities.
All recommendations must be submitted by the recommender through the application portal. To complete
and submit the letter of recommendation, please click on the link you received via email and submit the
recommendation. The letter must have a handwritten signature and/or be on letterhead from the
preceptor’s organization/institution and include the following:
1) Applicant’s first, middle initial and last name;
2) Last four digits of the applicant’s Social Security Number (if known);
3) Applicant’s anticipated specialty;
4) Recommender’s Name (printed) and Title;
5) Recommender’s Address (unless already on letterhead);
6) Handwritten Signature;
7) A description of the preceptor’s relationship to the applicant and length of applicant’s rotation; and
8) A discussion of the following items:
a. The preceptor’s experience with the applicant during the rotation;
b. The applicant’s ability to work and communicate effectively with patients and colleagues;
c. An assessment of the applicant’s particular characteristics, interests, and motivations to
serve populations in underserved communities; and
d. An assessment of the applicant’s work experiences, course work, special projects, research,
or other activities that demonstrate an interest in and commitment to serving underserved
populations and communities.
Public Burden Statement: The purpose of the NHSC SP, NHSC S2S LRP, and the NHHSP is to provide scholarships or loan repayment to qualified students who
are pursuing primary care health professions education and training. In return, students agree to provide primary health care services at approved facilities
located in designated Health Professional Shortage Areas (HPSAs) once they are fully trained and licensed health professionals. An agency may not conduct or
sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control
number for this information collection is 0915-0146 and it is valid until XX/XX/202X. This information collection is required to obtain or retain a benefit (NHSC
SP: Section 338A, Section 338C-H of PHS Act; NHSC S2S: Section 338B and Section 331(i) of the PHS Act; NHHSP: Native Hawaiian Health Care Improvement
Act of 1992, as amended [42 U.S.C. 11709]). Public reporting burden for this collection of information is estimated to average xx hours per response, including
the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding
this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer,
5600 Fishers Lane, Room 14N136B, Rockville, Maryland, 20857 or paperwork@hrsa.gov.