Form IHS-817 Scholarship Program Agreement

HEALTH PROFESSIONS PREPARATORY AND PREGRADUATE
EDUCATION SCHOLARSHIP PROGRAM AGREEMENT
SCHOOL YEAR 2023 - 2024

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
PUBLIC HEALTH SERVICE
INDIAN HEALTH SERVICE

Section 103 of the Indian Health Care Amendments of 1988 authorizes the Secretary of Health and Human Services (“Secretary”), acting
through the Indian Health Service, to provide applicants selected to be participants in the Health Professions Preparatory and Pregraduate
Education Scholarship Program for Indians (“Scholarship Program”) with scholarship awards. The statute is codified at 25 U.S.C. 1613 and the
implementing regulations are codified at 42 CFR, Part 36, Subpart J, Subdivision J-3. In return for awards, applicants must indicate an intent to serve
Indians as health care professionals in the discipline or specialty for which the award is given upon completion of their health care professional
education.
Program policy requires applicants to submit with their applications a signed Agreement which states the terms and conditions of participation in the
Scholarship Program. The Secretary shall sign only those Agreements submitted by applicants who are selected for participation.
The terms and conditions of participating in the Scholarship Program for the 2023-2024 school year are set forth below.
Section A – Obligations of the Secretary
Subject to the availability of funds appropriated by the Congress of the
United States for the Scholarship Program of the Indian Health Service
(“IHS”), the Secretary agrees to provide the undersigned applicant
(“applicant”) with a scholarship award for the school year 2023-2024
during which the applicant must be:
1. enrolled, or is accepted for enrollment, as a full-time or part-time
student in an accredited (as determined by the Secretary) educational institution in one of the several States, the District of Columbia, the Commonwealth of Puerto Rico, the Commonwealth of the
Northern Mariana Islands, the Virgin Islands, Guam, or American
Samoa, and
2. pursuing a preparatory education course or curriculum necessary
for enrollment or reenrollment in a health professions school, or
3. pursuing pregraduate education leading to a baccalaureate degree
in premedicine, predentistry, preoptometry, prepodiatry,
prephysical therapy, or other health profession which has been
determined to be needed by the Indian Health Service for
participation in the Scholarship Program.
Scholarship grants made under this section may cover costs of tuition,
books, transportation, board, and other necessary related expenses of a
grantee while attending school.
The Scholarship award may consist of payments, in whole or in part, for
tuition, an amount of all other reasonable educational expenses incurred
by the student, and a monthly stipend for the academic period covered by
the award beginning with the first month of each school year in which the
applicant is a participant in the Scholarship Program.
Section B – Obligations of the Applicant
The applicant agrees:
1. to accept the scholarship award provided to the Secretary under
Section (A) of this Agreement for the school year 2023-2024;
2. to maintain full-time or part-time enrollment until completion of
the course of study for which the scholarship award is provided;
3. to maintain an acceptable level of academic standing while enrolled in the course of study for which the scholarship award is
provided; and

4. that it is his/her intent to provide services to Indians, as a full-time
practitioner of the profession for which the education scholarship
is awarded, upon completion of the necessary education and training, and that it is his/her intent that these services will be provided
in the Indian Health Service, an urban Indian organization assisted
under 42 CFR, Part 36, Subdivision J-6, in a program conducted
under a contract entered under the Indian Self Determination Act,
in a program assisted under Title V of the Indian Health Care Improvement Act, or in a health professional shortage area designated
under Section 332 of the Public Health Service Act which address
the health care needs of a substantial number of Indians as determined by the Secretary in accordance with guidelines of the Indian
Health Service.
Section C – Breach of Agreement
If the applicant:
Withdraws from the educational program for any reason, or fails
to maintain an acceptable level of academic standing in the
education program for which the scholarship award is provided, the
scholarship award will be terminated and to be reinstated, the
applicant will have to apply and compete as a new applicant during
the regular application cycle.
Section D – Extension of Scholarship Award
1. The applicant may annually request extension of this scholarship
award, for a period not to exceed 12 months, if the request is submitted in accordance with procedure established by the Secretary.
2. Subject to the availability of funds appropriated by the Congress
of the United States for the Indian Health Service Scholarship Program, the Secretary shall approve the request for an extension if:
a. The request does not extend the total period of scholarship
award beyond two (2) years on a full-time basis (or the parttime equivalent thereof, as determined by the Secretary)for a
preparatory education award or beyond four (4) years (or the
part-time equivalent thereof, as determined by the Secretary)
for a pregraduate baccalaureate degree award, and
b. The applicant is otherwise eligible for continued participation in
the Health Professions Preparatory and Pregraduate Education
Scholarship Program.

The Secretary or his/her authorized representative must sign this contract before it becomes effective.
Applicant Name (Please Print)

Secretary of Health and Human Services

IHS-817 (4/20)

Applicant’s Signature

Date

Date

EF