Hawai'i Healthcare Education Loan Repayment Program (HELP)

2026 Application Period

Application materials accepted via this online form and Dropbox ONLY.

Emailed or in-person drop off of application materials will NOT be accepted.

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General Information

The Hawai'i/Pacific Basin Area Health Education Center is pleased to announce the Healthcare
Education Loan Repayment Program (HELP), a program funded by the Hawai'i State Legislature.
HELP provides qualified educational loan debt repayment to health professionals licensed or
otherwise certified to practice in Hawai'i and provide care to patients in Hawai'i. The Internal
Revenue Service defines Qualified Educational Loans under 26 USC 221(d)(1). The State expects
the HELP to help improve the number of providers in medically underserved areas of Hawai'i, as
well as improve the recruitment and retention of healthcare workers caring for the people of
Hawai'i by lessening the burden of large educational debt.

To qualify for HELP, applicants must be (or must become) a healthcare professional licensed or
otherwise certified in Hawai'i who provides clinical care to human patients living in Hawai'i and
accepts public insurance for at least 30% of their patient care claims. This can be measured in
two ways as described in Section G of this document. For HELP purposes, the following are
considered public insurance: Medicare Fee For Service, Medicare Advantage, Medicaid Fee For
Service, QUEST Integration (Med-QUEST), Veterans Administration, and TRICARE.

Interns, residents, or fellows currently in professional training in one of the recognized health
professions are encouraged to apply. Terms of loan repayment and other HELP programmatic terms and
conditions may differ from already licensed or certified healthcare professionals.

*Applicants must be United States citizens or lawful permanent residents, have no outstanding
contractual obligation for health professional services to the Federal Government, no judgment
lien against their property for a debt to the U.S. government, and not be excluded, debarred,
suspended, or disqualified by a Federal agency.

Initial eligibility will be evaluated through background checks and credit checks.

Awarded participants will be selected by a subcommittee of the HELP Steering Committee.
All applicants who are selected for the HELP program and choose to participate are obligated to
commit to a minimum of two (2) years of full-time or half-time service at a site serving patients
in Hawai'i. In addition to caring for the community they serve, participants are encouraged to
be involved with workforce development activities, including health career recruitment,
teaching, or community health outreach.

Funding will be secured for the full contract amount. After the initial contract period,
participants may be eligible to extend their contract. However, as this is a state-funded
program, continuation from year to year is subject to the availability of funds appropriated by
the state legislature.

Instructions for Applying

● Contracts will be awarded on a competitive basis. The highest priority will be given to primary care
providers and behavioral health providers working throughout the state, specialists in rural
Hawai'i, and individuals in residency programs as defined by Hawai'i Revised Statutes 1B-1. Priority will also be given to other healthcare providers working in professions and areas for which there is a documented shortage.

● The following documents MUST BE submitted for an application package to be considered complete:

1. Completed Online Application, including all parts.

The following must be submitted via Dropbox link:

1. Educational Debt Reporting Form, Part F of the application.

2. Copy of current lender statements, dated within one month of application submission, for each loan to be included in the loan repayment. The lender statement must include the applicant's full name, full account number, current balance, and the mailing address of the lender.

3. Copy of current Hawai'i professional license or certificate (i.e., for certain
technologists).

4. Certification of Practice Site, Part G of the application; *

5. Copy of a valid government-issued identification (such as passport or driver's
license)
*If the practice site is not finalized, please contact the AHEC Office at 808-692-1060.
*An employment start date is required.

● Please read the application instructions very carefully.

If you have questions regarding the application, application process, or your eligibility for the HELP
program, please email us at helpprg@hawaii.edu or call at (808) 778-7961.

Part A: Personal Information

*Last Name:

*First Name:

*Middle Initial:

*required

*Mailing Address:

*City:

*Country:

*State:

*Zip:

*Phone Numbers (provide at least 2):

*Email Address:

*Date of Birth:

*Gender:

Are you in a residency program?

* must provide value

Yes No

reset

Are you in a fellowship program?

* must provide value

Yes No

reset

Do you work full-time (36 hours per week)?

* must provide value

Yes No

reset

If No, how many hours do you work per week on average?

* must provide value

How many hours of direct patient care to patients in Hawai'i do you perform each week?

* must provide value

Are you a veteran of the U.S. Armed Forces?

* must provide value

Yes No

reset

Race/Ethnicity:

The race/ethnicity information requested below is optional and will not be used for the purposes of
evaluating your application. It will be used to satisfy federal and/or State of Hawaii reporting
requirements and may be used for other purposes allowed by law. Please select all that apply.

List languages you speak, read, and or write in addition to English (check all that apply):

1.
2.
3.

*Professional School where graduated:

*Year of Graduation:

*City:

State:

Zip:

*required

Postgraduate Training:

Year Completed /or Expected Year of Completion:

Board Eligible:		Board Certified:
Professional License #:		Certificate #:

NPI:

Part B: Qualifications and Eligibility

*1. Are you a United States citizen or lawful permanent resident?
*2. Do you have a current and unrestricted Hawai'i license or state/national certification to practice your profession in Hawai'i?
*3. Are you free of judgments arising from Federal debt?
*4. Are you delinquent with any court-ordered child support?
*5. Did you apply for the NHSC Federal Loan Repayment Program? (If yes, please indicate the date of submission):

*a. Do you owe an existing service obligation to another entity, or have you received any other loan repayment funding in the past? (i.e., National Health Service Corps, Department of Defense, Public Health Service)

(If yes, please indicate existing service obligation or source of other loan repayment funding)

Part C: Health Profession Information

Select your current health profession:

* must provide value

Physician, Specialty:

Nurse Practitioner, Specialty:

Physician Assistant, Specialty:

Acupuncturist

Athletic Training

Audiologist

Certified Nurse Aide

Clinical Laboratory Director

Clinical Laboratory Specialist

Cytotechnologist

Dental Hygienist

Dentist

Licensed Bachelor Social Worker

Licensed Clinical Social Worker

Licensed Genetic Counselor

Licensed Marriage/Family Therapist

Licensed Practical Nurse

Licensed Social Worker

Medical Assistant

Medical Laboratory Technician

Medical Technologist (MLS)

Mental Health Counselor

Midwife

Naturopathic Physician

Nursing Home Administrator

Occupational Therapist

Occupational Therapy Assistant

Pharmacist

Physical Therapist

Physician Therapist Assistant

Podiatrist

Psychologist

Radiologic Technology

Registered Dietician

Registered Nurse

Respiratory Therapist

School Psychologist

Speech Language Pathologist

Surgical Technician

Other:

Part D: Ties to Hawai'i

Yes

Born in Hawai'i

* must provide value

reset

High school in Hawai'i

* must provide value

reset

College in Hawai'i

* must provide value

reset

Graduate or Professional education in Hawai'i

* must provide value

reset

Clinical Training in Hawai'i

* must provide value

reset

Work(ed) in Hawai'i. When / How long?

* must provide value

reset

Have family in Hawai'i

* must provide value

reset

Own a home in Hawai'i

* must provide value

reset

Teach health professions students

* must provide value

reset

Perform outreach activities in Hawai'i. Please specify:

* must provide value

reset

Part E: Questionnaire (optional)

Where did you hear about Hawaii's HELP?

Work (employer/co-worker)

AHEC Website

Other Website

Family member, friend, or acquaintance

Other source (please specify):

Part H: Applicant Certification

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 that I
am willing to sign, or have signed a written agreement with a practice setting committing to a minimum
of two years of direct patient service on either a full-time (40 hours per week) or half-time (20 hours per
week) basis.

I authorize representatives of the University of Hawai'i, including but not limited to representatives from
the John A. Burns School of Medicine, Hawai'i Pacific Basin Area Health Education Center (UH JABSOM
HPB AHEC), 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.
I also authorize representatives of the University of Hawai'i, only for the purpose of evaluating whether I
am qualified for HELP to which I am applying, to obtain a copy of my credit report and investigate my
background and qualifications, which may include obtaining information relating to my criminal history
record. I understand that the University of Hawai'i will utilize an outside firm(s) to assist it in checking
such information, and I specifically authorize such an investigation by information services and outside
entities of the company's choice. I also understand that I may withhold my permission and that in such a
case, no investigation will occur, and my application for the HELP will not be processed further.

The criminal history record, as received from the reporting agencies, may include arrest and conviction
data as well as plea bargains and deferred adjudications and delinquent conduct committed as a
juvenile. I understand that if I remain a participant, the criminal history records check, and credit check
may be repeated at any time.

I hereby affirm that my answers to the foregoing questions are true and correct and that I have not
knowingly withheld any fact of circumstances that would, if disclosed, affect my application unfavorably.
I understand that false information submitted in this application may result in my discharge and/or
termination from HELP.

I understand that I am not allowed to receive loan repayment from an additional source that requires a
commitment that may conflict with HELP (such as National Health Service Corps or State Loan
Repayment Programs) during my participation in the HELP. I understand that the UH JABSOM HPB AHEC
staff will periodically contact my practice site to verify employment.

I understand that if I fail to meet my service commitment to HELP, I will have to repay the University of
Hawai'i in the amounts and/or rates specified in my Applicant Terms and Conditions, which are the
terms and conditions of HELP that each participant signs and agrees to upon acceptance and
matriculation into HELP. Damages and penalty terms if I do not meet my service commitment would
result in payment by me of an amount equal to: (A) the total amount of HELP support paid by the
University of Hawai'i for any period of service commitment I did not serve; (B) an amount equal to the
product of the number of months of service commitment that I did not complete, multiplied by $5,500,
but not to exceed two hundred percent (200%) of my total award amount; and (C) interest on the total
amounts due under subsection (A), calculated at five percent (5%) per annum. Further, regardless of the
above formula, the total amount I will owe in damages shall not be less than $31,000 or 150% of my total award
amount, whichever is less.

I, the undersigned, do, for myself, my heirs, executors, and administrators, hereby waive, release, and
discharge any and all claims, demands, actions, rights, and causes of action for any and all illness,
personal or bodily injury, death, economic and property damage, severe emotional loss, and any other
loss, damage, or injury (collectively the "Injuries/Damages"), that I may sustain or suffer from the
investigation of my background in connection with my application to become a participant of HELP
(collectively the "Released Claims").

I agree to indemnify, defend, and hold harmless the University of Hawai'i, and its past, present and
future Board of Regent members and University of Hawai'i officers, employees, agents, and assigns from
any and all Released Claims and any and all demands, actions, judgments, injunctions, orders, directives,
penalties, assessments, liens, liabilities, losses, damages, costs, and expenses (including attorneys' fees),
arising or resulting from or caused by the investigation of my background in connection with my
application to become a participant of HELP.

*Signature:

*Date:

*Print Name:

Part F. Educational Debt Reporting

Please report the CURRENT TOTAL debt balance and lender in the below fields.

You may add ALL loans from the SAME account number. If you have multiple loans under DIFFERENT account numbers, please list the biggest one or the one in which you would like for us to repay first.

*Current total debt balance:

*Loan service/lender name:

*required

Download and complete the attached Part F. Educational Debt Reporting form.

Save the form using the following file name format: [Last Name]_[First Name]_PartF_Edu_Debt_Form.pdf

Upload the completed Part F. Educational Debt Reporting form as a PDF file to the following Dropbox link:

H.E.L.P Loan Documents Dropbox

Emailed or in-person drop off forms will NOT be accepted.

Part G. Certification of Participating Site

Please report the following info regarding your current workplace:

**If you are a RESIDENT, please indicate the school and location of your Residency Program.

*Workplace Name:
*City:
*Island:
*Start Date:

*required

Download and complete the attached Part G. Certification of Participating Site form.

Save the form using the following file name format: [Last Name]_[First Name]_PartG_Certification_Site.pdf

Upload the completed Part G. Certification of Participating Site form as a PDF file to the following Dropbox link:

H.E.L.P Loan Documents Dropbox

Emailed or in-person drop off forms will NOT be accepted.

Upload copy of a valid government-issued identification (such as passport or driver's license) to Dropbox link: https://www.dropbox.com/request/8Itbh1wVqvyp5JXC2bOv

Upload copy of current Hawaii professional license or certificate (i.e., for certain technologists) to Dropbox link: https://www.dropbox.com/request/8Itbh1wVqvyp5JXC2bOv

Did you read and complete each section of the application

in its entirety and to the best of your ability?

Submission Checklist:

1. Completed Online Application
2. Part F. Educational Debt Reporting Form (submit via Dropbox)
3. Part G. Certification of Participating Site Form (submit via Dropbox)
4. Copy of government-issued identification (submit via Dropbox)
5. Copy of current Hawaii professional license or certification (submit via Dropbox)

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