Cal. Code Regs. Tit. 22, § 97930.6 - Loan Application Process
(a) Each person desiring a loan repayment
shall submit a completed application.
(b) The completed loan repayment application
shall include information and documentation to establish the following:
(1) Proof of licensure, including license
number issued by the California Board of Behavioral Sciences or the California
Board of Psychology, or proof of registration, including registration number
issued by the California Board of Behavioral Sciences, or a unique
identification number issued by the California Board of Psychology.
(2) Current employment as a licensed mental
health service provider providing direct patient care in or through a qualified
facility or in a mental health professional shortage area.
(3) The loan repayment amount requested with
documentation on outstanding educational loans related to education required to
become a licensed mental health service provider, including the current
outstanding loan balance(s);
(4)
Community background and involvement;
(5) Career goals;
(6) Cultural and linguistic
competence;
(7) Two (2) letters of
recommendation, dated within six (6) months of the application deadline,
including author's name, mailing address, phone number, and relationship to
applicant. Letters may comment on applicant's work experience, community
service, volunteer activities, memberships in clubs, and/or attributes that
indicate the applicant's likelihood to continue to practice in or through a
qualified facility or in a mental health professional shortage area after
service obligation has ended;
(8) A
personal statement indicating qualifications, attributes, or characteristics
that would increase the likelihood the applicant would continue to provide
direct patient care in or through a qualified facility or in a mental health
professional shortage area in California after service obligation has ended;
and
(9) Any other information the
applicant believes is relevant.
(c) For the first calendar year of
implementation, applications shall be due the fourth Friday in September. From
the second year on, deadlines for the two (2) annual loan application cycles,
shall be March 24 and September 11.
Notes
Note: Authority cited: Sections 127010 and 127015, Health and Safety Code. Reference: Section 128454, Health and Safety Code.
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