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You may apply for an extension in the Health Care Workforce Financial Assistance Program if you have an active grant contract in the loan repayment program. You must notify DHHS of your interest in an extension prior to the final 6 months of your contract agreement to be considered.

Applications must be completed in one sitting. If you leave the application open without interacting with it, it will time out and fail to submit.

Once you have completed your application, please email opcrh@utah.gov to confirm that you applied for an extension.
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The Office of Primary Care and Rural Health is required to report demographic information of loan repayment award recipients to the Health Resources and Services Administration. Demographic information will not be used to determine award eligibility.
Include information on the allocation of time at the practice preference location in which you are applying for financial assistance: As stated in R434-40-9, full time is equal to 40 hours per week or more, and part time is equal to 20 hours per week or more.
I certify that the information I have provided in this application is accurate and complete
to the best of my knowledge and belief. I understand my responses may be investigated
and any willfully false representation is sufficient cause for rejection of this application.
* 
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I am applying for educational loan repayment through the Health Care Workforce Financial Assistance Program.

By checking this box, I consent to the release to the Utah Department of Health private, sensitive, privileged and
otherwise confidential information about me to the extent that it bears upon any of the following:
my education; internship, post-graduate, preceptorship, or residency specialty training, board certification;
experience; professional conduct; ethics; ability to work with others; hospital and other affiliations;
disciplinary actions; malpractice claims history; litigation experience; state licensure;
and controlled substance licensure. I intend that this consent include all information that
reflects on my ability to safely, competently, and professionally perform the professional
activities required of me should I receive a grant under this program.

I agree that this consent extends to all persons, institutions, and entities that have such information about me including:
colleges, universities, professional societies, hospitals, specialty boards, practice groups, clinics, insurance companies,
partnerships, professional corporations, and employers, and to persons and committees associated with any of these.
I also give my consent for all such persons, institutions, and entities to express their evaluation of me and make
recommendations about my professional skill, conduct, and ability to perform clinical duties in the area for
which I have applied. I intend that a copy of this document may be relied upon as if it were the original.
 
Required for provider applicants: email Rachel at opcrh@utah.gov that you have submitted your application.
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Can I annotate fields to indicate their intended use?

Yes. You can provide "Help" to your users for any field:

1. On any page in your application, click "Customize" then "Fields". If it is a multi-table application, select the table.

2. Click the "Edit" button next to the field for which you want to add an annotation.

3. In the "Help" text input box, enter text that will assist your users, and click "Save".

Your text will appear when the user hovers over or clicks on the question mark icon next to that field on the Add Record and Edit Record pages.
 
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    When you bring additional fields into a conversion, Quickbase often finds inconsistencies. For example, say you're converting your Companies column into its own table. One company, Acme Corporation, has offices in New York, Dallas and Portland. So, when you add the City column to the conversion, Quickbase finds three different locations for Acme. A single value in the column you're converting can only match one value in any additional field. Quickbase needs you to clean up the extra cities before it can create your new table. To do so, you have one of two choices:

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