Section 590.APPENDIX A  Sample Contract for Medical Student Scholarship (Student Contract)

ILLINOIS DEPARTMENT OF PUBLIC HEALTH

FAMILY PRACTICE RESIDENCY ACT

SCHOLARSHIP FOR MEDICAL STUDENTS

S T U D E N T    C O N T R A C T

The Illinois Department of Public Health (Department) and

(Name of Student)

hereby agree as follows:

1)         The Department shall pay the sum of $__________ to

(Name of Medical School)

on behalf of Student pursuant to the Family Practice Residency Act, (Ill. Rev. Stat. 1989, ch. 144, par. 1451 et seq.) as amended, which is made a part hereof and fully incorporated herein.

2)         All funds paid to Student through the above named organization by Department pursuant to this Contract constitute a scholarship which shall be repaid to Department by Student unless Student is excused from repayment by Department pursuant to the terms of this Contract.

3)         If Student fails to complete medical studies because of academic failure, Student shall be discharged from any and all obligations under this Contract.

4)         If Student fails to complete medical studies for any reason other than academic failure, death or permanent disability, Student shall repay to Department all funds paid pursuant to this Contract. Repayment shall be made in equal monthly installments in such amounts so that all sums due and owing will be paid within a period of time equal to the period of time funds were paid, or as otherwise approved by Department. Payments shall begin within 30 days after Student leaves medical school.

5)         If Student dies or suffers total and permanent disability either while pursuing studies under this Act or, after Student's medical degree, while engaging in medical practice in Illinois up to the onset of fatal illness or such disability, the scholarship or any balance due on it shall be excused and deemed satisfied.

6)         Student's service term shall begin within 30 days of Student's licensure to practice medicine, except that service may be deferred until completion of an approved residency program in primary care. In all cases where service is deferred, service shall begin within 30 days after Student leaves residency program.

7)         Student may request an emergency deferment because of temporary personal disability or to fulfill family obligations which delay the start of Student's medical practice. Emergency deferments will be granted on a quarterly basis, at the discretion of Department. Student shall begin medical practice within 30 days of the ending date of the emergency deferment.

8)         Upon Student's licensure to practice medicine or completion of an approved residency program in primary care, Student shall agree to enter into a contract with Department to serve as a full-time primary care physician engaged in direct patient care in only the designated shortage areas in Illinois approved as a practice site(s) for that individual. Full-time practice is defined in the Family Practice Residency Code, (77 Ill. Adm. Code 590). Upon request Student shall confirm, in writing, the location and office hours of the medical practice. The terms of this service shall be at the rate of one year of full-time service for each school year, or portion thereof that funds were paid.

9)         If Student fails to perform any of the foregoing terms and conditions of this Contract, Student shall, in accordance with the Family Practice Residency Act, pay to Department a sum of money equal to three times the amount of the average annual scholarship grant for each year recipient fails to fulfill such obligation. Payment shall be made in equal monthly installments in such amounts so that all sums due and owing will be paid within a period of time equal to Student's remaining service term or as otherwise approved by Department. Payments shall begin within 30 days after Student fails to perform any of the terms and conditions of this Contract. In the event that Student fails to pay any required installment to Department, Department may file suit to collect all sums and future sums due and owing under this Contract or may refer the matter to a collection agency.

10)         Student shall inform Department, in writing, within seven days of any of the following changes:

a)         status as a student

b)         address

c)         illness, disability, or family considerations affecting obligations of this Contract

11)         Notwithstanding any other provisions of this agreement, Student shall repay in full all funds received by Student pursuant to this agreement in the event of breach of any provisions of this agreement by Student within 60 days of written demand of Department.

12)         Student shall pay all costs of suit, including attorney fees, and all collection costs in the event Department shall prevail in suit for money damages against Student pursuant to this Contract.

13)         This Contract shall be governed in all respects by the laws of the State of Illinois.

14)         This Contract may not be amended without prior written approval of both Department and Student.

15)         This Contract may not be sold, assigned or transferred in any manner.

16)         Department and Student understand and agree that this Contract constitutes the total agreement between them and that no promises, terms or conditions not recited herein or incorporated herein, or referenced herein shall be binding upon either Department or Student.

17)         Obligations of Department will cease immediately without penalty of further payment being required if the Illinois General Assembly fails to appropriate or otherwise make available sufficient funds for this Contract.

18)         Student hereby certifies that Student has not been convicted of bribery or attempting to bribe an officer or employee of the State of Illinois, nor has Student made an admission of guilt of such conduct which is a matter of record.

19)         Student agrees to comply with the provisions of the Illinois Purchasing Act (Ill. Rev. Stat. 1989, ch. 127, pars. 132.11-1 through 132.11-5) prohibiting conflict of interest.

20)         The Student certifies that Student is not in default on an educational loan as provided in Public Act 85-827.

21)         In the event the Family Practice Residency Act is amended while this Contract is in effect, this Contract shall be amended automatically to incorporate such amendments to such Law, provided that obligations of Student shall not be increased.

22)         In the event any portion of this Contract is held invalid by any court of law, the remaining terms and conditions shall remain in full force and effect.

23)         Obligations of Student shall remain in full force and effect until Student has either fulfilled the service obligation pursuant to the Family Practice Residency Act or repaid all funds to Department pursuant to the terms of this Contract.

24)         The term of this Contract is for the period July 1, 19__ through June 30, 19__. It is further understood between the parties hereto that this Contract is subject to appropriations to Department, in subsequent years, for the purpose herein described.

25)         Under penalties of perjury, I certify that the social security number shown below is my correct Federal Taxpayer Identification Number.

Executed this _________day of_______________________, 19___.