CHAPTER I: DEPARTMENT OF PUBLIC HEALTH
SUBCHAPTER g: GRANTS TO DENTAL AND MEDICAL STUDENTS
PART 590 FAMILY PRACTICE RESIDENCY CODE
SECTION 590.APPENDIX B SAMPLE CONTRACT FOR SCHOLARSHIP SERVICE OBLIGATION
Section 590.APPENDIX B Sample Contract for Scholarship Service Obligation
ILLINOIS DEPARTMENT OF PUBLIC HEALTH
FAMILY PRACTICE RESIDENCY ACT
SCHOLARSHIP FOR MEDICAL STUDENTS
S E R V I C E C O N T R A C T
For awards Made Before July 1986
The Illinois Department of Public Health (Department) and ________________ (Contractor) hereby agree as follows:
1) Paragraph ___ of Contract #___________ signed by Department and Contractor on _________________________ requires Contractor to enter into a contract with Department to serve as a full-time primary care physician engaged in direct patient care in designated shortage areas in Illinois approved as practice site(s) for that individual. A copy of Contract #______________ is attached and incorporated herein.
2) The Contractor received $_____________ in academic year 19___-19___; $__________ in academic year 19___-19___; $__________ in academic year 19___-19___; $_____________ in academic year 19___-19___, totaling $_____________. Copies of the State of Illinois documents verifying award amounts are attached and incorporated herein.
3) Contractor agrees to serve as a primary care physician at a rate of one year of full-time service for each school year or portion thereof that funds were provided except that no more than three years of service shall be provided. Contractor was provided funds for the academic years detailed in item 2 above. Uninterrupted service shall begin __________________________ and end __________________________. Uninterrupted service is defined as continual full-time patient care except for time allowed for continuing education, vacation, personal time, or sick time at the rate permitted by written policies of contractor's employer or as approved by the Department, at the sole discretion of the Department. The approved practice location shall be ______________________.
4) Full-time practice for an ____________________________ is defined as ___________________ ( ) hours a week of direct patient care at the approved practice site(s) when services are not provided to office patients in the hospital setting.
5) If Contractor becomes disabled the terms and conditions of this Contract shall be suspended until such time as Contractor is able to resume repayment.
6) In the event the Contractor fails to perform any of the foregoing terms and conditions of this Contract, Contractor shall, in accordance with the Family Practice Residency Act, pay to the Department a sum of money equal to three times the amount of average scholarship grants for each year Contractor fails to fulfill such obligations. Payments 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 Contractor's remaining service term or as otherwise approved by the Department. Payments shall begin 30 days after Contractor fails to perform any of the terms and conditions of this Contract. In the event the Contractor fails to pay required installments to the 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.
7) Contractor shall pay all costs of suit including attorney's fees and all collection costs in the event the Department shall prevail in suit for money damages against Contractor pursuant to this Contract.
8) Contractor shall inform Department in writing within seven days of any of the following changes:
a) status of employment,
b) address,
c) illness, disability, or family considerations affecting obligations of this Contract.
9) This Contract shall be governed in all respects by the laws of the State of Illinois.
10) This Contract may not be amended without prior written approval of both Department and Contractor.
11) This Contract may not be sold, signed or transferred in any manner.
12) The Department and Contractor understand and agree that this Contract constitutes the total agreement between them and that no promises, terms or conditions not recited, incorporated or referenced herein shall be binding upon either Department or Contractor.
13) 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 into law. However, obligations of the Contractor shall not be increased.
14) In the event any portion of this Contract is held invalid by any court of competent jurisdiction, remaining terms shall remain in full force and effect.
15) This Contract shall remain in full force and effect until Contractor has repaid all obligations to the Department pursuant to the terms of this Contract and all financial obligations shall be abated on a monthly basis in direct proportion to the service provided.
16) 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 __.
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Contractor |
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Director of Public Health |
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Social Security Number |
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ILLINOIS DEPARTMENT OF PUBLIC HEALTH
FAMILY PRACTICE RESIDENCY ACT
SCHOLARSHIP FOR MEDICAL STUDENTS
S E R V I C E C O N T R A C T
For Awards Made After June 1986
The Illinois Department of Public Health (Department) and ______________________ (Contractor) hereby agree as follows:
1) Paragraph _____ of Contract #___________ signed by Department and Contractor on __________________________ requires Contractor to enter into a contract with Department to serve as a full-time primary care physician engaged in direct patient care in designated shortage areas in Illinois approved as practice site(s) for that individual. A copy of Contract #____________ is attached and incorporated herein.
2) The Contractor received $_____________ in academic year 19___-19___; $_____________ in academic year 19___-19___; $_____________ in academic year 19___-19___; $_____________ in academic year 19___-19___, totaling $_____________. Copies of the State of Illinois documents verifying award amounts are attached and incorporated herein.
3) Contractor agrees to serve as a primary care physician at a rate of one year of full-time service for each school year or portion thereof that funds were provided except that no more than three years of service shall be provided. Contractor was provided funds for the academic years detailed in item 2 above. Uninterrupted service shall begin ______________________ and end ______________________. Uninterrupted service is defined as continual full-time patient care except for time allowed for continuing education, vacation, personal time, or sick time at the rate permitted by written policies of contractor's employer or as approved by the Department, at the sole discretion of the Department. The approved practice location shall be ______________________.
4) Full-time practice for an __________________ is defined as __________________ ( ) hours a week of direct patient care at the approved practice site(s) when services are not provided to office patients in the hospital setting.
5) If Contractor becomes disabled the terms and conditions of this Contract shall be suspended until such time as Contractor is able to resume repayment.
6) In the event the Contractor fails to perform any of the foregoing terms and conditions of this Contract, Contractor shall, in accordance with the Family Practice Residency Act, pay to the Department a sum of money equal to three times the amount of average scholarship grants for each year Contractor fails to fulfill such obligations. Payments 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 Contractor's remaining service term or as otherwise approved by the Department. Payments shall begin 30 days after Contractor fails to perform any of the terms and conditions of this Contract. In the event the Contractor fails to pay required installments to the Department, Department may file suit to collect all sums and future sums due and owing under this Contract.
7) Contractor shall pay all costs of suit including attorney's fees and all collection costs in the event the Department shall prevail in suit for money damages against Contractor pursuant to this Contract.
8) Contractor shall inform Department in writing within seven days of any of the following changes:
a) status of employment,
b) address,
c) illness, disability, or family considerations affecting obligations of this Contract.
9) This Contract shall be governed in all respects by the laws of the State of Illinois.
10) This Contract may not be amended without prior written approval of both Department and Contractor.
11) This Contract may not be sold, signed or transferred in any manner.
12) The Department and Contractor understand and agree that this Contract constitutes the total agreement between them and that no promises, terms or conditions not recited, incorporated or referenced herein shall be binding upon either Department or Contractor.
13) 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 into law. However, obligations of the Contractor shall not be increased.
14) In the event any portion of this Contract is head invalid by any court of competent jurisdiction, remaining terms shall remain in full force and effect.
15) This Contract shall remain in full force and effect until Contractor has repaid all obligations to the Department pursuant to the terms of this Contract and all financial obligations shall be abated on a monthly basis in direct proportion to the services provided.
16) 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 __.
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Contractor |
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Director of Public Health |
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Social Security Number |
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