Section 590.APPENDIX D   Sample Contract for Education Loan Repayment

ILLINOIS DEPARTMENT OF PUBLIC HEALTH

FAMILY PRACTICE RESIDENCY ACT

EDUCATIONAL LOAN REPAYMENT

C O N T R A C T

The Illinois Department of Public Health (Department) and ________________________ (Contractor) agree as follows:

1)         Contractor will provide patient care in the community or area indicated on the educational loan repayment application on a full-time basis, as defined in the Family Practice Residency Code, (77 Ill. Adm. Code Chapter I, Part 590) for a minimum period of two years.

2)         Contractor will use funds to repay loans used only for educational purposes in pursuit of medical degree.

3)         Contractor will provide the Department with photocopies of promissory notes or other evidence to document amount of indebtedness and the institutions owed.

4)         Contractor will provide the Department with photocopies of cancelled checks to document payments Contractor has made for his/her educational loan indebtedness and for which reimbursement is sought from the Department.

5)         Contractor may request from the Department written approval for the transfer of his or her educational loan repayment eligibility to another designated shortage area, if the new area is of the same, or a higher priority classification than the original practice location.

6)         If Contractor moves to a practice location in a lower priority classification, or moves from an urban to a rural location, or vice versa, all educational loan repayment will cease immediately.

7)         Department will make educational loan repayments directly to the Contractor, or to the financial or educational institution holding the indebtedness. Retrospective payments will be made to the Contractor on a quarterly basis. Prospective payments on the Contractor's behalf will be made on a quarterly basis directly to the financial or educational institution holding the indebtedness, if so agreed by the lender.

8)         Department will pay twenty-five percent of the educational loan indebtedness, or up to $20,000 whichever is less, for each year Contractor practices in the selected underserved area or facility.  Should the Contractor fail to pay monies due, the Department may refer the matter to the Attorney General or to a collection agency.

9)         If Contractor ceases full-time practice in an underserved area or facility or moves from the originally selected underserved area or facility to one with a lower priority ranking as described in 77 Illinois Administrative Code Chapter I, Part 590 before completing the required two years of practice, all sums paid to Contractor or paid on Contractor's behalf will be due to Department within 30 days of the practice change.

10)        If Contractor moves from the approved practice area and the Department has made prospective payments to the financial or educational institution, Contractor must repay funds in direct proportion to the length of practice in the approved area.

11)        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.

12)        Contractor shall inform Department in writing within seven days of any changes in the following areas:

a)         status of employment or practice

b)         address

c)         illness, disability, or family considerations affecting obligations of 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 Contractor.

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

16)         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.

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)         Contractor certifies he/she has not been convicted of bribery or attempting to bribe an officer or employee of the State of Illinois, nor has Contractor made an admission of guilt of such conduct which is a matter of record.

19)         Contractor certifies he/she is not in default on any educational loans as provided in Public Act 85-827.

20)         Contractor agrees to allow Department to request from the lending institution an annual confirmation of the status of Contractor's educational loans.

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 into law. However, obligations of the Contractor shall not be increased.

22)         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.

23)         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.

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

The term of this Contract is____________________ through _____________________.

Executed this__________ day of ___________________________, 19 __.