Primary Care Certification

CERTIFICATION OF PRIMARY CARE TRAINING OR PRACTICE

As a graduate of Boston University Medical Campus (BUMC) and a recipient of funds from the BUMC Primary Care Pool, you agreed to certify that you are either training in or practicing primary health care according to the terms of your scholarship or loan agreement. PLEASE NOTE: Submitting this information is very important! Recipients of federal funds who do not submit it annually are subject to severe financial penalties, even if they are complying with all other aspects of the obligation.

You must submit this information annually if you received funds from the following sources while at BUMC:

Federal Primary Care Loan (PCL)
John I. Sandson Primary Care Loan
John and Hannah Sandson Primary Care Loan
Ruth M. Batson Primary Care Loan
Robert Wood Johnson Foundation Loan

You may submit the certification information to Student Financial Services (SFS) at BUMC by completing the sections below and clicking on the “Send Form” button at the bottom of your screen.

Name
Home Address
Home Telephone #
Work Telephone #
Work Address
E-Mail
Residency Training Program
Name of Program
Begin Date
(Projected) End Date
Comments
Practice Activities
Comments
By submitting this form, I certify that the information supplied is accurate and that I am in compliance with the primary care training and practice obligations specified in my agreement for the scholarship and/or loan program(s) identified above.
Primary teaching affiliate
of BU School of Medicine