The Michigan Department of Community Health invites all eligible medical, dental and mental health care providers to apply for the Michigan State Loan Repayment Program.  Your Complete, Single-submission SLRP Application  Package consists of your: SLRP Provider Application, Parts A and B; W-9 Tax Form; Payee Registration Form; and, SLRP Practice Site Application & Declaration of Intent, which must be completed by your employer but included as part of your Complete, Single-submission SLRP Application Package.  This means that all required documents must arrive together by mail at the SLRP Office in a single package and that each document must be 100% complete and legible.  If you have difficulty printing clearly, it will be best to ask someone else to complete your application documents.  Providers and employers will find all necessary application forms on this website.

Please note that:

SLRP Providers must clearly indicate the type of contract for which they are applying  at the top of the first page of Part A of their SLRP Provider Application.  They may only apply for one of the following types of contracts:

·         Competitive Contract,

·         Local Match Contract, or

·         CMH/DOC State Match Contract.

Please use the Successful SLRP Application Check List, found below, to ensure your application meets the Complete, Single-submission SLRP Application Package Requirement.  This is important because only complete and legible applications will be reviewed.

While using the Successful SLRP Application Check List, please pay careful attention to its instructions regarding Part B of the SLRP Provider Application.  Part B of the Provider Application takes considerable time to complete and you must have your lenders complete Part B before you return it to the SLRP Office as part of your Complete, Single-Submission SLRP Application Package.  First, you must complete Sections l and ll and mail or fax it to the organizations that hold your loans.  You must ask them to complete Sections III, IV and V and then mail or fax it back to YOU.  You must then receive the completed Part B back in time to include it with your Complete, Single-submission Application Package, which you must mail to the SLRP Office with the required postmark for that application period.  This process can take several weeks, so it makes sense to get an early start on Part B.

Also, do not instruct your lenders to send their completed Part B to the SLRP Office.  It is your responsibility to include each completed Part B in your Complete, Single-submission SLRP Application Package, which you must mail to the SLRP Office.

Please note that you may save a great deal of time by faxing Part B to your lenders and requesting that they fax it back to you.  Previously faxed Parts B are acceptable, as long a they are legible and arrive at the SLRP Office by mail as part of your Complete, Single-submission SLRP Application Package.  Application forms faxed directly to the SLRP Office will be discarded without notification to the applicant.

Employment Requirement:

You must secure employment before you apply for SLRP and your employer must mail a SLRP Practice Site Application & Declaration of Intent to the SLRP Office to document their intention of employing your throughout the term of your SLRP contract, should your application prove successful.  You must start your employment with that employer before the start date of  your SLRP contract.  Please keep in mind that you must also include an updated SLRP Practice Site Application & Declaration of Intent, completed and signed by your employer, as part of your Complete, Single-submission SLRP Application Package, even if your employer has already mailed one to the SLRP Office.

Do not submit your application until you have secured employment at an appropriate Practice Site and have enclosed an updated  SLRP Practice Site Application & Declaration of Intent completed and signed by your employer.  Employers must use the SLRP Practice Site Application & Declaration of Intent found on this website.

Complete, Single Submission SLRP Application Package Requirement:

This means that all required documents must arrive together at the SLRP Office in a single package and that each document must be 100% complete and legible.  If any portion of your application is incomplete or illegible, it will not be reviewed. Furthermore, due to the great number of applications received by the SLRP Office, we will not be able to contact you regarding incomplete or illegible portions of your application.

Before submitting your application, make certain you have included all required application materials and that each document is 100% complete and legible.  Applications not meeting the Complete, Single Submission Application Package Requirement will not be reviewed.

Please print and use the "Successful SLRP Application Check List, below, to guide you through completion of your application package.