REGULATIONS
Vol. 32 Iss. 26 - August 22, 2016

TITLE 12. HEALTH
DEPARTMENT OF HEALTH
Chapter 507
Forms

REGISTRAR'S NOTICE: Forms used in administering the following regulation have been filed by the Department of Health. The forms are not being published; however, online users of this issue of the Virginia Register of Regulations may click on the name of a form to access it. The forms are also available from the agency contact or may be viewed at the Office of the Registrar of Regulations, General Assembly Building, 2nd Floor, Richmond, Virginia 23219.

Title of Regulation: 12VAC5-507. Nursing Scholarships and Loan Repayment Program Requiring Service in a Long-Term Care Facility.

Contact Information: Adrienne McFadden, MD, JD, Director, Office of Health Equity, Department of Health, 109 Governor Street, Richmond, VA 23219, telephone (804) 864-7425, FAX (804) 864-7440, or email adrienne.mcfadden@vdh.virginia.gov.

FORMS (12VAC5-507)

Long-Term Care Facility Nursing Scholarship Program Application Checklist and Requirements, LTC-SA-1 (rev. 5/2016)

Virginia Nurse Loan Repayment Program Application, LTC-NLRP-1 (rev. 5/2016)

Virginia Nurse Loan Repayment Program Practice Site Application, LTC-NLRP-2 (rev. 5/2016)

VA.R. Doc. No. R16-4825; Filed August 1, 2016, 1:08 p.m.