Health Care Practitioner Application Package - Delaware Health and Social Services

Health Care Practitioner Application Package

Applicants: Please read the State Loan Repayment Program (SLRP) Program Guidance Manual in its entirety prior to proceeding to the health professionals' application. This guidance and the state loan repayment website provide the details, eligibility criteria and qualifying regulations that govern Delaware's program. Applicants must have a complete understanding of their commitment to serve as a SLRP recipient within an approved practice site in a health professional shortage area.

All required information must be completed and required documentation must be uploaded before an application can be deemed complete.

Once the applications - Part A through Part C - have been filled out completely, please submit your application in one of three ways: 1) Mail the signed and completed original application containing all of the requested information and documentation; 2) Email the application; or 3) Fax the application

Note: Part C, page 3, requires original signature in blue ink AND notary seal. The original document must be mailed or hand-delivered to the Delaware Health Care Commission office.

Mail: Delaware Health Care Commission
Margaret O'Neil Building
410 Federal Street, Suite 7
Dover, DE 19901

Email/PDF scan: dhcc@delaware.gov

Fax to: (302) 739-6927

To obtain a copy of the online application (Word fillable form) for the Delaware State Loan Repayment Program, please visit

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