Virginia State Loan Repayment Program Applications and Forms

Quick Links

Virginia State Loan Repayment Program Overview

Applications and Forms

Shortage Area Maps

Virginia State Loan Repayment Flyer


*Please review ALL FAQs before calling the office

The application is a Microsoft Word document. Please follow the instructions below:

(1) Download the application and save it on your computer
(2) Complete the application by typing your responses directly in the Microsoft Word document
(3) Print and obtain the required original signatures

Important Notes

  • Please send all required information in one envelope.
  • Criminal background checks are the applicant’s responsibility. Applicants must submit the required forms and payments directly to the State Police and type YOUR name and address in the “Mail reply to” section of the application.
  • All applicants will be notified when their application is received.


  • Applicant:  VA-SLRP Application Part 1
  • Employer/Practice Site: VA-SLRP Practice Site Application Part 2
  • Required Cash Match:  VA-SLRP Cash Match Sample Letter   OR
  • VA-SLRP Cash Match Sample Letter (Request for State Matching Funds)
  • VA- SLRP Tobacco Region Funds Request

Existing Applicants’ Forms

  • Verification of Employment VOE
  • Verification of Employment (VOE) First 30 days
  • Change of Demographic Form