Fillable Printable Narrative Statements

Narrative Statements

DEPARTMENT OF HEALTH AND HUMAN SERVICES

PUBLIC HEALTH SERVICE

INDIAN HEALTH SERVICE

PUBLIC LAW 94-437 – TITLE I SCHOLARSHIP PROGRAM

NARRATIVE STATEMENTS

FORM APPROVED:

OMB Approval No: 0917-0006

Exp. Date: 08/31/2013

See Estimated Average Burden Time

per Response on Reverse Side.

APPLICANT’S NAME SOCIAL SECURITY NUMBER

DEGREE TRACK IHS AREA OFFICE EMAIL ADDRESS

Explain why you are requesting this scholarship**

State your career goals**

Explain how these goals will help to meet the health needs of the Indian people**

** If more space is required, use addi tional sh eets of 8 1/2” x 1 1” paper. Wri te your n ame and social sec urity num ber on ea ch additi onal shee t of paper. Securely a ttach

additional sheets to this form.

IHS-856-4 EF