Arizona Loan Repayment Program

Loan Repayment Application – Apply for Repayment

To apply for loan repayment, applicants must provide to the Arizona Department of Health Services a complete application packet that includes the following:

  1. Primary Care Provider Application Form
  2. Loan Information and Certification
  3. Applicant Certification and Privacy Act Release Authorization
  4. Service Site Application Form

Applicants must also submit a Substitute W9 Form with an original signature and must register at the ProcureAZ website. The website offers step-by-step instructions on vendor registration.

NOTE: Only complete applications will be considered. If additional documentations are required, the program manager will contact the applicant and will be given one week to provide such requirements.

Submission Deadlines

The application form must be submitted along with any required supporting documentation to the ALRP program manager, postmarked no later than the last date specified for a particular phase of the award cycle. Timelines are as follows:

Submission Deadlines
Contract Start Date Application Period
July 1 December 16 - March 15
October 1 March 16 - June 15
January 1 June 16 - September 15
April 1 September 16 - December 15

Applications should be submitted to:

Workforce Section Manager
Bureau of Health Systems Development, ADHS
150 N. 18th Avenue, Suite 300
Phoenix, AZ 85007