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Get TITLE I SCHOLARSHIP PROGRAM FACULTY/ADVISOR EVALUATION. IHS SCHOLARSHIP PROGRAM FACULTY/ADVISOR

AM See Estimated Average Burden Time per Response on page 2. FACULTY/ADVISOR EVALUATION RECIPIENT S NAME SOCIAL SECURITY NUMBER ADDRESS DEGREE PROGRAM PHONE: CELL IHS AREA OFFICE HOME EMAIL ADDRESS The student identified above is requesting a change of status related to his/her Indian Health Service (IHS) scholarship. The information on this form is requested pursuant to Section 751-756 of the Public Health Service Act, as amended, and applicable program regulations which provide tha.

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