For the latest COVID-19 campus news and resources, visit umassmed.edu/coronavirus.

Search Close Search
Search Close Search
Page Menu

Forms

For graduates entering monetary repayment:

Five and one half months after ceasing forbearance, borrowers who do not qualify for service payback may contact ECSI to request that accrued interest be Capitalized, i.e., added to the principal (so that interest is not all due in the first payment) and pay bills as they come due. Borrowers wishing to make automatic electronic payments need to contact ECSI. Delinquent accounts will be sent to collection, and delinquent borrower's academic records will not be released until account is current.

Interest Capitalization Request Form

 

For graduates in residency/fellowship:

Forbearance Process: Borrowers eligible for forbearance, i.e., transfers to other medical schools and medical residents or fellows, print the Forbearance Form and complete the form as directed on the instructions page, and send it to University of Massachusetts Chan Medical School, 55 Lake Ave North, Attn: Tina Sasseville S1-416, Worcester, MA, 01655.

For graduates providing service:

Postponement Form: At the beginning of each year (period of 12 months) of qualified service payback (list of qualified services), borrowers print the Postponement Form, complete the form as directed on the instructions page, and submit the original form, along with an original copy of your job description, to University of Massachusetts Chan Medical School, 55 Lake Ave North, Attn: Tina Sasseville S1-416, Worcester, MA, 01655. After the Learning Contract Advisory Group approves the employment for service payback, the FAO notifies ECSI to put the account in Postponement (suspended billing) status.

          Postponement form for Primary Care, Public Service or Community Service

          Postponement form for Underserved

Job descriptions for the Learning Contract must include the following information on letterhead from employer: dates requesting postponement, date of hire, number of hours worked per week, a brief description of employment duties, and signature and title of authorized individual (human resources, business manager, supervisor or program director).  Please note that only ORIGINAL copies will be accepted.

Cancellation of Learning Contract: After graduate completes their service they will print a Cancellation form, complete the form as directed on the instructions page, and submit the original form to University of Massachusetts Chan Medical School, 55 Lake Ave North, Attn: Tina Sasseville S1-416, Worcester, MA, 01655. After the Learning Contract Advisory Group formally votes to approve the service payback, the Learning Contract will be considered paid in full.