SCHOLARSHIP AGREEMENT FORM

This Scholarship Agreement is entered into on the date noted below in compliance with Federal regulations at Title 34 of the CFR (Code of Federal Regulations), Part 386 related to the Long-Term Training Program funded by the Rehabilitation Services Administration of the U.S. Department of Education. The Federal regulations noted above in this Agreement and the RSA Long-Term Training Scholarship Manual have been made available to me by the institution that awarded the scholarship funds. An official of the applicable institution, by signing this Agreement, acknowledges that the terms and conditions of the scholarship have been fully disclosed to the scholar by providing all applicable information.

I, ____________________________ agree to abide by the stipulations noted below as conditions of receipt of the scholarship for training in the Orientation and Mobility or Rehabilitation Teaching Master of Arts program at The University of Arkansas at Little Rock.

My receipt of these scholarship funds is predicated upon the expectation that I will maintain or seek employment in a designated State rehabilitation agency or in a nonprofit rehabilitation agency, professional corporation, professional practice group, or related agency providing services to individuals with disabilities under an agreement with a designated State agency. Under the terms of the Long-Term Training Program, scholarship funds include all disbursements or credits for student stipends, tuition and fees, and student travel in conjunction with training assignments.

Therefore, as a designated Long-Term Training scholar, I agree to

1. Maintain employment

A. in a nonprofit rehabilitation agency or related agency, including a professional corporation, professional practice group through which the agency has a service arrangement with a designated State agency;

B. on a full- or part-time basis; and

C. for a period of not less that the full-time equivalent of two years for each academic year for which the scholarship assistance was received, within a period, beginning after I complete the training for which the scholarship was awarded, of not more that the sum of the number of years required in this paragraph and two additional years; and

2. Repay all or part of any scholarship received, plus interest, if I do not fulfill the requirements of paragraph (I ) of this Agreement (immediately above), except as the Secretary of Education by regulations may provide for repayment and deferrals.

3. The employment obligation as applied to a part-time scholar will be based on the accumulated academic years of training for which the scholarship is received.

4. Until I have satisfied the employment obligation described above, I will inform the institution which awarded the scholarship of any change of name, address, or employment status and will document employment satisfying the terms of the Agreement.

5. Subject to this provision in 34 CFR 386.41 of the Federal regulations, regarding a deferral or exception, if I enter repayment status under 34 CFR 386.43 (e), the amount of the scholarship that has not been retired through eligible employment will constitute a debt owed to the United States that --

    1. will be repaid by me, including interest and costs of collection as provided in 34 CFR 386.43; and

    2. may be collected by the Secretary of Education in accordance with 34 CFR part 30, in the case of a failure to meet the obligation of 34 CFR 386.43.
    _____________________
    (Signature of Scholar)

    _____________________
    (Date)

    (Social Security Number of Scholar)

    ___________________________

    (Signature of Project Director)

    _______________________

    (Project Number)
    ________________________