Forms and Other Resources

Forms you’ll need to complete the service obligation or request a temporary deferment and frequently asked questions about the process.

Nurse helping patient.

Employment Verification and Service Obligation Requirements

The forms available on this webpage are for recipients of the West Virginia Nursing Scholarship Program. Applicants do not need to submit additional information beyond their application via their WVSAM account. All necessary details will be collected securely through our contacts with your program at the appropriate times.

For a more detailed explanation of service obligation requirements, please visit the Service Obligations section of this website.

For WV Nursing Scholarship Recipients Completing Their Service Obligations

If you received a West Virginia Nursing Scholarship award and need to verify your employment, you have two form options. Please review the descriptions carefully to choose the one that best suits your situation.

  • Electronic Employment Verification Form: This option allows you to input your information and provide your supervisor’s email address. Your supervisor will receive an email from wvColleges via AirSlate to complete their portion.
    • Important: Follow up with your supervisor to ensure they complete their part, as we do not receive the form until their submission is complete.
    • Firewall Alert: Some organizations have security filters that may block AirSlate emails. If your supervisor does not receive the email (check inbox and spam folders), please use the fillable PDF form instead.
Complete Electronic Employment Verification Form
  • Fillable PDF Employment Verification Form: This option allows you to print and complete the form manually with your supervisor. Submit the completed form by scanning or taking a photo and emailing it to nursing@wvhepc.edu.
Complete Fillable PDF Employment Verification Form

Additional Verification Guidelines

  • Pay stubs will not be accepted as proof of employment.
  • We cannot directly contact employers to verify compliance with service obligations.
  • If you encounter difficulties obtaining your employer’s verification, you may submit a letter on official company letterhead containing the following details:
    • Your first and last name
    • Employment position
    • Employment status (full-time/part-time)
    • Employment start date
    • Employment end date (if applicable)
    • Contact information for a supervisory authority at your organization

All letters should be submitted via email to nursing@wvhepc.edu.

Temporary Deferments from Service Obligation Requirements

If you have received a West Virginia Nursing Scholarship award but are facing circumstances that prevent you from completing your service obligation as scheduled, you may be eligible for a temporary deferment.

Common reasons for deferment include:

  • Enrollment in another academic program
  • Challenges passing the NCLEX examination
  • Extenuating life circumstances that delay or prevent you from starting or continuing your service obligation

A temporary deferment pauses your service obligation for a specified period and is approved on a case-by-case basis.

Important Note

Temporary deferments are not the same as employment verification. If you need to verify your employment, please only use the designated employment verification forms.

How to Apply

To request a temporary deferment, please complete the form linked below. Be sure to provide a detailed explanation of your situation. You will receive an email notification once a decision has been made.

Complete Temporary Deferment Form

Frequently Asked Questions About the Employment Verification Process

I verified my employment but am still receiving bills from ECSI or reminder emails. Why?
I changed jobs since I last verified my employment. What should I do?
I had a gap in employment between jobs. How does this impact my service obligation?
I worked at my employer before finishing my program. When does my service obligation start? Can it be backdated?
I left West Virginia to work as a nurse in another state but have returned. Can I still fulfill my service obligation?
I am not going to complete my full service obligation term. What should I do?
I forgot to submit my employment verification. What should I do?
I am going back to school and won’t be working full-time. Do I have to repay?
My employer refuses to complete the employment verification form. What can I do?
Can I submit pay stubs to verify my employment?
I need to repay my award. How do I do that?
I am a travel nurse in West Virginia. How do I verify my compliance with the service obligation?

Other Financial Assistance for Nursing Students

In addition to the West Virginia Nursing Scholarship Program, you may be eligible for other scholarship and loan repayment programs. Please see the directory of Health Sciences Financial Aid Programs below for more details about these programs.

Health Sciences Financial Aid Programs Directory coming soon!