Health Professional Education Program (HPEP) Form, 2026-2027

Nevada Western Interstate Commission for Higher Education

PURPOSE FOR REQUESTING STUDENT SIGNATURE ON CONSENT AND WAIVER FORM: Public Law 93-380, the Federal Family Education Rights and Privacy Act of 1974, requires all who hold custody of student records to insure protection of personally identifiable information. Administration of Nevada Office of WICHE Health Profession Education Program requires the exchange of educational information about student applicants in order to provide for consideration of enrollment and transfer of funds by the state in the case of admission by the school. In order to facilitate exchange of necessary documents, the student application is asked to sign a “Consent and Waiver” statement.

DESCRIPTION OF USE OF PERSONAL RECORDS: The program collects and uses information concerning student eligibility for the program; admission; enrollment; academic progress; graduation and/or termination from the professional program; and payment of fees by the State of Nevada through Nevada Office of WICHE to the receiving school. This information is exchanged between and among the Nevada Office of WICHE staff; Nevada System of Higher Education administrative staff assisting the Nevada Office of WICHE and the professional school(s) to which the student makes an application and is admitted. Periodic accounting for the Nevada Office of WICHE programs may result in publication of reports which contain year of enrollment, enrolling institution, and money spent by the Nevada Office of WICHE to support the student’s effort to reach an educational objective.

NOTIFICATION CONCERNING STUDENT ACCESS TO PERSONAL RECORDS: Any student participant or applicant for participation in the Nevada Office of WICHE Health Profession Education Program has access to their personal records maintained as a part of the exchange activity. If you want to review your record, contact the Nevada Office of WICHE that maintains the record to make appropriate arrangements. Nevada Office of WICHE has 45 calendar days to comply. The student participant may inspect and/or receive copies at a cost not to exceed the actual cost of reproduction. Per Nevada Revised Statute 239.080 the Nevada WICHE Commission/Nevada Office of WICHE state record retention schedule for applicant files that are unfunded are retained five (5) years and recipient files are retained for twenty (20) fiscal years after contract satisfaction. After the retention period has ended the records can be destroyed securely.

CONSENT AND WAIVER

• I understand that it is necessary to process student records in order to carry out the purpose of the Nevada Office of WICHE Health Profession Education Program, providing access to educational opportunities for Nevada residents.
• I understand that the record-keeping process requires preparation, transmission, receipt, filing, and reporting of information appropriate to the effectiveness and continuity of the program.
• I hereby consent to the transfer of personally identifiable educational records between and among the participants in the Nevada Office of WICHE Health Profession Education Program to include the following:
  • Information concerning student eligibility, acceptance, and educational attainment.
  • Information concerning fees paid by the Nevada Office of WICHE to the receiving school.
  • Lists of applicants certified as eligible for support.
  • Admissions reports, withdrawal reports, and annual reports for Nevada Office of WICHE Health Profession Education Program Participants.
• I understand that the information referred to herein will be available only to Nevada Office of WICHE Program staff members, Nevada System of Higher Education staff supporting Nevada Office of WICHE; designated institutional officials as required to carry out their official duties.

• You are voluntarily choosing to sign your HPEP Application electronically
  


• You understand and agree that no certification authority or other third party verification is necessary to validate your E-Signature and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting contract between you and The Nevada Office of WICHE
  


• You understand that you have the right to withhold your consent to the use of electronic documents and signatures and that you have the right to withdraw your consent at any time prior to completing the e-sign process. Please be aware, however, that withdrawal of consent may result in the termination of your HPEP application.