Professional Student Exchange Program Form, 2025-2026

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 WICHE Student Exchange 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 through WICHE to the receiving school. This information is exchanged between and among the certifying office of the student’s home state; the staff of the Student Exchange Program, Western Interstate Commission for Higher Education; and the professional school(s) to which the student makes application and is admitted. The WICHE Commissioners of the sponsoring state may also review applications to consider eligibility of student(s). Periodic accounting for the Student Exchange Program in the state and in the region may result in publication of reports which may contain the student’s name, home state, year of enrollment, enrolling institution, and money spent by the state 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 Student Exchange 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 Student Exchange Program, providing access to educational opportunities for residents of the western states.


• 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 Student Exchange Program of the Western Interstate Commission for Higher Education to include the following:
  
  
  
  • Information concerning student eligibility, acceptance, and educational attainment;
  
  
  • Information concerning fees paid by the sending state through WICHE to the receiving school;
  
  
  • Lists of applicants certified as eligible for support;
  
  
  • Admissions reports, withdrawal reports, and annual reports for WICHE Exchange Students;
  
  
  • Support agreement forms and invoices; and
  
  
  • Special letters of inquiry and response as required to address questions and concerns identified by participants.
  
  
  
  


• I understand that the information referred to herein will be available only to Student Exchange Program staff members, designated institutional officials, and sending state officials as required to carry out their official duties.


• I further consent to the transfer of all or a portion of the above educational records to admissions officers and certifying officers as required to accommodate the needs of the Student Exchange Program provided that the officers receiving the information will not permit any other party to have access to such information without the express written consent of the undersigned.


• I hereby waive my right to receive specific notification of the transfer of such records. I understand that personally identifiable educational records will be used only to the extent necessary to carry out the purposes of the Student Exchange Program including reasonable research studies necessary to evaluate and improve the program. Any general research report of information that might prove harmful or embarrassing will be included only when anonymity is preserved. Use of the information will be permitted only when, in the judgment of the Student Exchange Program Director or other designated staff member, the request for information is wholly consistent with my best interest and the purpose of the Student Exchange Program.


• I understand that a log will be maintained to identify access to my records, which is permitted pursuant to law, and this information will be available to me upon appropriate request.


• Personal education records are securely stored electronically or in a locked file.

If you do not fulfill your practice obligation your stipend will convert to a loan with penalties and interest. Due to this possibility, We are providing links to loan disclosure forms specific to the program you will be pursuing. Please review these loan disclosure documents:

• Occupational Therapy Loan Disclosure Form
• Physical Therapy Stipend Application Loan Disclosure Form
• Physician Assistant Stipend Application Loan Disclosure Form
• Pharmacy 3-yr Accelerated Application Loan Disclosure Form

View all PSEP Loan Disclosure Forms

The Truth in Lending Act (TILA), Title I of the Consumer Credit Protection Act, 15 U.S.C. § 1601 et seq., Regulation Z, 12 CFR Part 1026 requires lenders to provide clear and detailed information about the terms and costs associated with education loans, helping borrowers make informed decisions.

The Nevada Office of WICHE Stipend Conversion to Loan for Non-fulfillment of Practice Obligation Approval Disclosure form is an estimate* of the total loan amount, interest, finance charge, schedule of payments if the stipend amount received while in school is converted to a loan if you breach the terms of your stipend contract, for example by not fulfilling your practice obligation.

*Nevada WICHE recipients are not guaranteed a yearly stipend to complete their practice program. Selection of stipend recipients is based on eligibility (i.e., Nevada residency such as Nevada Driver’s License or Nevada Identification Card, acceptance to professional program), meeting compliance requirements (i.e., regular submission of Practice Questionnaire with supporting documents such as Nevada Driver’s License or Nevada Identification Card to demonstrate maintaining residency in Nevada, unofficial transcript for academic progress or Nevada Practice license, Nevada employer verification letter) as well as availability of funding from the Nevada Legislature.

• You are voluntarily choosing to sign your PSEP 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 PSEP application.