10-0491g
Health Professional Scholarship Program (HPSP), Visual Impairment and Orientation and Mobility Professionals Scholarship Program (VIOMPSP), & Veterans Healing Veterans Medical Access and Education Scholarship Program (VHVMAESP)
VA Form 10-0491G is the Department of Veterans Affairs application for the Health Professional Scholarship Program (HPSP) and the Visual Impairment and Orientation and Mobility Professionals Scholarship Program (VIOMPSP). VA's page also names the Veterans Healing Veterans Medical Access and Education Scholarship Program (VHVMAESP) in the form name. The form says to furnish all information in sufficient detail to enable VA to determine the applicant's eligibility and ranking for selection to receive a scholarship.
The PDF has seven pages: preliminary eligibility questions, a summary of the complete application package, Sections I to V on the program, the applicant, the education program, additional information and supplemental explanations, a consent to release FAFSA and FERPA protected information, the burden and Privacy Act notices, and Section VI, authentication. The form says to type or print in ink, and that initials are hand written and signatures hand signed.
You can fill out the PDF free in your browser on this page and download the result without an account.
Eight yes or no questions on enrollment, a cumulative grade point average of 3.0 or above, clinical tours, the VA employment obligation, U.S. citizenship, federal debt, other service obligations and Pediatrics support. The form says how the answers affect eligibility.
The program (HPSP or VIOMPSP), length of award (1 year or 2 or more years), clinical program and degree sought, from associate (HPSP only) to doctorate, with the major field of study.
Items 5a to 22: name and other names, address, phones, Social Security number, email, citizenship, prior VA scholarships and breaches, a contact person, highest degree, military service, court-martial, VA employment, Vocational Rehabilitation or GI Bill benefits and healthcare work.
The college or university, department, phone and address, academic advisor, program type (traditional, non-traditional or mixed), program start and end dates, and willingness to meet the HPSP clinical tour requirement.
Awards, professional activities and memberships, four essay questions (35a to 35d) with a 250 word limit each, questions 36 to 41 on licenses, malpractice, discharges, convictions and federal debt, and five initialed program requirements in item 42.
Item 43 for explanations keyed to question numbers, the consent to release FAFSA and FERPA protected information naming the school, and the authentication certification with the applicant's printed name, signature and date.
The form says that an answer of No to any of questions 1 to 5, or Yes to question 6 or 8, means the applicant is not eligible and should not submit an application.
The form lists this application, the Academic Verification Form (VA Form 10-0491), the Evaluation & Recommendation Forms (VA Form 10-0491e), an academic transcript, a resume or CV and the Declaration for Federal Employment (OF 306).
Type or print in ink. If more space is needed, or a Yes answer calls for an explanation, use Section V and give the question number.
The form says all initials in item 42 are hand written and all signatures hand signed, on the consent page and in Section VI.
Send the completed application to the HPSP/VIOMPSP office of the Department of Veterans Affairs in New Orleans, Louisiana.
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
HPSP/VIOMPSP, Department of Veterans Affairs, 1250 Poydras Street, Suite 1000 New Orleans, LA 70113.
The form says it is the applicant's responsibility to ensure the package is complete, accurate and submitted by the deadline date, and that incomplete applications will not be reviewed. The PDF prints no date.
The form says to read the accompanying Applicant Information Bulletin before completing it.
The form says all material submitted becomes the property of the Federal Government and will not be returned.
The PDF footer reads VA FORM SEP 2026 10-0491g, matching the September 2026 revision date on VA's page. Page 1 shows OMB Control No. 2900-0793, expiring 09/30/2029, and a burden of 90 minutes. The burden statement on page 7 prints the expiration as XX/XX/20XX.
10-0491
481 fields, 7 pages
10-0491e
17 fields, 2 pages
10-0491k
35 fields, 1 page
10-0491f
13 fields, 4 pages
10-0491L
12 fields, 3 pages
The form is filled in by scholarship applicants. Others supply parts of the package.
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It is the application for the VA Health Professional Scholarship Program (HPSP) and the Visual Impairment and Orientation and Mobility Professionals Scholarship Program (VIOMPSP).
The form lists VA Form 10-0491g, the Academic Verification Form (VA Form 10-0491), Evaluation & Recommendation Forms (VA Form 10-0491e), an academic transcript (unofficial acceptable, MCATs for physician applicants only), a resume or curriculum vitae and the Declaration for Federal Employment (OF 306).
The form sets a 250 word limit for each of questions 35a to 35d and asks for 10pt or 12pt font.
The form says resumes should not exceed 5 pages and must be at least 11 point font, and that resumes longer in length or written in smaller font will not be reviewed.
No. Item 31 says the HPSP requires willingness to perform clinical tours in assignments or locations determined by VA while enrolled, and that the VIOMPSP does not require clinical tours.
The form says to submit the completed application to HPSP/VIOMPSP, Department of Veterans Affairs, 1250 Poydras Street, Suite 1000 New Orleans, LA 70113.
