Durham VA Health Care System
Greenville HCC Stipend Residents
Congratulations on your new appointment as a trainee at the Greenville Health Care Clinic (GHCC). We are excited to have you on the team as part of the Durham VA Health Care System. We hope your time with us is exciting, educational, and motivating, as you excel your career. Below you will find links to the GHCC Paperwork required for Associated Health Trainees.
If you have any questions, regarding your paperwork, please feel free to contact:
Dalonia Clemons, Program Support Assistant
Am I Eligible - Download and complete this checklist to be sure you meet all eligibility requirements to train at VA facilities.
VA Form 10-0453 HR Screening Checklist Dated January 2017,
(Provide FIRST, FULL MIDDLE, & LAST NAME). If you don’t have a middle name, indicate “No Middle Name”. If you have only initials in your name, provide them and indicate “Initial only”. (Provide your SSN) (Your Service/Office is: Education) (Your Service/Office is: Greenville HCC) (Type of Appointment is: Healthcare Professions Trainee)
Welcome Letter (For your records)
VA Form 10-294 Letter for ECU GME Appointment. (Complete, print out, sign pages 3 & 4 and turn in all paperwork together. Send to Dalonia Clemons at Greenville VA HCC) . Include a copy of Visa and passport, if non-US Citizen.
VA Form 10-2850D Application for Health Professions Trainee Dated Nov 2011 (Provide FIRST, FULL MIDDLE, & LAST NAME). If you don’t have a middle name, indicate “No Middle Name”. If you have only initials in your name, provide them and indicate “Initial only”. (Please provide your complete name & SSN at top of Pages 2-4.) (Complete, print out, sign pages 3 & 4 and turn in all paperwork together. Send to Dalonia Clemons at Greenville VA HCC)
Selective Service System: Male trainees are required to visit https://www.sss.gov to register, print proof of registration or, if not registered, apply for a status information letter (SIL). The SIL denotes one’s requirement for registration, and, if applicable, exemption from the registration requirement. (Send a copy of this letter along with all of your paperwork to Dalonia Clemons at Greenville VA HCC)
Federal law requires that most males living in the US between the ages of 18 and 26 register with the Selective Service System. This includes individuals who are US citizens, non-US citizens and dual nationals, regardless of their immigration status. Male for this purpose is defined as those individuals born male on their birth certificate regardless of current gender. Only male, non-US citizens on a student or visitor visa are exempt from registration.
Determination & Certification of English Language Proficiency (Complete, print out, sign and turn in all paperwork together. Send to Dalonia Clemons at Greenville VA HCC)
Courtesy Fingerprinting: If you have a nearby VA, you can begin the fingerprint clearance process prior to arriving in Greenville, NC (Present the DVAMC Appointment letter and the Courtesy fingerprints document to your Local VA Facility. Locations for courtesy fingerprints can be found at: http://www.va.gov/pivproject/piv_badge_offices.asp. Advise Dalonia Clemons at Greenville VA HCC when courtesy prints were taken.
VHA Mandatory Training for Trainees (MTT): Go to TMS website-Self register and complete MTT. Provide Dalonia Clemons, at the Greenville VA HCC, a copy of your course completion certificate.
You need the following information to complete self-registration:
VA Location: DUR POC: Dalonia Clemons, Program Support Assistant
POC Email: Dalonia.Clemons@va.gov
NON-US Citizen Request Memo (If applicable) (Only to be completed by non-US Citizens. Complete highlighted blocks through item 3, print, sign, and turn in with all paperwork. Send to Dalonia Clemons at the Greenville VA HCC. Include a copy of VISA and passport)
Personal Identity Verification (Submit a copy of your social security card and driver's license, state ID or VISA with all other paperwork. Send to Delonia Clemons at the Greenville VA HCC.
Please notify Dalonia Clemons of any changes to Driver’s License, State ID or VISA prior to orientation.
Lost, Stolen, Destroyed, or Damaged PIV Badge (If previously issued a PIV badge that has been lost, stolen, or destroyed, please fill out the PIV Memo through your signature line, print, sign, and turn in with all paperwork. Send to Dalonia Clemons at the Greenville VA HCC.
Current PIV badge holders (If you have a PIV badge from another VA facility, please inform Dalonia Clemons) NPI Number (Print Page with NPI Number. Send to Dalonia Clemons at the Greenville VA HCC)
Complete form: select new user if no previous VA history; select re-activation if you have previously been at VA; Access to: Durham; Appointment status: select correct box; Type of Access Needed: check all boxes; Certifications: check mandatory training for trainee’s box; and Requested menus and security keys- leave blank. Turn in with all paperwork. Send to Dalonia Clemons at the Greenville VA HCC.
CPRS Tab by Tab Training Electronic Click on “Go to course content”. You must complete all 27 sections of the video training. At the bottom right corner, click on “next section” to complete all 27 sections. Once all sections have been completed, the certificate printing will be available. At the end of section 27, click “Next Section” and follow the instructions for printing a certificate. Turn in with all paperwork. Send to Dalonia Clemons at the Greenville VA HCC.