Forms and Instructions for MHSA Stipend Recipients

Below you will find links to all of the IBH Program forms that you will need as an MHSA stipend recipient. Please scan and email completed, signed forms to To capture form images with a mobile device, use CamScanner or a similar application to ensure readability.
Questions? Email the IBH Program at

If you are changing positions, you will need to complete and submit an Employment Completion form for the position you are leaving and then complete and submit an Employment Verification form for the next position you begin.

  1. Placement Verification Form
  2. Change of Personal Information Form
  3. Employment Search Log
  4. Extension Petition Instructions
  5. Progress Update Form
  6. Employment Verification Form
  7. Employment Completion Form
  8. Job Search and Reporting Requirements for Recent Graduates