Florida Health Care Innovation Loan Application Portal

(1) I certify that I am the authorized representative of the AHCA-licensed entity; that I have authority to enter into binding legal agreements, including loan applications, closing documents, and promises to pay, on behalf of the entity; and that I am responsible for all information submitted on the entity’s behalf. I understand that loan approval is not guaranteed and is subject to review and approval as prescribed by section 381.4015, Florida Statutes, and related rules. *

(2) I authorize the Florida Department of Health and the loan originator to verify the information provided in this application, including but not limited to obtaining credit reports from consumer reporting agencies, contacting employers and financial institutions, and verifying other relevant details applicable to the Applicant, the owners of the Applicant, and the authorized representatives of the Applicant.

(3) I hereby consent to the verification of my identity by the Florida Department of Health, and I authorize the use and disclosure of my personal information, as provided in this application, to confirm eligibility and to process this loan request in accordance with applicable laws, regulations, and privacy policies. *

(4) I understand that all information provided will be verified, that it is essential that I provide accurate and truthful information, and that misrepresentation or falsification of any details may result in rejection of this application and may result in legal action against me and/or the entity for which I am authorized to act.

(5) By checking 'I Agree,' you confirm that you are who you claim to be, and that all information submitted is true and correct to the best of your knowledge.

(1) I certify that I am the authorized representative of the educational, or clinical training provider working in partnership with a AHCA-licensed entity; that I have authority to enter into binding legal agreements, including loan applications, closing documents, and promises to pay, on behalf of the entity; and that I am responsible for all information submitted on the entity’s behalf. I understand that loan approval is not guaranteed and is subject to review and approval as prescribed by section 381.4015, Florida Statutes, and related rules. *

(2) I authorize the Florida Department of Health and the loan originator to verify the information provided in this application, including but not limited to obtaining credit reports from consumer reporting agencies, contacting employers and financial institutions, and verifying other relevant details applicable to the Applicant, the owners of the Applicant, and the authorized representatives of the Applicant.

(3) I hereby consent to the verification of my identity by the Florida Department of Health, and I authorize the use and disclosure of my personal information, as provided in this application, to confirm eligibility and to process this loan request in accordance with applicable laws, regulations, and privacy policies. *

(4) I understand that all information provided will be verified, that it is essential that I provide accurate and truthful information, and that misrepresentation or falsification of any details may result in rejection of this application and may result in legal action against me and/or the entity for which I am authorized to act.

(5) By checking 'I Agree,' you confirm that you are who you claim to be, and that all information submitted is true and correct to the best of your knowledge.