Form 1 AENT

Advanced Education Nursing Traineeship (AENT) and Nurse Anesthetist Traineeship (NAT)

AENT Tables final

Advanced Education Nursing Traineeship (AENT) and Nurse Anesthetist Traineeship (NAT)

OMB: 0915-0305

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0915-0305 can be found here:

2010-02-04 - Revision of a currently approved collection

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OMB No. 0915-

Exp. Date:

Advanced Education Nursing Traineeship (AENT) Program

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 0915-xxxx. Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-33, Rockville, Maryland, 20857.

AENT Program Tables

Complete the following table(s), as appropriate, summarizing enrollment, student support, graduate data, and enrollment projections:

Table 1 - AENT: Clinical Nurse Specialist, Clinical Nurse Leader, Nurse Practitioner, Nurse Administrator/Nurse Educator, and Post-Nursing Master’s Certificate Enrollment, Traineeship Support and Graduate Data

Table 2 - AENT: Nurse-Midwifery Certificate, Nurse-Midwifery Master’s, Nurse-Midwifery Doctoral and Nurse Anesthesia Enrollment, Traineeship Support and Graduate Data

Table 3 - AENT: Doctoral Enrollment, Traineeship Support and Graduate Data

Table 4 – AENT: Graduate Data – Rural, Underserved, or Public Health

Table 5 – AENT: Minority/Disadvantaged Status Data

IMPORTANT NOTE: All appropriate AENT Program Specific Tables must be submitted by the due date. If not, your grant application may be deemed non-responsive to the Program Guidance and the grant application will not be considered for funding. Applicants must adhere to the table instructions to ensure that the data provided are accurate and complete. Schools are encouraged to consult with Program Staff for technical assistance prior to submitting the grant application.

Specific instructions follow each table.
Do not change the structure/format or elements of these tables.
Review and confirm that all Grand Totals provided in each column of the tables are accurate.

Table 1 – AENT: Clinical Nurse Specialist, Clinical Nurse Leader, Nurse Practitioner, Nurse Administrator/Nurse Educator and Post-Nursing Master’s Certificate Enrollment, Traineeship Support and Graduate Data

IDENTIFY SPECIALTY FOCUS AREAS

PLEASE TYPE

(See Table 1 Instructions)

Total Enrollment (Headcount)

(As of 10/15/06)

Total # of Students Supported by Traineeship

7/1/05-6/30/06

(Budget Period)

Graduates

7/01/05-6/30/06

Total # of

Students

Projected

by 10/15/07

Clinical Nurse Specialist

Clinical Nurse Leader

Nurse Practitioner

Nurse

Administrator/

Nurse Educator

Post-Nursing Master’s Certificate

Total # of Graduates Supported by

Traineeships

Total # of

Graduates

GRAND TOTALS

NOTE: Post Nursing Master’s Certificate students who complete all program requirements are recognized as graduates and must be counted in the Total # of Graduates column on this Table and on Table 4.

Instructions for Completing Table 1 - AENT:

Complete this Table for Clinical Nurse Specialist, Clinical Nurse Leader, Nurse Practitioner, Nurse Administrator/Nurse Educator and Post-Nursing Master’s Certificate Program enrollment and graduate activity only.

Use the list provided below to indicate the specialty focus areas for Clinical Nurse Specialist, Clinical Nurse Leader, Nurse Practitioner, Nurse Administrator and/or Nurse Educator, and Post-Nursing Master’s Certificate Program enrollment and graduate activity at your institution.

A program degree focus that is not already listed on this Table should be specified under “other” specialty focus.

SPECIALITY FOCUS LIST

Acute Care	Home Health	Pediatrics
Adult	Immunosuppressive Nursing	Perinatal
Adolescent	Informatics	Primary Care
Case Management	Maternal-Child/Parent-Child Health	Psychiatric-Mental Health
Chronic/Long Term	Medical-Surgical	Public Health
Community Health	Neonatal	Public Policy
Critical Care	Nurse Administration	Rehabilitation
Environmental	Nurse Anesthesia	Research
Family	Nurse Education	School Health
Forensics	OB/GYN/Women’s Health	Other (Specify):
Geriatric/Gerontology	Occupational
Generalist	Oncology
Genetics	Palliative Care

IMPORTANT NOTES:

Count each student only once under the “Specialty Focus” areas; for students with more than one specialty please indicate the primary specialty only.

For each specialty focus identified, please provide the data in the appropriate columns.

For “Total Enrollment (Headcount)”, enter total number of full-time and part-time students enrolled as of 10/15/06 by specialty focus area.

For “Total # of Students Supported by Traineeship”, enter the total number of full-time and part-time students who received traineeship support between 7/01/05 and 6/30/06 by specialty focus area.

For “Total # of Graduates Supported by Traineeships”, enter the total number of full-time and part-time graduates who received traineeship support and completed degree requirements between 7/01/05 and 6/30/06 by specialty focus area. Students that complete the Post-Nursing Master’s Certificate Program and received traineeship support should be included in this column.

For “Total # of Graduates”, enter the total number of full-time and part-time graduates who completed degree requirements between 7/01/05 and 6/30/06 by specialty focus area. Students that complete the Post-Nursing Master’s Certificate Program should be included in this column.

For “Total # of Students Projected” enter the total number of full-time and part-time students projected to be in the program by 10/15/07. Include the students projected to continue and the potential number of applicants eligible to be admitted into the program.

GRAND TOTAL: The grand total row must reflect the total of the numbers reported in each column(s). Numbers omitted in the column(s) of the Table will not be counted in the grand total.

Table 2 – AENT: Nurse-Midwifery Certificate, Nurse-Midwifery Master’s, Nurse-Midwifery Doctoral and Nurse Anesthesia Enrollment, Traineeship Support and Graduate Data

Nurse-Midwifery Certificate, Nurse-Midwifery Master’s, Nurse-Midwifery Doctoral Degree Programs

and

Nurse Anesthesia (first year students only)

TOTAL

ENROLLMENT

(Headcount)

(As of 10/15/06)

Total # of

Students Supported by Traineeship

7/01/05-6/30/06 (Budget Period)

GRADUATES

7/01/05-6/30/06

Total # of

Students

Projected

by 10/15/07

Total # of

Graduates Supported by

Traineeship

Total # of Graduates

Nurse- Midwifery Certificate

Nurse-Midwifery Master’s

Nurse-Midwifery Doctoral

Nurse Anesthesia (First Year Only)

GRAND TOTALS:

NOTE: Part-time Nurse Anesthesia students cannot be supported under AENT.

Instructions for Completing Table 2 - AENT:

Complete this Table for Nurse Midwifery Certificate, Nurse-Midwifery Master’s, Nurse-Midwifery Doctoral and Nurse Anesthesia (Full-time, First-year Only) Enrollees, Traineeship Support and Graduate Data only.

IMPORTANT NOTE:

Only first-year nurse anesthesia students may be supported under the Advanced Education Nursing Traineeship Program.

For “Total Enrollment (Headcount)”, enter total number of full-time and part-time students enrolled as of 10/15/06.

For “Total # of Students Supported by Traineeship”, enter the total number of full-time and part-time students who received traineeship support between 7/01/05 and 6/30/06.

For “Total # of Graduates Supported by Traineeship”, enter the total number of full-time and part-time graduates who received traineeship support and completed degree requirements between 7/01/05 and 6/30/06.

For “Total # of Graduates”, enter the total number of full-time and part-time graduates who completed degree requirements between 7/01/05 and 6/30/06.

For “Total # of Students Projected” enter the total number of full-time and part-time students projected to be in the program by 10/15/07. Include the students projected to continue and the potential number of applicants eligible to be admitted into the program.

GRAND TOTAL: The grand total row must reflect the total of the numbers reported in each column(s). Numbers omitted in the column(s) of the Table will not be counted in the grand total.

Table 3 - AENT: Doctoral Enrollment, Traineeship Support and Graduate Data

IDENTIFY SPECIALTY FOCUS AREAS

PLEASE TYPE

(See Table 3 Instructions)

Total Enrollment (Headcount)

(As of 10/15/06)

Total # of Students Supported by Traineeship

7/1/05-6/30/06

(Budget Period)

Graduates

7/01/05-6/30/06

Total # of

Students

Projected

by 10/15/07

PhD

DNSc /

DNS

DNP, DrNP, DNAP,

(see Sub-Specialty Focus List)

Other

(specify- i.e. ND)

Total # of Graduates Supported by

Traineeships

Total # of

Graduates

GRAND TOTALS

Instructions for Completing Table 3 - AENT:

Complete this Table for Doctoral students and graduates only.

Use the list provided below to indicate the specialty focus areas.

A program degree focus that is not listed on this Table should be specified under “other” specialty focus.

SPECIALITY FOCUS LIST

Acute Care	Home Health	Palliative Care
Adult	Immunosuppressive Nursing	Pediatrics
Adolescent	Informatics	Perinatal
Case Management	Maternal-Child/Parent-Child Health	Primary Care
Chronic/Long Term	Medical-Surgical	Psychiatric-Mental Health
Community Health	Neonatal	Public Health
Critical Care	Nurse Administration	Public Policy
Environmental	Nurse Anesthesia	Rehabilitation
Family	Nurse Education	Research
Forensics	OB/GYN/Women’s Health	School Health
Geriatric/Gerontology	Occupational	Other (Specify):
Genetics	Oncology

IMPORTANT NOTES:

Count each student only once under the “Specialty Focus” areas; for students with more than one specialty please indicate the primary specialty only.

DNP includes the following list of Specialties:

DNP SPECIALITY FOCUS LIST

Acute Care Nurse Practitioner	Nurse Administrator
Adult Health CNS	Nurse Educator
Adult Nurse Practitioner	Pediatric CNS
Adult Psych/Mental Health CNS	Pediatric Nurse Practitioner
Child /Adolescent Psych/MH CNS	Primary Care Nurse Practitioner
Family Nurse Practitioner	Public/Community Health CNS
Forensic CNS	Post MSN
Gerontological CNS	WHNP/OB-GYN NP
Gerontological Nurse Practitioner	Other (Specify):
Neonatal NP

For “Total Enrollment (Headcount)”, enter the total number of full-time and part-time students enrolled as of 10/15/06 by Doctoral focus.

For “Total # of Students Supported by Traineeship”, enter the total number of full-time and part-time students who received traineeship support between 7/01/05 and 6/30/06 by Doctoral focus.

For “Total # of Graduates Receiving Traineeship Support”, enter the total number of full-time and part-time doctoral graduates who received traineeship support and completed degree requirements between 7/01/05 and 6/30/06 by Doctoral focus.

For “Total # of Graduates”, enter the total number of full-time and part-time graduates who completed degree requirements between 7/01/05 and 6/30/06 by Doctoral focus.

For “Total Number of Students Projected” enter the total number of full-time and part-time students projected to be in the program by 10/15/07. Include the students projected to continue and the potential number of applicants eligible to be admitted into the program.

GRAND TOTAL: The grand total row must reflect the total of the numbers reported in each column(s). Numbers omitted in the column(s) of the Table will not be counted in the grand total.

TABLE 4 - AENT: GRADUATE DATA - RURAL, UNDERSERVED, OR PUBLIC

HEALTH (7/01/05-6/30/06)

Complete the following table, as appropriate, providing data on the number of graduates in academic year 7/1/2005-6/30/2006 who spend at least 50 percent of their work-time in clinical practice sites substantially benefiting rural or underserved populations, or in State or local health departments. Each graduate is to be counted only once. Table 4 is also used to determine if the institution meets the Statutory Funding Preference.

Table 4 - AENT: Graduate Data - Rural, Underserved, or Public Health (Graduates from 7/1/05- 6/30/06)

	TABLE 1					TABLE 2			TABLE 3	GRAND TOTAL
PRACTICE SETTINGS	CNS	CNL	NP	NA / NE	PNMC	NMW Certificate	NMW Master’s	NMW Doctoral	Doctoral (PhD, DNSc / DNS, DNP, DrNP, DNAP, Other)	GRAND TOTAL
Community Health Centers
Migrant Health Centers
Health Care for the Homeless Grantees
Public Housing Primary Care Grantees
Rural Health Clinics
National Health Service Corps Sites
Indian Health Service / Tribal Health Sites
Federally Qualified Health Centers
Health Professional Shortage Areas (HPSAs)
State or Local Health Departments
Ambulatory Practice Sites Designated by State Governors
Other Rural or Underserved Population
Total # of Graduates Supported by Traineeships from 07/01/05 to 06/30/06 working in these Settings
Total # of Graduates in these Settings (from 07/01/05 – 06/30/06)
Total # of Graduates (from 07/01/05-06/30/06)
Percentage of Graduates in these Settings (Total # of Graduates in these Settings ÷ Total # of Graduates (from 07/01/05-06/30/06)

NOTES:  The “Total # of Graduates” in the Grand Total column must reconcile with the combined graduate totals from Tables 1-3.  Do not include Nurse Anesthetist graduates on this Table (the AENT Program supports first year Nurse Anesthesia students.)

nstructions for completing Table 4 - AENT:

All applicant institutions requesting the Statutory Funding Preference must complete this table (please see the Statutory Funding Preference information in this application).

Do not make changes to this table.

Data on Table 4 should reflect graduate totals for the Clinical Nurse Specialist, Clinical Nurse Leader, Nurse Practitioner, Nurse Administrator, Nurse Educator, Post Nursing Master’s Certificate, Nurse-Midwifery Certificate, Nurse-Midwifery Master’s, Nurse-Midwifery Doctoral and Doctoral students who completed program/degree requirements between 07/01/05 and 6/30/06. Do not include Nurse Anesthetist graduates on Table 4. The AENT Program supports 1^st year nurse anesthetist students only.

Although a graduate’s practice site may qualify under more than one category, each individual graduate should be reported only once. For example: a rural health clinic may be located in a primary care health professional shortage area.

Enter the number of graduates employed in each of the settings listed in the appropriate columns. For each setting, enter the grand total in the “Grand Total” column. The grand total column must reflect the total of the numbers reported in each row. Numbers omitted in the row(s) of Table 4 will not be counted.

In the “Total of Graduates Supported by Traineeships” row, enter the total number of graduates who received traineeship support and completed degree requirements between 7/01/05 and 6/30/06 and worked in the identified setting.

In the “Total # of Graduates in These Settings” row, enter the total number of graduates in each appropriate identified column. Enter the grand total: The grand total column must reflect the total of the numbers reported in each row. Numbers omitted in this row of Table 4 will not be counted.

In the “Total # of Graduates” row, enter the total number of graduates, which are reported on Tables 1-3, who completed degree requirements between 7/01/05 and 6/30/06 in the appropriate column. Enter the grand total: The grand total column must reflect the total of the numbers reported in each row. Numbers omitted in this row of Table 4 will not be counted.

IMPORTANT NOTE: The total number of graduates reported in the “Grand Total” column MUST be consistent with the combined “Total # of Graduates” reported on

Tables 1-3.

In the “Percentage of Graduates in these Settings” row, enter the percentage of graduates working in the identified settings in the “Grand Total” column.

TABLE 5 - AENT: MINORITY/DISADVANTAGED STATUS DATA

Provide the total number of enrollees and graduates reported on Tables 1-3 by each ethnicity/race/disadvantaged category. Instructions for completing Table 5 are below.

	American Indian or Alaska Native	Underrepresented Asian Subgroup*	Asian (Not Under- Represented)	Black or African American	Hispanic or Latino	Native Hawaiian or Other Pacific Islander	White: Disadvantaged	White: Not- Disadvantaged	More than one race	Unreported/Unavailable Student Ethnicity/Race	GRAND TOTAL
ENROLLEES (As of 10/15/06)
STUDENTS SUPPORTED (7/1/05-6/30/06)
GRADUATES (7/1/05-6/30/06)
GRADUATES SUPPORTED (7/1/05-6/30/06)

*Any Asian other than Chinese, Filipino, Japanese, Korean, Asian Indian, or Thai.

Instructions for completing Table 5:

Enter the total number of “Enrollees” by ethnicity/race and the “grand total” for students enrolled as of 10/15/2006. Include only full-time, first-year nurse anesthetist enrollees on Table 5. THIS FIGURE SHOULD RECONCILE WITH DATA REPORTED ON TABLES 1, 2 AND 3.
Enter the total number of “Students Supported” by ethnicity/race for students supported as of 7/1/05-6/30/06.
Enter the total number of “Graduates” by ethnicity/race and the “grand total” for graduates who completed degree requirements between 7/01/2005 and 6/30/2006. Post Nursing Master’s Certificate students who complete all program requirements are recognized as graduates and must be counted on Table 5. THIS FIGURE SHOULD RECONCILE WITH DATA REPORTED ON TABLES 1, 2 AND 3.
Enter the total number of “Graduates Supported” by ethnicity/race for graduates supported as of 7/1/05-6/30/06.

IMPORTANT NOTE: Enrollees and graduates that do not report ethnicity/race or those for which data are unavailable must be reported in the Unreported/Unavailable Student Ethnicity/Race column.

Use the following definitions from the OMB standards for the classification of Federal data on race and ethnicity for the identified ethnicity/racial categories:

American Indian or Alaska Native: a person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.

Asian: a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Black or African American: a person having origins in any of the black racial groups of Africa.

Hispanic or Latino: a person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin regardless of race. The term “Spanish Origin” can be used in addition to “Hispanic or Latino”.

Native Hawaiian or Other Pacific Islander: a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

White: a person having origins in any of the original peoples of Europe, North Africa, or the Middle East.

More than one race: a person reporting more than one race.

Use the following definition for low-income populations to determine Disadvantaged status:

Low-income populations are defined as individuals who come from a family with an annual income below a level based on low-income thresholds according to family size, published by the U.S. Bureau of the Census, and adjusted annually for changes in the Consumer Price Index, and by the Secretary for use in health professions and nursing programs. Low-income populations are considered to be at risk of poor health outcomes. A family is a group of two or more individuals related by birth, marriage, or adoption who live together or an individual who is not living with any relatives. Most HRSA programs use the income of the student’s parents to compute low income status, while a few programs, depending upon the legislative intent of the program, programmatic purpose of the low income level, as well as the age and circumstances of the average participant, will use the student’s family as long as he or she is not listed as a dependent upon the parents’ tax form. The figures to be used to determine low-income eligibility for purposes of this grant program are:

Size of parents’ family * Income Level **

1 $19,600

2 $26,400

3 $33,200

4 $40,000

5 $46,800

6 $53,600

7 $60,400

8 $67,200

* Includes only dependents listed on Federal

income tax forms. Some programs will use the

student’s family rather than his or her parents’

family.

** Adjusted gross income for calendar year

2005.

File Type	application/msword
File Title	DEPARTMENT OF HEALTH AND HUMAN SERVICES
Author	LGentry
Last Modified By	HRSA
File Modified	2006-12-04
File Created	2006-12-04