Form 0305 1 0305 1 AENT Revised Tables and Instructions

U.S. Department of Health and Human Services

Health Resources and Services Administration

Bureau of Health Professions

Division of Nursing

Advanced Education Nursing Traineeship (AENT) Program

New Competition

Announcement Number HRSA-11-XXX

Catalog of Federal Domestic Assistance (CFDA) No. 93.358

PROGRAM GUIDANCE

Fiscal Year 2011

Phase 1: Application Due Date in Grants.gov: (date)

Phase 2: Supplemental Information Due Date in EHBs: (date)

Release Date: (date)

Date of Issuance: (date)

Contact Name: Karen Delia Breeden, MPA

Title, Office: Program Analyst, Bureau of Health Professions, Division of Nursing

Telephone: (301) 443-5787

Fax: (301) 443-0791

Authority: Title VIII of the Public Health Service (PHS) Act as amended, Sections 811(a)(2) and 811(f), (42 U.S.C. 296j).

APPENDIX B

LIST OF AENT PROGRAM ATTACHMENTS AND TABLES INCLUDED IN GUIDANCE

Grants.gov(Phase 1) Submission due date (date)

SF-424 R&R Short Form and HHS Checklist Form PHS-5161.

HRSA EHBs (Phase 2) Submission due date (date). Refer to Section IV of this guidance for detailed instructions. See the Attachments and AENT Program Tables and Instructions and Special Consideration Assurance Statement information below.

Attachments

Attachment 1 – AENT Full-Time and Part-Time Status / Tuition, Fees and Stipends

Attachment 2 – Accreditation Documentation

Attachment 3 – Biographical Sketch (http://www.cdrewu.edu/download/1109_112604_NIH_biosketch.doc )

AENT Program Tables and Instructions and Special Consideration Assurance Statement

Table 1 - AENT: Clinical Nurse Specialist, Nurse Practitioner, Nurse Administrator, Nurse Educator, Other Advanced Roles, Public Health Nurse and Post-Nursing Master’s Certificate (Master’s and Post-Nursing Master’s Program data only)

A. Student Enrollment and Projected Data

B. Student Traineeship Support and Students Projected to

Receive Traineeship Support

C. Graduates Supported By Traineeships and Projected

Graduates to be Supported by Traineeships

D. Graduate Data and Graduates Projected

Table 2 - AENT: Nurse-Midwifery Certificate, Nurse-Midwifery Master’s, Nurse-Midwifery Doctoral, Nurse Anesthesia Enrollment – Master’s (First Year Only) and Nurse Anesthesia Enrollment – Doctoral (First Year Only); Traineeship Support and Graduate Data

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

A. Doctoral Enrollment and Projected Data

B. Doctoral Student Traineeship Support and Students

Projected to Receive Traineeship Support

C. Doctoral Graduates Supported By Traineeships and

Projected Doctoral Graduates to be Supported by

Traineeship

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

Table 4B – AENT: Graduates Supported by Traineeship Data – Rural, Underserved, or Public Health

Table 5 – AENT: Ethnicity Data

Table 6 – AENT: Race / Disadvantaged Data

Table 7 – AENT: Age and Gender Data

AENT Special Consideration Assurance Statement - Electronic version

ATTACHMENT 1

AENT FULL-TIME AND PART-TIME STATUS / TUITION, FEES AND STIPENDS

FULL-TIME AND PART-TIME STATUS

Provide information on how the applicant institution defines the following:

(1) Full-time graduate study: ____ (Indicate the number of credit hours or units required per term)

(2) Part-time graduate study: ____ (Indicate the number of credit hours or units required per term)

IMPORTANT NOTE: Institutions are no longer required to provide full-time equivalent (FTE) calculations for part-time enrollees.

TUITION, FEES AND STIPENDS

1. Provide the in-state and out-of-state tuition costs for a full-time and part-time student.

TUITION	Full-Time Students PER YEAR	Part-Time Students PER CREDIT HOUR
Tuition: In-State
Tuition: Out-of-State

(2) Indicate the total cost of stipend support that would be required to support all the graduates eligible for support from July 1, 2010 - June 30, 2011 based on $8,800 for a 12-month period, if funds were available: $_______________

(3) Based on the “Projected Student Enrollees” (full-time and part-time) reported on

Tables 1-3, indicate the total cost of tuition and fees that would be required to

support all the graduate students eligible for support from July 1, 2010 - June 30, 2011, if funds were available: $_______________.

ATTACHMENT 2 – ACCREDITATION DOCUMENTATION

Accreditation Documentation of the Program (CCNE, NLNAC, COA, ACNM letter or certificate; letter from the United States Department of Education providing reasonable assurance of accreditation) for your Program(s) and also include a statement regarding accreditation with the complete expiration date (i.e. 02/31/2012 or May 31, 2017 for Spring 2017).

Also attach Approval Documentation if applicable.

Failure to provide documentation of accreditation with the HRSA program application will render the application non-responsive and the application will not be considered for funding under this announcement.

OMB No. 0915-0305 Exp. Date: 03/31/2010

AENT Program Tables and Instructions

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 0915-0305. Public reporting burden for this collection of information is estimated to average 1.5 hours 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.

Once the application has been successfully submitted by the applicant into Grants.gov, the applicant will receive an email from HRSA within 7 business days. This email will provide instructions and necessary information needed to access your application through the HRSA EHBs. This email will be sent to the authorizing official, the business official, the point of contact and the project director listed on the face page of the application.

Data for AENT Tables 1-6 and the AENT Special Consideration Assurance Statement (electronic version) must be entered electronically via the HRSA EHBs or the applicant will not be given an award.

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

Table 1 - AENT: Clinical Nurse Specialist, Nurse Practitioner, Nurse Administrator, Nurse Educator, Other Advanced Roles, Public Health Nurse and Post-Nursing Master’s Certificate (Master’s and Post-Nursing Master’s Program data only)

A. Student Enrollment and Projected Data

B. Student Traineeship Support and Students Projected to

Receive Traineeship Support

C. Graduates Supported By Traineeships and Projected

Graduates to be Supported by Traineeships

D. Graduate Data and Graduates Projected

Table 2 - AENT: Nurse-Midwifery Certificate, Nurse-Midwifery Master’s, Nurse-Midwifery Doctoral, Nurse Anesthesia Enrollment – Master’s (First Year Only) and Nurse Anesthesia Enrollment – Doctoral (First Year Only); Traineeship Support and Graduate Data

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

A. Doctoral Enrollment and Projected Data

B. Doctoral Student Traineeship Support and Students

Projected to Receive Traineeship Support

C. Doctoral Graduates Supported By Traineeships and

Projected Doctoral Graduates to be Supported by

Traineeship

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

Table 4B – AENT: Graduates Supported by Traineeship Data – Rural, Underserved, or Public Health

Table 5 – AENT: Ethnicity Data

Table 6 – AENT: Race / Disadvantaged Data

Table 7 – AENT: Age and Gender Data

Table 1 – AENT: Clinical Nurse Specialist, Nurse Practitioner, Nurse Administrator, Nurse Educator, Other Advanced Roles, Public Health Nurse and Post-Nursing Master’s Certificate (Masters and Post Nursing Master Certificate Data Only)

A. STUDENT ENROLLMENT AND PROJECTED DATA

IDENTIFY SPECIALTY FOCUS AREAS PLEASE TYPE (See Table 1 Instructions)

Total Student Enrollment (Headcount) (As of 10/15/10) and Students Projected by 10/15/11

Clinical Nurse Specialist (CNS)

Nurse Practitioner (NP)

Nurse Administrator (NA)

Nurse Educator (NE)

Other Advanced Roles (OAR)

Public Health Nurse (PHN)

Post-Nursing Master’s Certificate (PNMC)

Total # of Students Projected by 10/15/11

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GRAND TOTALS

NOTES: (1) Part-time students reported on this table must be enrolled in the last 12 months of study prior to graduation from the advanced education nursing program. (2) 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.

oMB No. 0915-0305 Exp. Date: 03/31/2010

Table 1 – AENT: Clinical Nurse Specialist, Nurse Practitioner, Nurse Administrator, Nurse Educator, Other Advanced Roles, Public Health Nurse and Post-Nursing Master’s Certificate (Masters and Post Nursing Master Certificate Data Only)

B. TRAINEESHIP SUPPORT AND PROJECTED DATA

IDENTIFY SPECIALTY FOCUS AREAS PLEASE TYPE (See Table 1 Instructions)

Total # of Students Supported by Traineeship 7/01/09-6/30/10 (Budget Period) and Students Projected to Receive Traineeship Support by 10/15/11

Clinical Nurse Specialist (CNS)

Nurse Practitioner (NP

Nurse Administrator (NA)

Nurse Educator (NE)

Other Advanced Roles (OAR)

Public Health Nurse (PHN)

Post-Nursing Master’s Certificate (PNMC)

Total # of Students Projected to Receive Traineeship Support by 10/15/11

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GRAND TOTALS

NOTES: (1) Part-time students reported on this table must be enrolled in the last 12 months of study prior to graduation from the advanced education nursing program. (2) 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.

OMB No. 0915-0305 Exp. Date: 03/31/2010

Table 1 – AENT: Clinical Nurse Specialist, Nurse Practitioner, Nurse Administrator, Nurse Educator, Other Advanced Roles, Public Health Nurse and Post-Nursing Master’s Certificate (Masters and Post Nursing Master Certificate Data Only)

C. GRADUATES SUPPORTED BY TRAINEESHIPS

IDENTIFY SPECIALTY FOCUS AREAS PLEASE TYPE (See Table 1 Instructions)

Total # of Graduates Supported by Traineeships 7/01/09-6/30/10 (Budget Period) and Projected Graduates To Be Supported by Traineeships by 10/15/11

Clinical Nurse Specialist (CNS)

Nurse Practitioner (NP)

Nurse Administrator (NA)

Nurse Educator (NE)

Other Advanced Roles (OAR)

Public Health Nurse (PHN)

Post-Nursing Master’s Certificate (PNMC)

Total # of Projected Graduates To Be Supported by Traineeships by 10/15/11

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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.

Table 1 – AENT: Clinical Nurse Specialist, Nurse Practitioner, Nurse Administrator, Nurse Educator, Other Advanced Roles, Public Health Nurse and Post-Nursing Master’s Certificate (Masters and Post Nursing Master Certificate Data Only)

D. GRADUATE ACTIVITY

IDENTIFY SPECIALTY FOCUS AREAS PLEASE TYPE (See Table 1 Instructions)

Total # of Graduates 7/01/09-6/30/10 (Budget Period) and Graduates Projected by 10/15/11

Clinical Nurse Specialist (CNS)

Nurse Practitioner (NP)

Nurse Administrator (NA)

Nurse Educator (NE)

Other Advanced Roles (OAR)

Public Health Nurse (PHN)

Post-Nursing Master’s Certificate (PNMC)

Total # of Graduates Projected by 10/15/11

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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 1A, 1B, 1C and 1D – AENT (Master’s and Post Nursing Master Certificate Level Only):

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 example, a Medical/Surgical Clinical Nurse Specialist (CNS) would be documented as an Adult CNS.

• Enrollees – Students that are enrolled in an Advanced Education Nursing Program and have not graduated or completed the program by 10/15/10.

• Graduates – Students who have successfully completed all educational requirements for a specified Advanced Education Nursing Program of study or have met the eligibility requirements for an Advanced Education Nursing Master’s or Doctoral degree or Post-Nursing Master’s Certificate between 07/01/09-06/30/10.

• Students supported is a subset of enrollees and graduates supported is a subset of the total number of graduates. Do not double count a student as both an Enrollee and a Graduate.

• For students who received traineeship support from 07/01/09-06/30/10 and graduated in that time period, the students should be reported under the “Total # of Graduates Supported by Traineeships” column. These students should not be reported under both “Students Supported by Traineeships” and “Graduates Supported by Traineeships”.

• For students who received traineeship support from 07/01/09-06/30/10 and did not graduate in that time period, the students should be reported under the “Students Supported by Traineeships” column only.

• In the HRSA EHBs (Phase 2) – Nurse Administrator and Nurse Educator are two separate data entry categories.

• Complete Table 1A for Clinical Nurse Specialist, Nurse Practitioner, Nurse Administrator, Nurse Educator, Other Advanced Roles, Public Health Nurse and Post-Nursing Master’s Certificate Enrollment and Projected Data only. Report Master’s and Post Nursing Master Certificate Level data only.

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

For “Total # of Students Projected” enter the total number of full-time and part-time students projected to be in the program by 10/15/11. 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.

• Complete Table 1B for Clinical Nurse Specialist, Nurse Practitioner, Nurse Administrator, Nurse Educator, Other Advanced Roles, Public Health Nurse and Post-Nursing Master’s Certificate Program Traineeship Support and Students Projected to Receive Traineeship Support data only. Report Master’s and Post Nursing Master Certificate Level data only.

For “Total # of Students Supported by Traineeship”, enter the total number of full-time and part-time students who received traineeship support between 7/01/09 and 6/30/10 by role / specialty focus area (part-time students must be enrolled in the last 12 months of study prior to graduation from the advanced education program).

For “Total # of Students Projected to Receive Traineeship Support” enter the total number of full-time and part-time students projected to be supported by the traineeship program by 10/15/11.

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.

• Complete Table 1C for Clinical Nurse Specialist, Nurse Practitioner, Nurse Administrator, Nurse Educator, Other Advanced Roles, Public Health Nurse and Post-Nursing Master’s Certificate Program Graduates Supported by Traineeships and Projected Graduates to Be Supported by Traineeships only. Report Master’s and Post Nursing Master Certificate Level data only.

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 7/01/09 and 6/30/10 by role / 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 Projected Graduates To Be Supported by Traineeships” enter the total number of full-time and part-time graduates projected to be supported by the traineeship program by 10/15/11.

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.

• Complete Table 1D for Clinical Nurse Specialist, Nurse Practitioner, Nurse Administrator, Nurse Educator, Other Advanced Roles, Public Health Nurse and Post-Nursing Master’s Certificate Program Graduate data only. Report Master’s and Post Nursing Master Certificate Level data only.

For “Total # of Graduates”, enter the total number of full-time and part-time graduates who completed degree requirements between 7/01/09 and 6/30/10 by role / specialty focus area. Students that complete the Post-Nursing Master’s Certificate Program should be included in this column.

For “Total # of Graduates Projected” enter the total number of full-time and part-time students projected to graduate from the program by 10/15/11. Include the students projected to continue and the potential number of applicants eligible for graduation.

IMPORTANT NOTE:

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

• Use the list provided below to indicate the role / specialty focus areas for Clinical Nurse Specialist, Nurse Practitioner, Nurse Administrator, Nurse Educator, Other Advanced Roles, Public Health Nurse and Post-Nursing Master’s Certificate Program enrollment, projections, supported and graduate activity at your institution.

• Subspecialty – select the role under Clinical Nurse Specialist (CNS) or Nurse Practitioner (NP) then also select from the Specialty / Emphasis Concentration. For example, Adult CNS can have a sub-specialty of Adult CNS – Informatics, Adult CNS – Critical Care.

Select the role under Nurse Administrator or Nurse Education then also select from the Specialty / Emphasis Concentration. For example, Nurse Administrator can have a sub-specialty of____________________________.

For Other Advanced Role, select from the Specialty / Emphasis Concentration list / drop down menu.

Clinical Nurse Leader – select Other Advanced Role then Generalist (CNL) from the Specialty / Emphasis Concentration list / drop down menu.

• If there is an entry for a Post-Nursing Master’s Certificate Program, please select the role / specialty focus (Other: i.e. Pediatric Nurse Practitioner) with the number of enrollees under the Post-Nursing Master’s Certificate column.

• Full-time first year nurse anesthesia students should not be included on this table; they should be included on Table 2: Nurse-Midwifery Certificate, Nurse-Midwifery Master’s, Nurse-Midwifery Doctoral and Nurse Anesthesia Enrollment, Traineeship Support and Graduate Data only.

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

AENT TABLE 1 SPECIALITY LIST

CLINICAL NURSE SPECIALIST (CNS)

Adult CNS	Geriatric / Gerontology CNS	Public Health Nursing CNS
Adult Psychiatric-Mental Health CNS	Home Health CNS	Women’s Health CNS
Child/Adolescent Psychiatric Mental Health CNS	Maternal Child/Maternal-Infant CNS	Other (Specify: append with CNS)
Family CNS	Neonatal CNS
Forensics CNS	Pediatric CNS

NURSE PRACTITIONER (NP)

Adult Acute Care NP	Child/Adolescent Psychiatric Mental Health NP	Pediatric NP – Primary Care
Adult/Gerontology NP – Primary Care	Family NP – Primary Care	Women’s Health NP – Primary Care
Adult-Gerontology Acute Care NP	Geriatric NP – Primary Care	Other (Specify: append with NP)
Adult NP – Primary Care	Neonatal NP

SPECIALTY EMPHASIS / CONCENTRATION

Ambulatory Care	Immunosuppressive Nursing	Public Policy
Cardiac Rehab	Informatics	Rehabilitation
Case Management	Nurse Administration	Research
Chronic/Long Term	Nurse Education	School Health
College Health	Cardiovascular	Other (Specify):
Community Health	Occupational
Critical Care	Oncology
Emergency	Palliative Care
Environmental	Perinatal
Generalist (CNL)	Pain Management
Genetics	Public Health

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

Nurse-Midwifery Certificate, Nurse-Midwifery Master’s, Nurse-Midwifery Doctoral Degree Programs and Nurse Anesthesia Master’s and Doctoral (first year students only)	TOTAL ENROLLMENT (Headcount) (As of 10/15/09)		Total # of Students Supported by Traineeship 7/01/09-6/30/10 (Budget Period)		GRADUATES 7/01/09-6/30/10				Total # of Students Projected by 10/15/11
					Total # of Graduates Supported by Traineeship		Total # of Graduates
	FT	PT	FT	PT	FT	PT	FT	PT	FT	PT
Nurse- Midwifery Certificate
Nurse-Midwifery Master’s
Nurse-Midwifery Doctoral
Nurse Anesthesia – Master’s (First Year Only)
Nurse Anesthesia – Doctoral (First Year Only)
GRAND TOTALS:

NOTE: Part-time Nurse Anesthesia students cannot be supported under AENT. OMB No. 0915-0305 Exp. Date: 03/31/2010

Instructions for Completing Table 2 - AENT:

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

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

IMPORTANT NOTES:

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

• Enrollees – Students that are enrolled in an Advanced Education Nursing Program and have not graduated or completed the program by 10/15/09.

• Graduates – Students who have successfully completed all educational requirements for a specified Advanced Education Nursing Program of study or have met the eligibility requirements for an Advanced Education Nursing Master’s or Doctoral degree or Nurse-Midwifery Certificate between 07/01/09-06/30/10.

• Students supported is a subset of enrollees and graduates supported is a subset of the total number of graduates. Do not double count a student as both an Enrollee and a Graduate.

• For students who received traineeship support from 07/01/09-06/30/10 and graduated in that time period, the students should be reported under the “Total # of Graduates Supported by Traineeships” column. These students should not be reported under both “Students Supported by Traineeships” and “Graduates Supported by Traineeships”.

• For students who received traineeship support from 07/01/09-06/30/10 and did not graduate in that time period, the students should be reported under the “Students Supported by Traineeships” column only.

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

• For “Total # of Students Supported by Traineeship”, enter the total number of full-time and part-time students who received traineeship support between 7/01/09 and 6/30/10.

• 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 7/01/09 and 6/30/10.

• For “Total # of Graduates”, enter the total number of full-time and part-time graduates who completed degree requirements between 7/01/09 and 6/30/10.

• For “Total # of Students Projected” enter the total number of full-time and part-time (excluding Nurse Anesthesia) students projected to be in the program by 10/15/11. 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

A. DOCTORAL ENROLLMENT AND PROJECTED DATA

IDENTIFY SPECIALTY FOCUS AREAS PLEASE TYPE (See Table 3 Instructions)

Total Enrollment (Headcount) (As of 10/15/10)

Total # of Students Projected by 10/15/11

PhD

DNSc / DNS

DNP, DrNP, DNAP

Other (specify – i.e. ND)

DELETE THIS COLUMN

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GRAND TOTALS

OMB No. 0915-0305 Exp. Date: 03/31/2010

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

B. DOCTORAL TRAINEESHIP SUPPORT AND PROJECTED DATA

IDENTIFY SPECIALTY FOCUS AREAS PLEASE TYPE (See Table 3 Instructions)

Total # of Doctoral Students Supported by Traineeship 7/01/09-6/30/10 (Budget Period)

Total # of Doctoral Students Projected to Receive Traineeship Support by 10/15/11

PhD

DNSc / DNS

DNP, DrNP, DNAP

Other (specify – i.e. ND)

DELETE THIS COLUMN

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GRAND TOTALS

OMB No. 0915-0305 Exp. Date: 03/31/2010

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

C. DOCTORAL GRADUATES SUPPORTED BY TRAINEESHIPS AND GRADUATE DATA

IDENTIFY SPECIALTY FOCUS AREAS PLEASE TYPE (See Table 3 Instructions)

Total # of Doctoral Graduates Supported by Traineeships 7/01/09-6/30/10 (Budget Period)

Total # of Projected Doctoral Graduates to receive traineeship By 10/15/11

Total # of Doctoral Graduates 7/01/09-6/30/10 (Budget Period)

Total # of Projected Doctoral Graduates by 10/15/11

PhD

DNSc / DNS

DNP, DrNP, DNAP

Other (specify – i.e. ND)

PhD

DNSc / DNS

DNP, DrNP, DNAP

Other (specify – i.e. ND)

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GRAND TOTALS

OMB No. 0915-0305 Exp. Date: 03/31/2010

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

• Part-time students reported on this table must be enrolled in the last 12 months of study prior to graduation from the advanced education nursing program.

• Complete this Table for Doctoral students and graduates only.

Complete Table 1 A for Doctoral Student Enrollment and Projected Data only. Report Doctoral Level data only.

Complete Table 1 B for Doctoral Students support by Traineeship 7/01/09-6/30/10 (Budget

Period) and the number of Projected Doctoral Students who will receive traineeship 10/15/2011 Report Doctoral Level data only.

Complete Table 1 C for Doctoral Graduates Supported By Traineeships 7/01/09-6/30/10 (Budget Period) and Projected Doctoral Graduates to receive traineeship 10/15/2010 and the total number of Doctoral Graduates 7/01/09-6/30/10 and the Project Number of Doctoral Graduates by 10/15/2011. Report Doctoral Level data 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.

SPECIALTY EMPHASIS / CONCENTRATION

Ambulatory Care	Immunosuppressive Nursing	Public Policy
Cardiac Rehab	Informatics	Rehabilitation
Case Management	Nurse Administration	Research
Chronic/Long Term	Nurse Education	School Health
College Health	Cardiovascular	Other (Specify):
Community Health	Occupational
Critical Care	Oncology
Emergency	Palliative Care
Environmental	Perinatal
Generalist (CNL)	Pain Management
Genetics	Public Health

IMPORTANT NOTES:

• Enrollees – Students that are enrolled in an Advanced Education Nursing Program and have not graduated or completed the program by 10/15/10.

• Graduates – Students who have successfully completed all educational requirements for a specified Advanced Education Nursing Program of study or have met the eligibility requirements for an Advanced Education Nursing Doctoral degree between 07/01/09-06/30/10.

• Students supported is a subset of enrollees and graduates supported is a subset of the total number of graduates. Do not double count a student as both an Enrollee and a Graduate.

• For students who received traineeship support from 07/01/09-06/30/10 and graduated in that time period, the students should be reported under the “Total # of Graduates Supported by Traineeships” column. These students should not be reported under both “Students Supported by Traineeships” and “Graduates Supported by Traineeships”.

• For students who received traineeship support from 07/01/09-06/30/10 and did not graduate in that time period, the students should be reported under the “Students Supported by Traineeships” column only.

DNP includes the following list of Specialties:

DNP SPECIALITY FOCUS LIST

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

CNS = Clinical Nurse Specialist NP = Nurse Practitioner

IMPORTANT NOTE:

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

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

For “Total # of Doctoral Students Projected” enter the total number of full-time and part-time students projected to be in the program by 10/15/2011. Include the students projected to continue and the potential number of applicants eligible to be admitted into the program

• For “Total # of Doctoral Students Supported by Traineeship”, enter the total number of full-time and part-time students who received traineeship support between 7/01/09 and 6/30/10.

(part-time students reported on this table must be enrolled in the last 12 months of study prior to graduation from the advanced education nursing program).

For “Total # of Doctoral Students Projected to Receive Traineeship Support” enter the total number of full-time and part-time students projected to be supported by the traineeship program by 10/15/11.

• For “Total # of Doctoral 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 7/01/09 and 6/30/10.

For “Total # of Doctoral Graduates Projected to Receive Traineeship Support” enter the total number of full-time and part-time graduates projected to be supported by the traineeship program by 10/15/2011.

• For “Total # of Doctoral Graduates”, enter the total number of full-time and part-time graduates who completed degree requirements between 7/01/09 and 6/30/10 .

For “Total # of Doctoral Graduates Projected” enter the total number of full-time and part-time students projected to graduate from the program by 10/15/2011. Include the students projected to continue and the potential number of applicants eligible for graduation.

• 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 (7/01/09-6/30/10)

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

HEALTH (7/01/09-6/30/10)

Complete Table 4A, as appropriate, providing data on the number of graduates in academic year 7/1/09-6/30/10 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 4A is also used to determine if the institution meets the Statutory Funding Preference.

Table 4B - AENT: Graduates Supported By Traineeship Data - Rural, Underserved, or Public Health (Graduates Supported By Traineeship from 7/1/09- 6/30/10)

Complete Table 4B, as appropriate, providing data on the number of graduates supported by traineeships in academic year 7/1/09-6/30/10 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 4B is for data analysis and reporting; thus, all applicant institutions must complete Table 4B; if there is no data to report then enter “0” in the Grand Total column.

Table 4A - AENT: Graduate Data - Rural, Underserved, or Public Health (Graduates from 7/1/09- 6/30/10)

TABLE 1

TABLE 2

TABLE 3

GRAND TOTAL

PRACTICE SETTINGS

CNS

CNL

NP

NA

NE

OAR

PHN

NMW Certificate

NMW Master’s

NMW Doctoral

Doctoral (PhD, DNSc / DNS, DNP, DrNP, DNAP, Other)

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

1. Total Number of Graduates in these Settings (from 07/01/09 – 06/30/10)

2. Total Number of Graduates (from 07/01/09 – 06/30/10)

3. Percentage of Graduates in these Settings (Item 1 divided by Item 2)

NOTE: Do not include Nurse Anesthetist graduates on this Table. The AENT Program also supports first year Nurse Anesthesia students.

OMB No. 0915-0305 Exp. Date: 03/31/2010

Table 4B - AENT: Graduates Supported By Traineeship Data - Rural, Underserved, or Public Health (Graduates Supported By Traineeship from 7/1/09- 6/30/10)

TABLE 1

TABLE 2

TABLE 3

GRAND TOTAL

PRACTICE SETTINGS

CNS

CNL

NP

NA

NE

OAR

PHN

NMW Certificate

NMW Master’s

NMW Doctoral

Doctoral (PhD, DNSc / DNS, DNP, DrNP, DNAP, Other)

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

1. Total Number of Graduates Supported by Traineeships working in these Settings (from 07/01/09 to 06/30/10)

2. Total Number of Graduates (from 07/01/09 – 06/30/10)

3. Percentage of Graduates Supported by Traineeships in these Settings (Item 1 divided by Item 2)

NOTE: This table is for data analysis and data reporting only. Do not include Nurse Anesthetist graduates on this Table; the AENT Program also supports first year Nurse Anesthesia students. OMB No. 0915-0305 Exp. Date: 03/31/2010

I

nstructions for completing Tables 4A (Statutory Funding Preference) and 4B (data analysis and reporting only) - AENT:

• All applicant institutions requesting the Statutory Funding Preference must complete Table 4A (please see the Statutory Funding Preference information in this application).

• All applicant institutions must complete Table 4B; if there is no data to report then enter “0” in the Grand Total column.

• Do not make changes to Table 4A or Table 4B.

• Data on Table 4A should reflect graduate totals for the Clinical Nurse Specialist, Nurse Practitioner, Nurse Administrator, Nurse Educator, Other Advanced Roles, Public Health Nurse and Post Nursing Master’s Certificate, Nurse-Midwifery Certificate, Nurse-Midwifery Master’s, Nurse-Midwifery Doctoral and Doctoral students who completed program/degree requirements between 07/01/09 and 6/30/10.

• Data on Table 4B should reflect graduates supported by traineeships totals for the Clinical Nurse Specialist, Nurse Practitioner, Nurse Administrator, Nurse Educator, Other Advanced Roles and Public Health Nurse Post Nursing Master’s Certificate, Nurse-Midwifery Certificate, Nurse-Midwifery Master’s, Nurse-Midwifery Doctoral and Doctoral students who completed program/degree requirements and were supported by the AENT Program between 07/01/09 and 6/30/10.

• Do not include Nurse Anesthetist graduates on Table 4A or Table 4B. The AENT Program also supports 1^st year nurse anesthetist students only.

• Although a graduate’s practice site may qualify under more than one category, each individual graduate / graduate supported 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 /graduates supported 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 4A or Table 4B will not be counted.

• Table 4A: In the “Total Number of Graduates Supported by Traineeships Working 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 4A will not be counted. This is a subset of “Total Number of Graduates”. For example, ___________.

• Table 4A: In the “Total Number of Graduates” row, enter the total number of graduates, which are reported on Tables 1-3, who completed degree requirements between 7/01/09 and 6/30/10 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 4A will not be counted.

IMPORTANT NOTE:

The total number of graduates reported in the “Grand Total” column MUST be consistent with the combined “Total Number of Graduates” reported on Tables 1-3.

This table reflects the combined totals of the Doctoral degree levels.

• Table 4A: In the “Percentage of Graduates in these Settings” row, enter the percentage of graduates working in the identified settings in the “Grand Total” column. Percentage of Graduates in these Settings = Total Number of Graduates in these Settings (from 07/01/09 – 06/30/10) divided by Total Number of Graduates (from 07/01/09 – 06/30/10).

• To reiterate, all applicant institutions requesting the Statutory Funding Preference must complete Table 4A (please see the Statutory Funding Preference information in this application).

• Table 4B: In the “Total Number of Graduates Supported by Traineeships Working in these Settings (from 07/01/09 to 06/30/10)” row, enter the total number of graduates who received traineeship support and completed degree requirements between 7/01/09 and 6/30/10 and worked in the identified setting. This table is for data analysis and data collection; it is imperative that all applicant institutions complete Table 4B. This is a subset of “Total Number of Graduates”. For example, ___________.

TABLE 5 - AENT: ETHNICITY DATA

Provide the total number of enrollees, students supported, graduates and graduates supported reported on Tables 1-3 by each category. All race categories should also be included in the Not Hispanic or Latino column. Instructions for completing Table 5 are below.

	Hispanic or Latino	Not Hispanic or Latino	Unreported/ Unavailable	TOTAL
ENROLLEES (As of 10/15/10)
STUDENTS SUPPORTED (7/1/09-6/30/10)
GRADUATES (7/1/09-6/30/10)
GRADUATES SUPPORTED (7/1/09-6/30/10)

NOTE: The AENT Program supports first year NAT students only; therefore, do not report NAT graduates on this table.

Instructions for completing Table 5: Ethnicity Data

The total number of “Enrollees”, “Students Supported”, “Graduates” and “Graduates Supported” reported on Tables 1, 2, and 3 should be used to complete Table 5. The total should be indicated in two categories: Hispanic / Latino or Not Hispanic / Latino. Each Total column on this table will reconcile with the appropriate total numbers reported on Tables 1, 2 and 3.

• Hispanic or Latino is considered an ethnicity so on the following rows “Enrollees, Students Supported, Graduates and Graduates Supported” you enter the data for the number of Hispanic / Latinos in that specific column and the numbers for Not Hispanic or Latino in that Specific Column.

• Not Hispanic or Latino will include racial categories (White, Black, Asian, Native American or More Than One Race).

• Enter the total number of “Enrollees” by ethnicity as of 10/15/10. Also include only full-time, first-year nurse anesthetist enrollees in the total number of “Enrollees”.

• Enter the total number of “Students Supported” by ethnicity as of 7/1/09-6/30/10.

• Enter the total number of “Graduates” who completed degree requirements between 7/01/09 and 6/30/10. Post Nursing Master’s Certificate students who complete all program requirements are recognized as graduates and must be counted on Table 5.

• Enter the total number of “Graduates Supported” by ethnicity as of 7/1/09-6/30/10.

• Enter the data in the “Unreported/Unavailable” column if your institution does not track this data or you do not know the ethnicity of the student.

The TOTAL for each row is the Hispanic or Latino plus the Not Hispanic or Latino columns.

The TOTAL numbers on Table 5 should reconcile with the total numbers reported on Tables 1, 2, and 3.

IMPORTANT NOTES:

Enrollees, Students Supported, Graduates and Graduates Supported are the total numbers from Tables 1,2,3 separated and reported as Hispanic or Latino and Not Hispanic or Latino.

If your institution does not track this data or you do not know the ethnicity of the student, include those numbers in the Unreported/Unavailable column.

Instructions for completing Table 6: AENT: RACE/DISADVANTAGED DATA

• Enter the total number of “Enrollees” by race and the “total” for students enrolled as of 10/15/10 Also include only full-time, first-year nurse anesthetist enrollees in the total number.

• Enter the total number of “Students Supported” by race for students supported as of 7/1/09-6/30/10.

• Enter the total number of “Graduates” by race and the “total” for graduates who completed degree requirements between 7/01/09 and 6/30/10. Post Nursing Master’s Certificate students who complete all program requirements are recognized as graduates and must be counted on Table 6.

• Enter the total number of “Graduates Supported” by race for graduates supported as of 7/1/09-6/30/10.

IMPORTANT NOTES:

Enrollees, Students Supported, Graduates and Graduates Supported that do not report ethnicity or race must be reported in the appropriate Unreported / Unavailable column.

Also, indicate and include the Racial category of the Hispanic / Latino’s that are reported on Table 5 in each row count on Table 6 as appropriate. A Hispanic / Latino can be White, Black, Asian, Native American or More Than One Race.

When data is not captured for Hispanics / Latinos, include the numbers in the Unreported / Unavailable column.

TOTAL columns for “Enrollees, Students Supported, Graduates and Graduates Supported” should each reconcile with the total applicable specific data reported on Tables 1, 2, and 3.

• Use the following definitions from the OMB standards for the classification of Federal data on ethnicity and race 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 Levels

The Secretary defines a ``low-income family'' for programs included in Titles III, VII and VIII of the Public Health Service Act as having an annual income that does not exceed 200 percent of the Department's poverty guidelines. 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. Each program will announce the rationale and choice of methodology for determining low income levels in their program guidance.

The Department's poverty guidelines are based on poverty thresholds published by the U.S. Bureau of the Census, adjusted annually for changes in the Consumer Price Index. The Secretary annually adjusts the low-income levels based on the Department's poverty guidelines and makes them available to persons responsible for administering the applicable programs.

The income figures below have been updated to reflect increases in the Consumer

Price Index through December 31, 2008.

------------------------------------------------------------------------

Income

Size of parents' family * level **

------------------------------------------------------------------------

1........................................................... $21,660

2........................................................... 29,140

3........................................................... 36,620

4........................................................... 44,100

5........................................................... 51,580

6........................................................... 59,060

7........................................................... 66,540

8........................................................... 74,020

------------------------------------------------------------------------

* 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 2008.

TABLE 7 – AENT: AGE AND GENDER DATA

On the following Table 7, provide data on the total number of enrollees, students supported, graduates and graduates supported reported on Tables 1-3 by age and gender category. Count each student only once. Instructions for completing Table 7 are below.

Age and Gender
	Males	Females	Total
Under 20
Enrollees (As of 10/15/10)
Students Supported (7/1/09-6/30/10)
Graduates (7/1/09-6/30/10)
Graduates Supported (7/1/09-6/30/10)
Unreported/Unavailable
20-29
Enrollees (As of 10/15/10)
Students Supported (7/1/09-6/30/10)
Graduates (7/1/09-6/30/10)
Graduates Supported (7/1/09-6/30/10)
Unreported/Unavailable
30-39
Enrollees (As of 10/15/10)
Students Supported (7/1/09-6/30/10)
Graduates (7/1/09-6/30/10)
Graduates Supported (7/1/09-6/30/10)
Unreported/Unavailable
40-49
Enrollees (As of 10/15/10)
Students Supported (7/1/09-6/30/10)
Graduates (7/1/09-6/30/10)
Graduates Supported (7/1/09-6/30/10)
Unreported/Unavailable
50-59
Enrollees (As of 10/15/10)
Students Supported (7/1/09-6/30/10)
Graduates (7/1/09-6/30/10)
Graduates Supported (7/1/09-6/30/10)
Unreported/Unavailable
60 or older
Enrollees (As of 10/15/10)
Students Supported (7/1/09-6/30/10)
Graduates (7/1/09-6/30/10)
Graduates Supported (7/1/09-6/30/10)
Unreported/Unavailable
TOTAL

Instructions for completing Table 7:

IMPORTANT NOTES:

Do not double count a student as both an Enrollee and a Graduate.

• Enrollees – Students that are enrolled in an Advanced Education Nursing Program and have not graduated or completed the program by 10/15/10.

• Graduates – Students who have successfully completed all educational requirements for a specified Advanced Education Nursing Program of study or have met the eligibility requirements for an Advanced Education Nursing Master’s or Doctoral degree or Post-Nursing Master’s Certificate between 07/01/09-06/30/10.

• TOTAL columns for “Enrollees, Students Supported, Graduates and Graduates Supported” by age and gender should each reconcile with the total applicable specific data reported on Tables 1, 2, and 3.

• Enter the total number of “Enrollees” “Students Supported”, “Graduates” and “Graduates Supported” by age and gender for each category.

• Enter the total number of “Enrollees” by age and gender enrolled as of 10/15/2010.

• Enter the total number of “Students Supported” by age and gender and the “total” for students supported 7/01/2009 and 6/30/2010.

• Enter the total number of “Graduates” by age and gender and the “total” for graduates

who completed degree requirements between 7/01/2009 and 6/30/2010.

• Enter the total number of “Graduates Supported” by age and gender and the “total” for graduates supported that completed degree requirements between 7/01/2009 and 6/30/2010.

AENT PROGRAM

SPECIAL CONSIDERATION ASSURANCE STATEMENT

Applicant requesting “Special Consideration” must assure compliance with the following statement to be uploaded in HRSA EHBS and submitted electronically with the electronic application.

I certify that _______ of the _______ total number of students enrolled (total student enrollees

from AENT tables 1 through 3) as of October 15, 2010 have signed commitments to practice in

HPSAs after graduation. The percent of students who have signed commitments is __________.

The school of nursing at the applicant organization will retain the signed commitments for three years. The signed commitments will not be mailed to the HRSA Division of Nursing.