Form 1 PRGCA Manual

Department of Health and Human Services
Health Resources and Services Administration
Bureau of Health Professions

Performance Report for Grants and Cooperative Agreements

Reports Due: September 30, 2012
Reporting Period: July 1, 2011 to June 30, 2012

Contents
I. Introduction

v

II. Performance Reporting

vii

A. General Instructions
Individual Trainee-Level Data Collection
Table 1. Performance Reporting Required by Programs

vii
vii
1

B. Frequently Asked Questions

5

C. Required Reporting
Health Profession and Discipline - Setup

8
8

Financial Support and Faculty Development Support

11

Table LR-1: Total Number of Trainees in BHPr-Funded Programs

12

Table LR-2: Trainee Age and Gender

22

Table DV-1: Trainees by Ethnicity and Race

24

Table DV-2: Trainees with Disadvantaged Background

28

Table DV-3: Trainees by Residential Background

30

D. Cross Cutting and Program Specific Reporting
Table N-1: Nursing Programs: Supply Indicators for

31
32

Table PY-1: Prior Year Completers and Graduates

36

Table PC-1 (1a.1, 1a.2): Primary Care: Program Level Supply Indicators

43

Table PC-R: Primary Care Curriculum Content

49

Table R-1 (1a, 1b): Residency Programs: Program Level Supply Indicators

53

Table EXP-1 (1a, 1b): Experiential and/or Clinical Training (Sites/Clinic Programs)

61

Table EXP-2: Experiential Training -Type and Number of Training Sites per Training
Year (outcome)

70

Table IND-GEN: Individual Trainee General Characteristics

72

Table IND-FAC: Individual Faculty Trainee Characteristics

81

Table IND-INTPRACT: Individual Intent to Practice Characteristics

85

Table INDGEN-EXP: Trainee-to-Site Association

88

Table CLSET-1: Clinical Settings per Training Year

90

Table CE-1: Educational Offering/Continuing Education offerings

93

Table CE-TTY: Educational Offering/Continuing Education Trainee Type

102

Table CE-2: Educational Offering Trainee Employment Settings

105

Table DP-1 (1a.1, 1a.2): Diversity/Pipeline Content

107

Table OH-1: Oral Health Curriculum Content

118

Table GACA-1: Geratric Academic Career Award: Other Activities Descriptions

121

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Table CGEP-1 (1a, 1b): Comprehensive Geriatric Education Programs: Grant Purpose and Trainee
Characteristics and Outcomes
122
Table GTPD-1: Geriatric Training Program for Physicians, Dentists, and Behavioral and
Mental Health Professions - Description of Trainees and Completers

124

Table GEC-1: Geriatric Education Centers - Identify Evidence-Based Practice

130

Table GEC-2: Geriatric Education Centers: Implementation of Evidence-Based Practice

131

Table PHTC-1 (1a, 1b): Public Health Training Centers: Partnership Accreditation Activities

133

Table PMR-1: Preventive Medicine Residency - Curriculum Content

136

Table PD-1: Pre-doctoral Training in General, Pediatric, and Public Health Dentistry and
Dental Hygiene- Supply of Pre-doctoral Oral Health Provider

139

Table PYPDD-1: Oral Health Post-doctoral Training Program: Prior Academic Year Individual
Completer Outcome Data

142

Table FDD-1 (1a, 1b): Oral Health Faculty Development Supply- Faculty Development in
General, Pediatric, and Public Health Dentistry and Dental Hygiene

145

Table FDD-2: Oral Health Faculty Development - Curriculum Content

150

Table SOHWP-0 State Oral Health Workforce Legislative Activities

152

Table SOHWP-1: Activity 1 - Loan Forgiveness and Repayment Programs for Dentists

154

Table SOHWP-2: Activity 2 – Dental Recruitment and Retention Efforts

158

Table SOHWP-3: Activity 3 - Grants and Low-interest or No-Interest Loans to Help Dentists
Participating in the Medicaid/CHIP Program

159

Table SOHWP-4 (4a, 4b): Activity 4 - Establishment or Expansion of Dental Residency Programs
in States without Dental Schools
161
Table SOHWP-5 (5a, 5b): Activity 5 - Establishment or Expansion of Oral Health Services and
Facilities in Dental Health Professional Shortage Areas

164

Table SOHWP-8: Activity 8 - Teledentistry Practice Support

171

Table SOHWP-9: Activity 9 - Community-Based Prevention Services

172

Table SOHWP-10: Activity 10 - Programs that Promote Children Going into Oral Health and
Science Professions

174

Table SOHWP-11: Activity 11 - Establishment of Faculty Recruitment Programs

176

Table SOHWP-12: Activity 12 - Strengthening the State’s Dental Office

177

Table SOHWP-13: Activity 13 - Other Activities

179

Table DP-2: Health Careers Opportunity Program- Unstructured Pipeline Programs

180

Table DP-3: Nursing Workforce Diversity - Unstructured Pipeline Programs

182

Table DP-4: Centers of Excellence - Description of Faculty in Health Professions Schools

185

Table AAU-1: Academic Administrative Units in Primary Care Program: Characteristics
and Activities

190

Table PFD-1: Physician Faculty Development in Primary Care Program: Purpose and
Completer Outcomes

192

Table NEPQR-1: Nurse Education Practice, Quality, and Retention Program: Purpose of Grant

194

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Table NEPQR-2a: Nurse Education Practice, Quality, and Retention (purpose R4 only) -Nursing
Retention and Vacancy Data
195
Table NEPQR-2b: Nurse Education Practice, Quality, and Retention (purpose R4 only) – Patient
Care Core Indicators
197
Table NEPQR-3: NEPQR (Purpose R2): Internships and Residencies

198

Table N-2: Personal and Home Care Aides and Nursing Assistant and Home Health Aide Programs
Supply Indicators
200
Table PCO-1: State Primary Care Offices -Obligated Health Professional (OHP) Providing Care

202

Table PCO-2: State Primary Care Offices :Number of NHSC R&R Assistance Application State
Recommendation Forms Submitted

206

Table PCO-3a: State Primary Care Offices: New Safety Net Sites Developed or Expanded

207

Table PCO-3b: State Primary Care Offices: Number of Clients Who Received Technical Assistance
208

Appendix A. HRSA Strategic Goals

210

Appendix B. BHPr Workforce Cross-cutting Performance Measures

212

Appendix C.

242

Glossary

Appendix D. Matrix of Cross-cutting Data Tables Required by Program

255

Appendix E. Matrix of Program-Specific Data Tables

265

Appendix F. Progress Reporting Requirements for BHPr Programs

268

Table GACA-5: Other Activities- Geriatric Academic Career Award

269

Table GPE-3: Trainee Research Projects- Graduate Psychology Education

271

Table CDP-1: Description of Treatments- Chiropractic Demonstration Project

272

Table RH-1— Research

273

Table AHEC-1: Program Characteristics

275

Table AHEC-2: Center Characteristics

277

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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 0915-0061. Public reporting burden for the collection of this information is estimated to average
8.5 -12 hours per response for program aggregate data and 3-8 hours per response for individual traineelevel data, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information.
OMB No. 0915-0061
I. Introduction
The Bureau of Health Professions (BHPr) Performance Report for Grants and Cooperative Agreements
(PRGCA) is designed for grantees to submit data and information on program activities. It is a critical
information and data management tool that BHPr uses to ensure compliance with legislative requirements
and report on grantee success in achieving project objectives and cross-cutting programmatic goals to the
Office of Management and Budget (OMB), Congress, and other decision makers.
The BHPr performance measurement system reflects the overarching goals of the Department of Health
and Human Services (DHHS) as well as the Health Resources and Services Administration’s (HRSA)
goal to strengthen the health care workforce. These goals provide the basis for the BHPr performance
measures and the following BHPr performance goals:
Develop diverse well trained healthcare practitioners - Supply;
Enhance the quality of training - Quality;
Diversify the health professions pipeline - Diversity;
Influence practice location of health practitioners - Distribution; and
Build capacity with training infrastructure support - Infrastructure.
The BHPr performance measures address these performance goals with a specific focus on supply,
quality, diversity, distribution, and infrastructure. The BHPr performance measurement system ensures
that grantees are collecting data that both meet BHPr’s statutory requirements and demonstrate the extent
to which the priorities and goals of the BHPr, HRSA, and DHHS are met.
The BHPr performance measurement system includes three levels of measurement: individual traineelevel, program-level, and program cross-cutting. The new individual trainee-level data collection supports
the goal of assessing workforce recruitment, training activities, retention, intended practice location, and
trainee characteristics, such as disadvantaged background, and race and ethnic diversity. The programlevel measures provide information unique to the grant objectives for new and ongoing programs. The
program cross-cutting or cluster-level measures help to determine progress towards meeting BHPr goals
by assessing programs that offer similar activities and have similar performance outcome measures.
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The subsequent section of this manual details what data each program’s grantees are required to submit
and how to submit performance data. Refer to table 1 on page 3 to determine which programs are required
to report individual trainee-level information. Refer to Appendix D (Matrix of Cross-cutting Data Tables
Required by Program) to determine which cross-cutting tables grantees should provide data based upon
grant requirements. Refer to Appendix E (Matrix of Program-Specific Data Tables) to determine which
programs are required to report program-specific data.

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II. Performance Reporting
A. General Instructions
This section describes the submission instructions and requirements of the performance data. This
includes submission requirements, how to submit the data, and the due date for data submissions. Table 1
provides an overview of the performance reporting required for each program.
Submission Requirements and Submission Due Date
Performance reports are due September 30, 2012. Between September 1, 2012 and September 30, 2012,
grantees may work with the BHPr program officer to revise the performance data submitted. All data are
considered final on September 30, 2012. Any revisions requested after this date will not be accepted. The
electronic forms will be automated to generate total counts and sums that will save grantees time and
reduce the chance of arithmetical errors. The grantee will enter relevant information for year one of the
grant and in subsequent grant years, the grantee will only have to enter necessary edits rather than enter
data from previous years. The data from past years will be saved and displayed for each grant year.
Request Assistance
The BHPr staff members are ready to provide support as needed to help with the performance reporting
process. Multiple sources are available to provide assistance:
Visit http://bhpr.hrsa.gov/grants/
Contact the HRSA Call Center at 1-877-464-4772
E-mail [email protected]
Individual Trainee-Level Data Collection
In addition to reporting aggregate data through cross-cutting and program-specific reporting, certain
BHPr programs have been selected to submit data at the individual level. Not all programs will collect
individual trainee-level data. Refer to Table 1 on page 1 to determine which programs have been selected
for this data collection and the data required to be reported per program.
Data collection at the individual trainee-level will increase the usefulness of the data for program
evaluation purposes and is essential for longitudinal tracking of trainees. This data will help BHPr
understand the relationship between the experiences of trainees during the program and program
outcomes
Individual trainee-level data will be reported using unique trainee identifiers, which will maintain the
anonymity of all individuals participating in these programs. Grantees are required to create a unique
seven digit numeric identifier for each program trainee. Please do not use any personally identifying
information, such as birth dates or insurance numbers, when assigning trainees unique identifiers. The
unique trainee identifiers shall be maintained throughout each grant’s duration and should therefore
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remain consistent in all reports. That is, the unique identifiers initially assigned to trainees should not be
changed.

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Table 1. Performance Reporting Required by Programs
Note: All programs must submit performance data related to the legislative requirements (Tables LR-1,
LR-2 represent Trainee Information and DV-1, DV-2, and DV-3 represent Diversity Data Collection).
*Represents individual-level data.

Activity
Code

D54, D12,
D5A (ARRA)
A10
D09
T57
U76, U77

D34, D3E
(ARRA)
R18
D62
D87, D82
T88
D86

U1K

K01

Program Name
*=Trainee-level data collection

Academic Administrative Units in Primary
Care (AAU)
Advanced Education Nurse Traineeship
(AENT)
Advanced Nursing Education (ANE)
Advanced Nursing Education Expansion
(ANEE)
Area Health Education Centers (AHEC)(Infrastructure Development and Point of
Service Maintenance and Enhancement)
Centers of Excellence (COE)

Chiropractic Demonstration Project (CDP)
Comprehensive Geriatric Education
Programs (CGEP)
Dental Faculty Loan Repayment
Expansion of the Physician Assistant
Training (EPAT) Programs
Faculty Development in General, Pediatric,
and Public Health Dentistry and Dental
Hygiene (FDD)
Faculty Development: Integrated
Technology into Nursing Education and
Practice
Geriatric Academic Career Award (GACA)

2012 BHPr Performance reporting

Tables to be Completed

EXP-1; CLSET-1; IND-GEN*; INDFAC*; INGEN-EXP; AAU-1; Progress
report
N-1; CLSET-1; PY-1; IND-GEN*; INDINTPRAC*
N-1; EXP-2; CLSET-1; CE-1; PY-1
N-1; CLSET-1; IND-GEN*; INDINTPRAC*
EXP-1; CLSET-1; CE-1; CE-2; CE-TTY;
PY-1; IND-GEN*; IND-INTPRAC*;
INDGEN-EXP; DP-1a.1, 1a.2; Progress
report
EXP-1; CLSET-1; PY-1; IND-GEN*;
IND-FAC*; IND-INTPRAC*; INDGENEXP; DP-1a.1, 1a.2; DP-4a,4b
Progress report
CE-1; CE-TTY; CE-2; IND-GEN*; INDINTPRAC*; CGEP-1a, b
IND-GEN*; IND-FAC*
PC-1; PC-R; EXP-1; CLSET-1; PY-1;
IND-GEN*; IND-FAC*; INDGEN-EXP
IND-GEN*; IND-FAC*; FDD-1a.1, 1a.2;
FDD-1b.1,1b.2; FDD-2; OH-1
CE-1; CE-TTY; CE-2; IND-GEN*; INDFAC*
EXP-1; CLSET-1; CE-1; CE-TTY; CE-2;
IND-GEN*; IND-FAC*; INDGEN-EXP;
GACA-1; Progress report
Page 1 of 287

UB4

Geriatric Education Centers (GEC)

D01

Geriatric Training Program for Physicians,
Dentists, and Behavioral and Mental Health
Professions (GTPD)
Graduate Psychology Education (GPE)

D40

D18, D1H
(ARRA)
UD6
T85, T86
(ARRA)
M01
A22
E01, E0A
(ARRA)
T56 (ACA)
T51
D11

UD7
D19, D1N
(ARRA)
T82

Health Careers Opportunity Program
(HCOP)
Integrative Medicine Program and National
Coordinating
Interdisciplinary and Interprofessional Joint
Graduate Degree Program
Mental and Behavioral Health Education
and Training
Nurse Anesthetist Traineeship (NAT)
Nurse Faculty Loan Program (NFLP)
Nurse Managed Health Clinics (NMHC)
Nursing Assistant and Home Health Aide
Program (NAHHA)
Nursing Education, Practice, Quality, and
Retention (NEPQR)

Nursing Education, Practice, Quality, and
Retention (NEPQR) –IPCP (NEPQR-IPCP)
Nursing Workforce Diversity (NWD)

Personal and Home Health Aide State
Training (PHCAST)

2012 BHPr Performance reporting

EXP-1; CLSET-1; CE-1; CE-TTY; CE-2;
IND-GEN*; IND-FAC*; INDGEN-EXP;
GEC-1, 2
EXP-1; CLSET-1; PY-1; IND-GEN*;
IND-FAC*; INDGEN-EXP; GTPD-1a,1b
EXP-1; CE-1; IND-GEN*; INDINTPRAC*; INDGEN-EXP; Progress
report
DP-1a.1, 1a.2; DP-2; PY-1; IND-GEN*;
IND-INTPRAC*
R-1; EXP-1; CLSET-1; PY-1; IND-GEN;
IND-FAC; INDGEN-EXP; PMR-1;CE-1
PC-1; PC-R; EXP-1; CLSET-1; PY-1;
IND-GEN*; IND-FAC*; INDGEN-EXP
EXP-1; IND-GEN; IND-INTPRAC;
INDGEN-EXP; PY-1
N-1; CLSET-1; PY-1; IND-GEN*; INDINTPRAC*
N-1; CLSET-1; PY-1; IND-GEN*; INDINTPRAC*; IND-FAC*
EXP-1; CLSET-1; IND-GEN*;
INDGEN-EXP
CE-1;CE-2;N-2; IND-GEN*
N-1 for E1, E2, R1,R3;
EXP-1 for E2, P1, P2;
CE-1 for E2, P2, P3, R3, R4;
CE-TTY for E2, P2, P3, R3, R4;
CLSET-1 for E2, P1, P2;
CE-2 for E2, P2, P3, R3, R4;
PY-1 for E1, E2, R1 R3;
NEPQR-3 for R2;
NEPQR-2a,2b for R4
IND-GEN* for E1, E2, P1, P2, R1, R3;
INDGEN-EXP for E2, P1, P2
N-1; EXP-1; CLSET-1
N-1; EXP-1; CLSET-1; DP-1; PY-1;
IND-GEN*; IND-INTPRAC*; INDGENEXP; DP-3
CE-1;CE-2;N-2; IND-GEN*
Page 2 of 287

D57, D5B
(ARRA)
D55, D5C
(ARRA)

Physician Assistant Training in Primary
Care (PAT)
Physician Faculty Development in Primary
Care (PFD)

D13, D5G,
D88, D84
(ARRA)
D85, D83
(ARRA)

Post-doctoral Training in General, Pediatric,
and Public Health Dentistry (PDD)

D56, D5D
(ARRA)
D33
D5H
(ARRA)
U68, U6A
(ARRA)
R51, T89
(ACA)
A03, A0A
(ARRA)
D20, UC9,
UB6 (ACA)
D58, D5F
(ARRA)
T12

T91 (ACA)

Pre-doctoral Training in General, Pediatric,
and Public Health Dentistry and Dental
Hygiene (PD)
Pre-doctoral Training in Primary Care
Preventive Medicine Residencies (PMR)

Primary Care Office (PCO) (exclude LR-1,
LR- 2, DV-1, DV-2, and DV-3)
Primary Care Residency Expansion (PCRE)
Public Health Traineeships (PHT)
Public Health Training Centers (PHTC)

Residency Training in Primary Care
State Oral Health Workforce Program
(SOHWP) (exclude LR-1, LR- 2, DV-1,
DV-2, and DV-3)
Teaching Health Centers (THC)

PC-1; PC-R; EXP-1; CLSET-1; PY-1;
IND-GEN*; IND-FAC*; INDGEN-EXP
PC-1; PC-R; EXP-1; CLSET-1; PY-1;
IND-GEN*; IND-FAC*; INDGEN-EXP;
PFD-1; Progress report:RH-1
R-1; OH-1; EXP-1; CLSET-1; INDGEN*; INDGEN-EXP; PYPDD-1*
PD-1; OH-1; EXP-1; CLSET-1; INDGEN*; INDGEN-EXP
PC-1; PC-R; EXP-1; CLSET-1; PY-1;
IND-GEN*; IND-FAC*; INDGEN-EXP
R-1; EXP-1; CLSET-1; PY-1; INDGEN*; INDGEN-EXP; PMR-1
PCO-1; PCO-2; PCO-3
PC-R; R-1a,1b; EXP-1; CLSET-1; PY-1;
IND-GEN*; IND-FAC*; INGEN-EXP
PY-1; IND-GEN*; IND-INTPRAC*
EXP-1; CLSET-1; CE-1; CE-2; CE-TTY;
IND-GEN*; IND-INTPRAC*; INDGENEXP; PHTC-1a, 1b
PC-R; R-1a,1b; EXP-1; CLSET-1; PY-1;
IND-GEN*; IND-FAC*; INDGEN-EXP
EXP-1, CLSET-1, IND-GEN*, INDFAC*, INDGEN-EXP for activity 6; CE1, CE-TTY for activity 7
PC-R; R-1a,1b; EXP-1; CLSET-1; PY-1;
IND-GEN*; INDGEN-EXP

Cross-cutting Performance Measures Reporting
BHPr’s programs are designed to improve the health of the Nation’s underserved and vulnerable
populations by assuring a diverse, culturally competent workforce is ready to provide access to quality
health care services. Its more than 40 programs include a wide range of training, scholarship, loan, and
loan repayment programs that support the development, distribution, and retention of a diverse and
culturally competent health care workforce. The program cluster performance measure data is essential

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for BHPr to assess its success in achieving project objectives and cross-cutting programmatic goals to
improve health care workforce supply, quality, diversity, distribution, and infrastructure across programs.
Measurement Goals
The following BHPr Performance Goals are focus of the performance measures:
Supply—Increased supply of health professionals in workforce
Increasing the number of health professionals, especially in primary care.
Quality—Improved health workforce quality
Integrating core competencies into BHPr education and training programs and increasing
competency among program trainees.
Diversity—Increased diversity in the health workforce
Increasing the number of racial and ethnic minority practitioners to mirror the U.S. population.
Distribution— Influence practice location of health practitioners
Encouraging practitioners to practice in underserved areas and care for underserved people.
Infrastructure—Build capacity with training infrastructure
Providing opportunities for strengthening health professions training institutions and faculty.
Cross-cutting Measure Reporting
The program cross-cutting measure reporting comprises 23 tables designed to obtain comprehensive,
standardized operational and descriptive data that reflects BHPr goals and can be monitored over time to
assess trends. The tables reflect key areas of BHPr program focus, including workforce diversity, the
supply of health professionals in primary care, and the training contexts and content. For details of crosscutting data tables required by program, refer to Appendix D. Matrix of Cross-cutting Data Tables
Required by Program.
Program-Specific Reporting
In addition to cross-cutting measure reporting, some grantees are required to report program-specific data.
For details of program specific data tables required by program, refer to Appendix E. Matrix of ProgramSpecific Data Tables.

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B. Frequently Asked Questions

General Questions
Q: What has changed from the old 2011 to the new 2012 BHPr Performance Report for Grants and
Cooperative Agreements (PRGCA)?
A: The 2012 BHPr PRGCA has been updated to better enable grantees to collect data regarding the
outputs and outcomes of their federally-funded programs. More specifically, revisions include improving
performance management at three levels of measurement: individual-level, program-level and program
cross-cutting-level. The new individual-level data collection will support the goal of assessing workforce
recruitment, participants’ training activities, retention, distribution (intended practice locations), and
trainee characteristics such as disadvantaged background, racial and ethnic diversity. Measurement data
are reported in Congressional Justifications and other documents regarding BHPr programs.
Program-level measures were revised to strengthen information unique to the grant objectives for new and
ongoing programs. These data incorporate accountability and are critical to reporting measureable outputs
and outcomes within program performance annually.
At the third level of measurement, revisions included clustering programs providing similar activities and
outcomes performance measures. These program cross-cutting-level measures were developed to assess
the broader BHPr goals, strategies, and outcomes. The revised performance measures will enhance
BHPr’s ability to assess its programs’ results related to cross-cutting or cluster measures
Relationship Between Measures
The three levels of measurement described above are inter-related. For example, non-identifiable
individual measures are aggregated by programs and provide reliability data for assessing program
performance. In collecting program-specific data, information regarding the training experiences in
nursing, public health, as well as dentistry and medicine focuses on unique training needs by discipline.
Cross-cutting program measures identify the commonalities of the training across discipline, e.g., pipeline
recruitment, diversity, continuing education activities and faculty development activities.
Grantees can meet these new performance reporting requirements using the EHB. Using the latest
technology, the EHB incorporates new tools allowing grantees to upload spreadsheets or stream data.
These new tools will reduce the burden and cost of manual data entry for some data collection forms
thereby reducing the time and costs that grantees devote to performance reporting. In fields that require
manual data entry, the system limits grantees’ data entry to those fields that are applicable to their
particular programs. The data tables are interlocked where data overlap, validations are built-in,
calculations (e.g., ratios, rates, percentages, totals) are automated, and historical data are preserved.
Though the system has been designed to be as user friendly as possible; ongoing grantee TA is provided
to ensure ease of use and minimize reporting burden.

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Q: Will grantees be able to provide suggestions and comments on the new performance measures
and indicators?
A: Yes. BHPr views performance measurement as an iterative improvement process. By maintaining an
open dialogue with grantees, BHPr will continually answer grantees’ questions and clarify data elements
and reporting instructions. BHPr will additionally request grantees’ feedback regarding the updated EHB
system and data templates. Through this process, BHPr will seek to balance improved performance
measurement with stability and ease of reporting.
Q: How will grantees be updated on BHPr performance measurement activities?
A: BHPr program officers provide quarterly technical assistance (TA) teleconferences with grantees to
provide information on BHPr ‘hot topics’ including performance measures and related reporting
requirements. BHPr program officers also post information electronically on the HRSA/BHPR Web site.
Grantees will receive a notice from the EHB on TA sessions and reporting due dates. As questions arise
about performance reporting, grantees are encouraged to contact their project officer.

Data Tables and Forms
Q: How should grantees generate the unique trainee identifier (ID)?
A: Select grantees are required to collect individual trainee-level data, which necessitates that they assign
each trainee a unique identifier (ID). A seven digit alphanumeric identifier is required. The unique ID
assigned to each trainee should remain the same in all reports throughout the duration of the grant. The
unique ID assigned to each trainee should maintain the anonymity of that individual. Grantees should not use
any personally identifiable information, such as Social Security numbers, birthdates, or health insurance ID
numbers, to create each unique ID.
Individual Trainee-Level Data Collection
Q: How does BHPr advise grantees to handle Institutional Review Board (IRB) issues related to
individual-level data collection?
A: BHPr performance reporting is a grant requirement for HRSA program evaluation and is not
considered research. It is not anticipated that IRB approval is required for program evaluation. If a grantee
believes that its institution will require IRB approval for individual-level data collection, the grantee
should immediately contact its project officer and submit in writing the institution’s IRB process and
expected response time. HRSA will provide guidance pertinent to the development of IRB protocols.
Q: Does the individual-level data collection adhere to the Family Education Rights and Privacy Act
(FERPA)?
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A: Yes. A FERPA violation will not result from the individual-level data collected by selected grantees.
Under FERPA, this type of information may be shared with those who have “the right to know.” This
includes government agencies, such as HRSA, that provide certain forms of support (e.g., student
scholarships) and therefore have the right to know the information that is necessary to measure the
performance of relevant grantees.

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C. Required Reporting
Health Profession and Discipline - Setup
Table purpose: To select health professions and disciplines applicable to the BHPr-funded programs.
Health Profession: (Select one)
Discipline: (Select all that apply)

Health Profession

Discipline

Instructions: Select a health profession and disciplines associated with the selected health profession and add the selections to the form. Repeat the
previous step to add multiple health profession/discipline combinations. The health professions and disciplines in this form will be populated in the
cross cutting and program specific forms. The glossary contains clarifications and/or definitions of key terms.
Health Profession Selections: Dentist; Medicine; Physician Assistant; Nursing; Behavioral Health/Public Health/Other;
HCOP Program: Dentist; Medicine; Physician Assistant; Nursing; Behavioral Health/Public Health/Other; Pipeline
Discipline Selections:
For Pre-doctoral Training in Primary Care, Interdisciplinary and Interprofessional Joint Graduate Degree Program, Expansion of the Physician
Assistant Training (EPAT) Program, and Physician Assistant Training in Primary Care (PAT) programs, discipline is not applicable.
For AHEC Program, select Not Applicable (N/A) if discipline is not applicable.
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Dentist Selections: FELLOWSHIP AND RESIDENCY PROGRAMS: Advanced Education In General Dentistry - AEGD 12 month
program (include optional 2nd year); AEGD 24 month program; Dental Public Health - DPH 12 month program; DPH 24 month program;
General Practice Residency - GPR 12 month program (include optional 2nd year); GPR 24 month program; Geriatric Dentistry; Pediatric
Dentistry (24 months);
OTHER PROGRAMS: Dental Assistant; Dental Hygiene; General Dentistry; Pediatric Dentistry; MPH year-General Dentistry (Master's in
Public Health); MPH year-Pediatric Dentistry; MPH year-Public Health Dentistry; MPH year-Dental Hygiene, Public Health Dentistry;
Other (specify)
Medicine Selections: Aerospace Medicine; Allopathic Medicine, Alternative/Complementary Medicine; Behavioral/Mental Health In School
Of Medicine And Osteopathic Medicine; Chiropractic; Family Medicine; General Internal Medicine; General Pediatrics; General Preventive
Medicine; General Preventive Medicine/ Family Medicine; General Preventive Medicine/ Internal Medicine; General Preventive Medicine/
Public Health; Geriatric Medicine; Geriatric Psychiatry; Integrative Medicine; Internal Medicine /General Pediatrics; Internal
Medicine/Family Medicine; Neurology; Obstetrics/Gynecology; Occupational Medicine; Osteopathic General Practice; Pediatrics/Family
Medicine; Pharmacy, Podiatry; Psychiatry; Radiology; Veterinary Medicine;
Physician assistants Selections: Disciplines are not applicable (N/A).
Nursing Selections: Alternative/Complementary Nursing; CNS-Adult gerontology; CNS-Family; CNS-Geropsychiatric; CNS-Neonatal;
CNS-Pediatrics; CNS-Psychiatric/Mental health; CNS-Women’s health; Clinical Nurse Specialist (CNS); Home Health Aide; Licensed
Practical/Vocational Nurse (LPN/LVN); NP - Other advanced nurse specialists; NP - Psychiatric/Mental health; NP –Adult gerontology; NP
–Family; NP –Neonatal; NP –Pediatrics; NP –Women’s health; NP- Acute care adult gerontology; NP- Acute care pediatric; NP- Emergency
care; NP- Geropsychiatric; Nurse Administrator; Nurse Anesthetist; Nurse Assistant/Patient Care Associate (PCA); Nurse Educator; Nurse
Generalist; Nurse Midwife; Nurse Practitioner (NP); Nurse Researchers/Scientists; Nursing Informatics; Public Health Nurse; Registered
Nurse; Registered Nurse Student; Other (specify);
Behavioral Health/Public Health/Other Selections:
Behavioral Health Selection: Counseling Psychology; Clinical Psychology; Clinical Social Work;; Marriage and Family Therapy;
Pastoral/Spiritual Care; Other Psychology; Other Social Work, Substance Abuse/Addictions Counseling; Other (specify);

2012 BHPr Performance reporting

Page 9 of 287

Public Health: Biostatistics; Biostatistics – Biometry; Community Health Worker Environmental Health; Environmental Health –
Environmental chemistry; Environmental Health – Environmental health planning; Environmental Health – Environmental sciences;
Environmental Health – Industrial hygiene; Environmental Health – Occupational safety and health; Environmental Health – Radiological
health; Environmental Health – Toxicology; Environmental Health – Water quality; Epidemiology; Geriatrics/Aging Populations
Global/International Health; Global/International Health – Tropical medicine; Health Education/Behavior; Health Education/Behavior –
Behavioral sciences; Health Education/Behavior – Community health sciences; Health Education/Behavior – Evaluation research; Health
Education/Behavior – Health behavior; Health Education/Behavior – Health promotion/disease prevention; Health Services Research; Health
Services/Hospital Administration; Health Services/Hospital Administration – Health management; Health Services/Hospital Administration –
Health planning; Health Services/Hospital Administration – Hospital administration; Maternal & Child Health; Maternal & Child Health –
Adolescent health; Maternal & Child Health – Infant and child health; Maternal & Child Health – Women’s health; Nutrition; Nutrition –
Dietetics; Nutrition – Public health nutrition; Occupational Health; Public Health (General Studies); Public Health Practice; Public Health
Practice – Community health practice; Public Health Practice – Program management; Urban Health; Veterinary Science – Veterinary public
health; Other (specify);
Other: Audiology; Bio-Engineering; Biomedicine; Biomedicine - Biochemistry; Biomedicine - Cancer biology; Biomedicine Immunology; Biomedicine - Microbiology; Biomedicine - Parasitology; Biomedicine - Pathobiology; Biomedicine - Biomedical and
Laboratory Sciences; Clinical Laboratory Worker; Clinical Researcher; EMT-Paramedic/First responder; Extended Care Administrator;
Forensic Science; Genetics; Health Information Systems/Data Analysis; Health Policy/Law; Lactation Consultant; Long-Term Care
Administration; Occupational Therapy; Occupational Therapy – Occupational therapy assistant; Optometry; Pharmacy; Physical Therapy;
Physical Therapy – Physical therapy assistant; Radiologic Services; Respiratory Therapy; Speech/Language Pathology; Other (specify);
Pipeline Selection: Refer to all discipline selections above.

2012 BHPr Performance reporting

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Financial Support and Faculty Development Support

Table purpose: To describe how programs support faculty development and/or non-faculty trainees.
Instructions: Answer questions below for the reporting period.
Does your program provide direct BHPr financial support for non-faculty trainees and/or faculty in faculty development training? Yes / No
Does your program provide BHPr-funded faculty development training? Yes/No

2012 BHPr Performance reporting

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Table LR-1: Total Number of Trainees in BHPr-Funded Programs
Table purpose: To describe the total number of trainees in BHPr-funded programs by category of trainees. For purposes of BHPr reporting,
anyone receiving training or education in a BHPr-funded program is considered a trainee.

Category of Trainees

Number

Enrollees (Exclude Continuing Education trainees from this row)
Trainees who are newly enrolled and/or continuing the program or did not graduate from a health professions
programs.
Attrition (subset of Enrollees)
Trainees who left permanently without completing the training program
Fellowships and Residencies (Exclude Enrollees from this row)
Trainees who are newly enrolled and/or continuing fellowship and residencies program.
Graduating Trainees (Exclude Program Completers from this row)
Trainees who successfully completed all educational requirements for a specified academic program of study
culminating in a degree or diploma, or certificate as in a university, college, or health professions programs
during this reporting period.
Program Completers (Exclude Graduating Trainees from this row)
Trainees who successfully completed a non-degree course of study or training program that was less than 120
hours.
Trainees who successfully completed a non-degree course of study or training program that was equal to or
more than 120 hours.
Total
Continuing Education (Exclude all of the above)
Trainees who successfully completed a continuing education offering. Include trainees receiving a continuing
education offering that may or may not have received CEU/GME credit.

2012 BHPr Performance reporting

Auto-calculate

Page 12 of 287

Instructions: Enter the number of BHPr-funded program trainees per category in for the reporting period. Count each trainee only once. The
glossary contains clarifications and/or definitions of key terms. See 2012 Program- Trainee Category Matrix for delineation of program response
possibilities to LR-1 table.
Notes:
T91 THC- Grantees should include ALL residents in their program (i.e. THC –funded and non-funded residents).
D33/D5H and UD6 PMR grantees will report PMR graduates as completers for the purpose of BHPr reporting.
D87- Dental faculty loan repayment
 Program completers <120hrs – faculty program participant who did not complete the required annual service to the
institution.
 Program completers >120hrs – faculty program participant who did complete their required annual service to the institution
in order to be a loan repayment recipient.
LR-1 Trainee Category Matrix
Activity
Code

D54,
D5A

Program Name

Enrollees:
PreProfessional
(K undergraduate
education)

Academic
Administrative
Units in Primary
Care (AAU)

2012 BHPr Performance reporting

Enrollees:
Advanced
Degree &
Health
Professions
Programs
(after
Bachelors
education
and beyond)
X

Residencies
and
Fellowships

Graduating
Trainees
(Focus of
program is to
graduate)

Program
Completers
<120 hrs.

Program
Completers
>=120 hrs.

X

X

faculty

faculty

Continuing
Education

Page 13 of 287

Activity
Code

Program Name

A10

Advanced
Education Nurse
Traineeship
(AENT)
Advanced
Nursing
Education (ANE)
Advanced
Nursing
Education
Expansion
(ANEE)
Area Health
Education
Centers (AHEC)(Infrastructure
Development and
Point of Service
Maintenance and
Enhancement)
Centers of
Excellence
(COE)

D09

T57

U76,
U77

D34,
D3E

Enrollees:
PreProfessional
(K undergraduate
education)

2012 BHPr Performance reporting

Enrollees:
Advanced
Degree &
Health
Professions
Programs
(after
Bachelors
education
and beyond)
X

Residencies
and
Fellowships

Graduating
Trainees
(Focus of
program is to
graduate)

X

X

X

X

X

X

Program
Completers
>=120 hrs.

Continuing
Education

X

X

X

Program
Completers
<120 hrs.

X

faculty

X

X

X

X

X

X

Page 14 of 287

Activity
Code

Program Name

Enrollees:
PreProfessional
(K undergraduate
education)

D62

Comprehensive
Geriatric
Education
Programs
(CGEP)
Dental Faculty
Loan Repayment

X

D87,
D82

T88

Expansion of the
Physician
Assistant
Training (EPAT)
Programs

2012 BHPr Performance reporting

Enrollees:
Advanced
Degree &
Health
Professions
Programs
(after
Bachelors
education
and beyond)
X

Residencies
and
Fellowships

Graduating
Trainees
(Focus of
program is to
graduate)

Program
Completers
<120 hrs.

Program
Completers
>=120 hrs.

Continuing
Education

X

X

X

X

Faculty
program
participant
who did not
complete the
required
annual service
to the
institution.

Faculty
program
participant
who did
complete their
require annual
service to the
institution in
order to be a
loan repayment
recipient
faculty

X

X

X

faculty

Page 15 of 287

Activity
Code

Program Name

Enrollees:
PreProfessional
(K undergraduate
education)

D86

Faculty
Development in
General,
Pediatric, and
Public Health
Dentistry and
Dental Hygiene
(FDD)
Faculty
Development:
Integrated
Technology into
Nursing
Education and
Practice
Geriatric
Academic Career
Award (GACA)
Geriatric
Education
Centers (GEC)

X (Dental
Hygiene)

U1K

K01

UB4

2012 BHPr Performance reporting

Enrollees:
Advanced
Degree &
Health
Professions
Programs
(after
Bachelors
education
and beyond)
X

X

Residencies
and
Fellowships

Graduating
Trainees
(Focus of
program is to
graduate)

Program
Completers
<120 hrs.

Program
Completers
>=120 hrs.

X

X

X

X

X

X

X

X

faculty

Continuing
Education

X

Page 16 of 287

Activity
Code

Program Name

D01

Geriatric Training
Program for
Physicians,
Dentists, and
Behavioral and
Mental Health
Professions
(GTPD)
Graduate
Psychology
Education (GPE)
Health Careers
Opportunity
Program (HCOP)
Integrated
Medicine
Program
Interdisciplinary
and
Interprofessional
Joint Graduate
Degree Program

D40

D18,
D1H

UD6
T85,
T86

Enrollees:
PreProfessional
(K undergraduate
education)

2012 BHPr Performance reporting

X

Enrollees:
Advanced
Degree &
Health
Professions
Programs
(after
Bachelors
education
and beyond)
X

Residencies
and
Fellowships

X

Graduating
Trainees
(Focus of
program is to
graduate)

Program
Completers
<120 hrs.

Program
Completers
>=120 hrs.

X

X

X

X

X

X

X

X

X

X

Continuing
Education

X

X

faculty

faculty

Page 17 of 287

Activity
Code

Program Name

M01

Mental and
Behavioral
Health Education
and Training
Nurse Anesthetist
Traineeship
(NAT)
Nurse Faculty
Loan Program
(NFLP)
Nurse Managed
Health Clinics
(NMHC)
Nursing Assistant
and Home Health
Aide Program
(NAHHA)
Nursing
Education,
Practice, Quality,
and Retention
(NEPQR)

A22

E01,
E0A
T56

T51

D11

Enrollees:
PreProfessional
(K undergraduate
education)

2012 BHPr Performance reporting

Enrollees:
Advanced
Degree &
Health
Professions
Programs
(after
Bachelors
education
and beyond)
X

Residencies
and
Fellowships

Graduating
Trainees
(Focus of
program is to
graduate)

X

X

X

X

X

X

X

X

X

Program
Completers
<120 hrs.

Program
Completers
>=120 hrs.

Continuing
Education

X

X

X

X

X

X

X

X

X

X

Page 18 of 287

Activity
Code

Program Name

UD7

Nursing
Education,
Practice, Quality,
and Retention
(NEPQR) –IPCP
(NEPQR-IPCP)
Nursing
Workforce
Diversity (NWD)
Personal and
Home Health
Aide State
Training
(PHCAST)
Physician
Assistant
Training in
Primary Care
(PAT)
Physician Faculty
Development in
Primary Care
(PFD)

D19,
D1N
T82

D57,
D5B

D55,
D5C

Enrollees:
PreProfessional
(K undergraduate
education)

2012 BHPr Performance reporting

X

Enrollees:
Advanced
Degree &
Health
Professions
Programs
(after
Bachelors
education
and beyond)
X

Residencies
and
Fellowships

Graduating
Trainees
(Focus of
program is to
graduate)

Program
Completers
<120 hrs.

Program
Completers
>=120 hrs.

Continuing
Education

X

X

X

X

X

X

X

X

X

X

faculty

faculty

X

X

X

X

X

X

X

X

X

X

Page 19 of 287

Activity
Code

D88,
D84,
D13,
D5G

D85,
D83

D56,
D5D

D33,
D5H
R51,
T89

Program Name

Enrollees:
PreProfessional
(K undergraduate
education)

Post-doctoral
Training in
General,
Pediatric, and
Public Health
Dentistry (PDD)
Pre-doctoral
Training in
General,
Pediatric, and
Public Health
Dentistry and
Dental Hygiene
(PD)
Pre-doctoral
Training in
Primary Care
Preventive
Medicine
Residencies
(PMR)\
Primary Care
Residency
Expansion

2012 BHPr Performance reporting

Enrollees:
Advanced
Degree &
Health
Professions
Programs
(after
Bachelors
education
and beyond)

Residencies
and
Fellowships

Graduating
Trainees
(Focus of
program is to
graduate)

X

X (Dental
Hygiene)

X

X

X

X

Program
Completers
<120 hrs.

Program
Completers
>=120 hrs.

Continuing
Education

X

X

X

faculty

faculty

X

X

X

X

X

Page 20 of 287

Activity
Code

Program Name

Enrollees:
PreProfessional
(K undergraduate
education)

Enrollees:
Advanced
Degree &
Health
Professions
Programs
(after
Bachelors
education
and beyond)

Residencies
and
Fellowships

Graduating
Trainees
(Focus of
program is to
graduate)

Program
Completers
<120 hrs.

Program
Completers
>=120 hrs.

Continuing
Education

X

X

X

X

X

X

X

X

X

(PCRE)
A03,
A0A
UB6

D58,
D5F
T91

Public Health
Traineeships
(PHT)
Public Health
Training Centers
(PHTC)
Residency
Training in
Primary Care
Teaching Health
Centers (THC)

2012 BHPr Performance reporting

X

X

X

X

Page 21 of 287

Table LR-2: Trainee Age and Gender
Table purpose: To describe the age and gender of trainees and those completing or graduating from BHPr-funded programs.
Trainee Category- Males

Age

Trainee Category - Females

#
#
# Program
#
Total
#
#
# Program
#
Total
Enrollees Graduates Completers Fellowships (auto Enrollees Graduates Completers Fellowships (auto
and
calcul
and
calcula
Residencies ate)
Residencies
te)

Grand
Total
(Autocalculate)

Under 20
years
20-29
years
30-39
years
40-49
years
50-59
years
60 – 69
years
70 years or
older
Unknown
Total

2012 BHPr Performance reporting

Page 22 of 287

Instructions: Each row represents an age range category. For each age range complete each column as described below for the reporting period.
Count each trainee only once. The glossary contains clarifications and/or definitions of key terms.
Total (Trainee Category): The total number of trainees will calculate automatically.
Grand Total: The total number of trainees will calculate automatically.

2012 BHPr Performance reporting

Page 23 of 287

Table DV-1: Trainees by Ethnicity and Race
Table purpose: BHPr-supported programs will describe the ethnicity and race of all trainees by trainee category as reported in table LR-1.
DV-1a: Hispanic or Latino Ethnicity
Trainee Category
Race

# Enrollees

# Graduates

# Program
Completers

# Program
Completers

(<120 hours)

(>120 hours)

# Fellowships and Total by
Race
Residencies

American Indian or Alaska
Native
Asian
(not underrepresented)*
Asian (underrepresented)*
Black or African- American
Native Hawaiian or Other
Pacific Islander
White
Unknown
More Than One Race
Total
(Auto-calculate)
*For purposes of this reporting, “underrepresented Asian” refers to any Asian sub-population other than Chinese, Filipino, Japanese, Korean,
Asian Indian, or Thai.
2012 BHPr Performance reporting

Page 24 of 287

Instructions: Each row represents a race category for Hispanic or Latino ethnicity trainees. Complete each column in the row as described below
for the reporting period. Count each trainee only once. The glossary contains clarifications and/or definitions of key terms.
Number of Enrollees: Enter the number of Hispanic or Latino enrollees by race category.
Number of Graduates: Enter the number of Hispanic or Latino graduates by race category.
Number of Program Completers (< 120 hours): Enter the number of Hispanic or Latino trainees, by race category, which successfully
completed a non-degree course of study or training program that was less than 120 hours.
Number of Program Completers (≥ 120 hours): Enter the number of Hispanic or Latino trainees, by race category, which successfully
completed a non-degree course of study or training program that was greater than or equal to 120 hours.
Number of Fellowships and Residencies: Enter the number of Hispanic or Latino trainees, by race category, which are enrolled in a continuing
fellowship or residency program.
Total by Race: The total number of Hispanic or Latino trainees in each race category will calculate automatically.
Total: Total numbers of Hispanic or Latino trainees per trainee category will calculate automatically.

2012 BHPr Performance reporting

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DV-1-b: Non-Hispanic or Non-Latino Ethnicity
Trainee Category
# Enrollees
Race

# Graduates

# Program
Completers

# Program # Fellowships and
Residencies
Completers

(<120 hours)

(>120 hours)

Total by
Race

American Indian or
Alaska Native
Asian
(not underrepresented*)
Asian
(underrepresented*)
Black or AfricanAmerican
Native Hawaiian or Other
Pacific Islander
White
Unknown
Asian (not
underrepresented*) and
White
More Than One Race
Total
(Auto-calculate)
2012 BHPr Performance reporting

Page 26 of 287

* For purposes of this reporting, “underrepresented Asian” refers to any Asian sub-population other than Chinese, Filipino, Japanese, Korean,
Asian Indian, or Thai.

Instructions: Each row represents a race category for non-Hispanic or non-Latino trainees. Complete each column in the row as described below
for the reporting period. Count each trainee only once. The glossary contains clarifications and/or definitions of key terms.
Number of Enrollees: Enter the number of non-Hispanic or non-Latino enrollees by race category.
Number of Graduates: Enter the number of non-Hispanic or non-Latino graduates by race category.
Number of Program Completers (< 120 hours): Enter the number of non-Hispanic or non-Latino trainees, by race category, which successfully
completed a non-degree course of study or training program that was less than 120 hours.
Number of Program Completers (> 120 hours): Enter the number of non-Hispanic or non-Latino trainees, by race category, which successfully
completed a non-degree course of study or training program that was greater than or equal to 120 hours.
Number of Fellowships and Residencies: Enter the number of non-Hispanic or non-Latino trainees, by race category, which are enrolled in a
continuing fellowship or residency program.
Total by Race: The total number of non-Hispanic or non-Latino trainees in each race category will calculate automatically.
Total: Total numbers of non-Hispanic or non-Latino trainees per trainee category will calculate automatically.

2012 BHPr Performance reporting

Page 27 of 287

Table DV-2: Trainees with Disadvantaged Background
Table purpose: To describe the disadvantaged and underrepresented minority status of trainees in BHPr-supported programs as reported in table
LR-1.

Trainee Category
# Enrollees

# Graduates

# Program
Completers

# Program
Completers

(<120 hours)

(>120 hours)

# Fellowships
and Residencies

Total

Trainees with Disadvantaged
Background
Unknown Disadvantaged
Background
Underrepresented Minority
Trainees Reported in DV-1 Tables
Unduplicated Disadvantaged
Trainees (Trainees in row 1 and
who were not counted as URM in
row 3)
Disadvantaged and/or
Underrepresented Minority
Trainees (unduplicated)

Instructions: Complete the table as described below for the reporting period. For each row count each trainee only once. The glossary contains
clarifications and/or definitions of key terms.
2012 BHPr Performance reporting

Page 28 of 287

Trainees with Disadvantaged Backgrounds: Enter the number of disadvantaged background trainees for each Trainee Category.
Unknown Disadvantaged Background: Enter the number of trainees for each Trainee Category whose disadvantaged background status is
unknown
Underrepresented Minority Trainees Reported in DV-1 Tables: Pre-populated based on previous responses in DV-1a and DV-1b.
Unduplicated Number of Disadvantaged Trainees: Enter the unduplicated number of disadvantaged trainees. This is the number of trainees
counted in row 1 who were not counted as a URM in row 3.
Disadvantaged and/or Underrepresented Minority Trainees: Pre-populated based on previous responses.

2012 BHPr Performance reporting

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Table DV-3: Trainees by Residential Background
Table purpose: To describe the residential background (rural/urban/suburban/frontier) of trainees in BHPr-supported programs as reported in
table LR-1.

Trainee Category

# Enrollees

# Graduates

# Program
Completers

# Program
Completers

(<120 hours)

(>120 hours)

# Fellowships
and
Residencies

Total

Trainees with Rural background
Trainees with Urban background
Trainees with Suburban
background
Trainees with Frontier
background
Unknown
Total

Instructions: Complete the table for the reporting period. Count each trainee only once. The glossary contains clarifications and/or definitions of
key terms.
For PMR programs, trainees are Residents or Program Completers > 120 hours
2012 BHPr Performance reporting

Page 30 of 287

D. Cross Cutting and Program Specific Reporting

2012 BHPr Performance reporting

Page 31 of 287

Table N-1: Nursing Programs: Supply Indicators for
Table purpose: To provide information about the training offered by nursing programs that confer a degree and trainee experiences, including
average length of time for program completion.
N-1: Characteristics of Trainees
Degree
Program

Training Program

Role
(Select
one)

Specialty/D
iscipline

Population
Foci

Number of
Enrollees

FullTime

PartTime

Total Number of
Enrollees

Number of
URM
Enrollees

(Auto-calculated)

Number of
Number of
Disadvantaged Expanded
Enrollees
Nursing
Training
Positions

(Select
one per (Select one, if (Select all
applicable) that apply)
row)

Program Description (continuation of N-1)
Number of Faculty Members
Supported for Professional
Development
Total

URM Only

2012 BHPr Performance reporting

Average Number of Months to
Complete
the Program
FullTime

PartTime

Number of Graduates

Total

Number of Trainees Receiving
Clinical Training

URM Only

Page 32 of 287

Instructions: Each row represents one nursing training program. Complete each column as described below for the reporting period. Trainees not
receiving a degree will be counted in Table CE-1.The glossary contains clarifications and/or definitions of key terms.
Education/Degree Program Offered: Select the education/degree program offered by the program.
Selections: Diploma; Associate’s degree; Bachelor’s degree; Master’s degree; Post-master’s certificate; DNP; PhD/DNSc.
Complete the remaining table columns based on the training program role selection.
Training Program: For each training program, select the role and population foci.
Role: The roles should be mutually exclusive.
Selections for the registered nurse role include: BSN; CNL; Diploma; ADN; Trainees completing an AS;
Selections for the APRN roles include: Clinical nurse specialist; Nurse administrator; Nurse anesthetist; Nurse educator; Nurse
informaticist; Nurse midwife; Nurse practitioner; Public health nurse.
Select ‘N/A’ if role is not applicable.
Population Foci: Selections: Acute care adult-gerontology nurse practitioner; Acute-care pediatric nurse practitioner; Adult Gerontology;
Adult-Gerontology Primary Care Nurse Practitioner; Family Nurse Practitioner; Family/Individual Across Lifespan; Neonatal; Neonatal Nurse
Practitioner; Pediatric Primary Care Nurse Practitioner; Pediatrics; Psychiatric/Mental Health Nurse ; Practitioner; Women’s Health/Gender
Related And Psychiatric Mental Health; Women’s Health/Gender-Related Nurse Practitioner.
Specialty/ Discipline:
Nursing Selections: Ambulatory care; Cardiac rehabilitation; Cardiovascular; Case management; College health; Critical care;
Emergency; Environmental health; Forensics; Gastroenterology; Genetics; HIV/AIDS; Home health; Hospice; Infectious disease; Longterm care; Occupational health; Oncology; Pain management; Palliative care; Perinatal; Public health; Public policy; Rehabilitation;
Renal/nephrology; School health.
Non-Nursing Selections:
2012 BHPr Performance reporting

Page 33 of 287

General Dentistry;
Medicine Selections: Alternative/Complementary Medicine; Behavioral/Mental Health In School Of Medicine And Osteopathic
Medicine; Family Medicine; General Internal Medicine; General Pediatrics; General Preventive Medicine;
Obstetrics/Gynecology/Women’s Health;
Physician assistant;
Pharmacy;
Behavioral Health Selection: Professional Behavioral/Mental Health Counseling; Psychology; Social Work; Substance Abuse
Counseling;
Public Health: Community Health Worker; Health Education/Behavior; Public Health (General Studies);
Other
Select ‘N/A’ if Specialty/Discipline is not applicable.
Number of Enrollees: The number of enrollees by student status. Count trainees only once.
Number of Full-Time: Enter the number of full-time enrollees, as defined by the institution.
Number of Part-Time: Enter the number of part-time enrollees, as defined by the institution.
Total Number of Enrollees: The total number of enrollees will calculate automatically based on data entered from the previous columns.
Number of URM Enrollees Of the total number of enrollees, enter the number of underrepresented minorities.
Number of Disadvantaged: Of the total number of enrollees, enter the number of disadvantaged enrollees.
Number of Expanded Nursing Training Positions: Of the total number of enrollees, enter the number of positions expanded through this grant.

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Number of Faculty Members Supported for Professional Development: Enter the total number of faculty who received support to attend
professional development activities, including continuing education activities, workshops, and seminars (only ANE program).
Number of URM Faculty Members Supported for Professional Development: Of the total number of faculty reported above, enter the number
of underrepresented minority (URM) faculty.
Average Number of Months to Complete the Program: Enter the average number of months for trainees to complete the program. Calculation:
Add the number of months attended by all trainees who completed the program during the reporting period and divide by the number of trainees
who completed the program during the reporting period. Calculate the average for full-time trainees and part-time trainees.
Number of Graduates: Enter the total number of program graduates who completed the program.
Number of URM Graduates: Of the total number of program graduates reported above, enter the number of URM graduates who completed the
program.
Number of Trainees Receiving Clinical Training: Enter number of trainees who received clinical training.

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Table PY-1: Prior Year Completers and Graduates
Table purpose: To describe the training experiences and outcomes of previous graduates, including subsequent employment in underserved areas
and primary care.
Health Profession: (Select one)
Discipline: (Select all that apply)
Degree Obtained: (Select all that apply)
Year
Nursing Training
Graduate Program
d/
Completio (Nursing Only)
n
Role
Populatio
n Foci
(ANE,
AENT, (ANE,
NAT, AENT,
NFLP, NAT,
NEPQ NFLP,
R,
NEPQR,
NWD) NWD)
(Select
one)

Total #
of
Program
Graduat
es

(Select
one)

Total # of
Completers w
ho Received a
Degree or
Diploma

# of Program
Graduates/Complet
ers Who Passed the
Profession-Specific
Certifying Exam or
Boards
(exclude AHEC,
HCOP)

Graduate
s/
Complete
rs
Working
in MUC
or Dental
HPSA
(exclude
AHEC,
HCOP)

# of
URM
Graduate
s/

# of
Program
Graduate
s/

# of
Program
Graduate
s/

# of
Program
Graduate
s/

Complete
rs
Working
in MUC
or Dental
HPSA

Complete
rs
Working
in Rural
Areas

Complete
rs
Working
in
Primary
Care

Complete
rs
Employed
as Faculty

(exclude
AHEC,
HCOP)

(exclude
AHEC,
HCOP)

(exclude
AHEC,
HCOP)

(exclude
AHEC,
HCOP)

2010-2011
2009-2010
2008-2009
2007-2008
2006-2007
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Continuation of PY-1:
# Program
Graduates
Accepted
into Primary
Care
Residency
(Predoctoral
Training in
Primary
Care, AAU,
Joint
Degree)

#
Graduates/Co
mpleters
Accepted into
Health
Professions
Program

# Graduates per Employment Site
(PHT, PMR)
Academia

City/County
Government

Communitybased
organization/
nonprofit

Federal
Government

Hospitals

Private
Industry

State
Govern
ment

Unknown

Other

(AHEC,
HCOP, NWD)

Other
Employment Site
Type

# Employed in
Field of Study

(required if #
Graduates for
Other is provided)

Faculty Level of Teaching
(ANE, AENT, NAT, NFLP, NEPQR, NWD)
Two-Year College Undergraduate
-Level

Graduate-Level

(PHT, PMR)

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Instructions: Complete the table per health profession/discipline/degree combination as described below for each of the five prior academic years.
The glossary contains clarifications and/or definitions of key terms.
AHEC Instructions: This table is applicable only for participants in health careers enrichment/training activities.
Health Profession:
Selections: Dentist; Medicine; Physician Assistant; Nursing; Behavioral Health/Public Health/Other
HCOP Program: Dentist; Medicine; Physician Assistant; Nursing; Behavioral Health/Public Health/Other; Pipeline
Discipline:
For Pre-doctoral Training in Primary Care, Interdisciplinary and Interprofessional Joint Graduate Degree Program, Expansion of the
Physician Assistant Training (EPAT) Program, and Physician Assistant Training in Primary Care (PAT) programs, discipline is not
applicable.
For AHEC Program, select Not Applicable (N/A) if discipline is not applicable.
Dentist Selections: FELLOWSHIP AND RESIDENCY PROGRAMS: Advanced Education In General Dentistry - AEGD 12 month
program (include optional 2nd year); AEGD 24 month program; Dental Public Health - DPH 12 month program-; DPH 24 month
program ; General Practice Residency - GPR 12 month program (include optional 2nd year); GPR 24 month program; Geriatric
Dentistry; Pediatric Dentistry (24 months);
OTHER PROGRAMS: Dental Assistant; Dental Hygiene; General Dentistry; Pediatric Dentistry; MPH year-General Dentistry
(Master's in Public Health); MPH year-Pediatric Dentistry; MPH year-Public Health Dentistry; MPH year-Dental Hygiene, Public Health
Dentistry; Other (specify)
Medicine Selections: Aerospace Medicine; Allopathic Medicine, Alternative/Complementary Medicine; Behavioral/Mental Health In
School Of Medicine And Osteopathic Medicine; Chiropractic; Family Medicine; General Internal Medicine; General Pediatrics; General
Preventive Medicine; General Preventive Medicine/ Family Medicine; General Preventive Medicine/ Internal Medicine; General
Preventive Medicine/ Public Health; Geriatric Medicine; Geriatric Psychiatry; Integrative Medicine; Internal Medicine /General
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Pediatrics; Internal Medicine/Family Medicine; Neurology; Obstetrics/Gynecology; Occupational Medicine; Osteopathic General
Practice; Pediatrics/Family Medicine; Pharmacy, Podiatry; Psychiatry; Radiology; Veterinary Medicine;
Physician assistants: Disciplines are not applicable (N/A).
Nursing: Alternative/Complementary Nursing; CNS-Adult gerontology; CNS-Family; CNS-Geropsychiatric; CNS-Neonatal; CNSPediatrics; CNS-Psychiatric/Mental health; CNS-Women’s health; Clinical Nurse Specialist (CNS); Home Health Aide; Licensed
Practical/Vocational Nurse (LPN/LVN); NP - Other advanced nurse specialists; NP - Psychiatric/Mental health; NP –Adult gerontology;
NP –Family; NP –Neonatal; NP –Pediatrics; NP –Women’s health; NP- Acute care adult gerontology; NP- Acute care pediatric; NPEmergency care; NP- Geropsychiatric; Nurse Administrator; Nurse Anesthetist; Nurse Assistant/Patient Care Associate (PCA); Nurse
Educator; Nurse Generalist; Nurse Midwife; Nurse Practitioner (NP); Nurse Researchers/Scientists; Nursing Informatics; Public Health
Nurse; Registered Nurse; Registered Nurse Student; Other (specify);
Behavioral Health/Public Health/Other Selections:
Behavioral Health Selection: Counseling Psychology; Clinical Psychology; Clinical Social Work;; Marriage and Family Therapy;
Pastoral/Spiritual Care; Other Psychology; Other Social Work, Substance Abuse/Addictions Counseling; Other (specify);
Public Health: Biostatistics; Biostatistics – Biometry; Community Health Worker Environmental Health; Environmental Health –
Environmental chemistry; Environmental Health – Environmental health planning; Environmental Health – Environmental sciences;
Environmental Health – Industrial hygiene; Environmental Health – Occupational safety and health; Environmental Health – Radiological
health; Environmental Health – Toxicology; Environmental Health – Water quality; Epidemiology; Geriatrics/Aging Populations
Global/International Health; Global/International Health – Tropical medicine; Health Education/Behavior; Health Education/Behavior –
Behavioral sciences; Health Education/Behavior – Community health sciences; Health Education/Behavior – Evaluation research; Health
Education/Behavior – Health behavior; Health Education/Behavior – Health promotion/disease prevention; Health Services Research;
Health Services/Hospital Administration; Health Services/Hospital Administration – Health management; Health Services/Hospital
Administration – Health planning; Health Services/Hospital Administration – Hospital administration; Maternal & Child Health; Maternal
& Child Health – Adolescent health; Maternal & Child Health – Infant and child health; Maternal & Child Health – Women’s health;
Nutrition; Nutrition – Dietetics; Nutrition – Public health nutrition; Occupational Health; Public Health (General Studies); Public Health
Practice; Public Health Practice – Community health practice; Public Health Practice – Program management; Urban Health; Veterinary
Science – Veterinary public health; Other (specify);

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Other: Audiology; Bio-Engineering; Biomedicine; Biomedicine - Biochemistry; Biomedicine - Cancer biology; Biomedicine Immunology; Biomedicine - Microbiology; Biomedicine - Parasitology; Biomedicine - Pathobiology; Biomedicine - Biomedical and
Laboratory Sciences; Clinical Laboratory Worker; Clinical Researcher; EMT-Paramedic/First responder; Extended Care Administrator;
Forensic Science; Genetics; Health Information Systems/Data Analysis; Health Policy/Law; Lactation Consultant; Long-Term Care
Administration; Occupational Therapy; Occupational Therapy – Occupational therapy assistant; Optometry; Pharmacy; Physical Therapy;
Physical Therapy – Physical therapy assistant; Radiologic Services; Respiratory Therapy; Speech/Language Pathology; Other (specify);
Pipeline Selection: Refer to all discipline selections above.
Education/Degree Obtained:
Selections: Grades K-6; Grades 7-8; Grades 9-12; Post-high school/pre-college; Certificate; Two-year college/community college;
Associates; Diploma (Nursing); Four-year college; Bachelors; Twelve-month post-baccalaureate; Pre-matriculation/pre-graduate school; Masters
(MHA, MS, MSN, MSW, MPH, MSPH); Post-Masters Certificate; Doctorate (PhD, DNP, DNSc; DC, DPT); Post-Doctorate; Resident; Fellow;
Faculty member; Post-graduate; Medicine Doctor (M.D.); Doctor of Osteopathy (D.O.); Doctor of Dental Surgery (D.D.S., D.M.D.); Doctor of
Pharmacy (Pharm.D.); Doctor of Veterinary Medicine (D.V.M.); Doctor of Psychology (Psy.D.); Doctor of Public Health (Dr.P.H.), ScD (Doctor
of Science), Doctor of Veterinary Medicine (D.V.M. or V.M.D.), Adult learner; Dislocated worker; Other.
Nursing Training Programs (Nursing programs only) (pre-populated after first year of data collected): For each program, enter the role and
population foci.
Role:
Selections for the registered nurse role include: BSN; CNL; Diploma; ADN; Trainees completing an AS;
Selections for the APRN roles include: Clinical nurse specialist; Nurse administrator; Nurse anesthetist; Nurse educator; Nurse
informaticist; Nurse midwife; Nurse practitioner; Public health nurse.
Select ‘N/A’ if role is not applicable.
Population Foci: Selections: Acute care adult-gerontology nurse practitioner; Acute-care pediatric nurse practitioner; Adult Gerontology;
Adult-Gerontology Primary Care Nurse Practitioner; Family Nurse Practitioner; Family/Individual Across Lifespan; Neonatal; Neonatal Nurse
Practitioner; Pediatric Primary Care Nurse Practitioner; Pediatrics; Psychiatric/Mental Health Nurse ; Practitioner; Women’s Health/Gender
Related And Psychiatric Mental Health; Women’s Health/Gender-Related Nurse Practitioner.
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Total Number of Program Graduates (pre-populated after first year of data collected): Enter the number of graduates.
Total Number of Program Completers who Received a Degree or Diploma (pre-populated after first year of data collected): Enter the
number of program completers
Total Number of Program Graduates/Completers Who Passed the Profession-Specific Certifying Exam (exclude AHEC and HCOP
programs): Enter the number of graduates/ program completers who passed the profession-specific certifying exam.
Physician Selections: United States Medical Licensing Exam (USMLE) Step 1, Step 2, and Step 3.
Physician Assistant Selection: Physician Assistant National Certifying Exam (PANCE).
Dentists: (N/A)
Nursing: National Council Licensure Examination (NCLEX). This column applies to NEPQR and NWD programs.
Allied Health/GTPD: Certificate of Added Qualifications
Number of Program Graduates/Completers Working in Medically Underserved Communities (MUC) or Dental HPSA (exclude AHEC
and HCOP programs): Enter the total number of graduates/ program completers who work in MUC or Dental HPSA.
Number of URM Program Graduates/Completers Working in Medically Underserved Communities (MUC) or Dental HPSA (exclude
AHEC and HCOP programs): Enter the number of URM graduates/ program completers who work in an MUC or Dental HPSA. (Subset of total
number from above)
Number of Program Graduates/Completers Working in Rural Areas (exclude AHEC and HCOP programs): Enter the number of
graduates/ program completers who work in rural areas.
Number of Program Graduates/Completers Working in Primary Care (exclude AHEC and HCOP programs): Enter the number of
graduates/ program completers who work in primary care.
Number of Program Graduates/Completers Employed as Faculty (exclude AHEC and HCOP programs): Enter the number of graduates/
program completers employed as faculty members.

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Number of Program Graduates Accepted into Primary Care Residency (Pre-doctoral Training in Primary Care, AAU, and Joint Degree
programs only): Enter the number of graduates entering a residency program as a post-graduate year one (PGY 1) for the following disciplines:
combine internal medicine-family medicine; combined internal medicine-pediatrics; family medicine; general pediatrics; internal medicine.
Number of Graduates/Completers Accepted into Health Professions Program (HCOP, NWD, AHEC programs only): Enter the total
number of graduates/program completers from each of the prior academic years who were accepted in a health professions program. Health
professions programs include : Allopathic medicine; Chiropractic; Clinical psychology; Clinical social work Community health worker; Dental
hygiene; General dentistry; Epidemiology; First responder (EMP, paramedic, fire rescue, HazMat); Health administration; Health education;
Health information systems/data analysis; Home health aide; Marriage and family therapy; Medical assistant; Nurse; Nurse midwife; Nurse
practitioner; Nutrition; Occupational health; Optometry; Osteopathic medicine; Pharmacy; Physical therapy; Physician assistant; Podiatry;
Professional counseling; Psychiatry; Psychology; Public health; Social work; Veterinary medicine; other.
Graduates per Employment Site (PHT, PMR programs only): For each Academic Year and Degree Discipline, indicate the number of
graduates for each employment site. Employment site selections are Academia; Federal government; State government; City/county government;
Hospitals; Community-based organization/nonprofit; Private industry; Unknown; Other.
Other Employment Site Type (PHT, PMR programs only): If number of graduates is provided for ‘Other’ employment site, enter employment
site type.
Number Employed in Field of Study: Enter the number of graduates/program completers from the previous academic years employed in the
field of study.
Faculty Level of Teaching (ANE, AENT, NAT, NEPQR, NFLP, and NWD programs only): For those employed as faculty, identify the level
of teaching and enter the number of faculty in each teaching level: Two-year College; undergraduate-level; graduate-level.

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Table PC-1 (1a.1, 1a.2): Primary Care: Program Level Supply Indicators
Table purpose: To provide information on the capacity of programs with primary care focus and trainee experiences, including program
completion and outcomes.
PC-1a.1: Description of Training Program and Graduates
Health Profession: (Select one)
Primary Care Focus: (Select one)
Trainee Level: (Select one)
Trainee Level-Specific Program Focus: (Select one)

Health Primary
Profession Care
Focus

Trainee
Level

Trainee Degree Primary Secondary Discipline # of Positions
Total # of Total # of Number
Level- Offered Degree
Degree
Offered/Recruited Program
URM
of
Specific
Focus
Focus
Graduates Program Trainees
Program
Area
Area
Graduates Receiving
(Select all
Focus
Clinical
(Select (Select
that
(Select
Training
all that
apply)
one)
one, if
apply)
applicable)

populated populated populated populated

Instructions: Complete each column as described below for the reporting period. Health Profession and Discipline selection values are populated
from the Health Profession and Disciplines – Setup form. The selection made in the Health Profession column will prompt selections in the
Primary Program Focus and Trainee Level columns. All other columns in the table must be answered for each trainee level. Count each trainee
only once. The glossary contains clarifications and/or definitions of key terms.
2012 BHPr Performance reporting
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Health Profession:
Selections: Dentist; Medicine; Physician Assistant.
Primary Care Focus:
Medicine and Dentist Selections: Academic department infrastructure development; Academic faculty training; Faculty training program
infrastructure development; Graduate medical education; Medical school infrastructure development; Public health; Residency program
infrastructure development; Residency training community; Undergraduate medical education; faculty training;
Physician Assistant Selections: Physician Assistant education program curriculum development, Physician assistant education program
infrastructure development
Trainee Level:
Physician and Dentist Selections: Fellow; Medical student; Physician- academic; Physician-community; Physician-resident; Resident;
Physician Assistant Selections: Physician Assistant - academic; Physician Assistant - community; Physician Assistant-student; Physician
Assistant-Resident.
For the purposes of this reporting, a physician or physician assistant –“community” is a provider working in a setting other than an academic
department (e.g., community preceptor). ‘Physician or physician assistant – “academic” is a provider working primarily in an academic
department or unit (e.g., medical school, physician assistant training program, residency program, department of pediatrics).
Trainee Level-Specific Program Focus:
Selections: Clinical skills; Educator skills; Graduate medical education; Graduate –Physician Assistant.; Leadership/administrative skills;
Public health; Research; Undergraduate medical education; Undergraduate – Physician Assistant;
All other columns in the table must be answered for each trainee level.
Degree Offered: Selections:
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Medicine: Fellow; MD; DO; Resident; MD/MPH; DO/MPH; MD/MSPH; DO/MSPH; MD/DRPH; DO/DRPH; MD/EdD; DO/EdD;
MD/MS; DO/MS; MD/ScD; DO/ScD; PhD.
For Interdisciplinary and Interprofessional Joint Graduate Degree Program: DO; DO/MSPH; DO/DRPH; DO/EdD;
DO/MS; DO/ScD; DO/PhD; Fellow; DO/MPH; MD/MPH; MD/MSPH; MD/DRPH; MD/EdD; MD/MS; MD/ScD; PhD;
MD/PhD; MD; Resident, DO/MHS, DO/MPP, DO/ScM, MD/MHS, MD/MPP, MD/ScM
Physician assistants: Associate’s degree; Bachelor’s degree; Master’s degree (MPAS, MSPAS,); Doctoral degree; MPAS/MPH
(physician assistant); MPAS/MS (physician assistant); MPAS/MMS (physician assistant); MPAS/DrPH; MPAS/PhD; DHSc/MPH; DrPH;
ScD
Dentists: DDS; Faculty member; Resident.
Primary Degree Focus Area: Selections: MD, DO, MSPAS, MPAS, MHS, MPP, ScM, MSPH, MPH Biostatistics; Community health education;
Disease Prevention and Health Promotion; Education/leadership; Environmental health science; Epidemiology; Health policy and management;
Infectious Diseases; Injury Control; Maternal and child health; Medical science; Pharmacotherapeutics; Public health administration and policy;
Social and behavioral sciences.
Secondary Degree Focus Area: Selections: Doctor of Medicine, Doctor of Osteopathy, Doctor of Dental Surgery, Doctor of Dental Medicine,
Master of Health Sciences, Master in Public Policy, Master of Science, Master of Science in Public Health, Master of Public Health,
Communication and informatics; Diversity and culture; Leadership; Professionalism; Program planning; Public health biology; Systems thinking;
Expansion of the Physician Assistant Training (EPAT) Program and Physician Assistant Training in Primary Care (PAT)
programs: Selections: Master of Physician Assistant Studies, Master of Science in Physician Assistant Studies, Physician Assistant
Communication and informatics; Diversity and culture; Leadership; Professionalism; Program planning; Public health biology; Systems
thinking
Discipline:
For Pre-doctoral Training in Primary Care, Interdisciplinary and Interprofessional Joint Graduate Degree Program, Expansion of the
Physician Assistant Training (EPAT) Program, and Physician Assistant Training in Primary Care (PAT) programs, discipline is not
applicable.
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Dentist Selections: FELLOWSHIP AND RESIDENCY PROGRAMS: Advanced Education In General Dentistry - AEGD 12 month
program (include optional 2nd year); AEGD 24 month program; Dental Public Health - DPH 12 month program; DPH 24 month program;
General Practice Residency - GPR 12 month program (include optional 2nd year); GPR 24 month program; Geriatric Dentistry; Pediatric
Dentistry (24 months);
OTHER PROGRAMS: Dental Assistant; Dental Hygiene; General Dentistry; Pediatric Dentistry; MPH year-General Dentistry
(Master's in Public Health); MPH year-Pediatric Dentistry; MPH year-Public Health Dentistry; MPH year-Dental Hygiene, Public Health
Dentistry; Other (specify)
Medicine Selections: Aerospace Medicine; Allopathic Medicine, Alternative/Complementary Medicine; Behavioral/Mental Health In
School Of Medicine And Osteopathic Medicine; Chiropractic; Family Medicine; General Internal Medicine; General Pediatrics; General
Preventive Medicine; General Preventive Medicine/ Family Medicine; General Preventive Medicine/ Internal Medicine; General
Preventive Medicine/ Public Health; Geriatric Medicine; Geriatric Psychiatry; Integrative Medicine; Internal Medicine /General
Pediatrics; Internal Medicine/Family Medicine; Neurology; Obstetrics/Gynecology; Occupational Medicine; Osteopathic General
Practice; Pediatrics/Family Medicine; Pharmacy, Podiatry; Psychiatry; Radiology; Veterinary Medicine;
Physician assistants: Disciplines are not applicable (N/A).
Number of Positions Offered or Recruited: Enter the number of residency positions or student and trainee positions offered or recruited for the
training year.
Total Number of Program Graduates: Enter the number of program graduates.
Total Number of URM Program Graduates: Enter the number of URM program graduates.
Number of Trainees Receiving Clinical Training: Enter number of trainees who received clinical training.

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PC-1a.2: Description of Enrollment and Outcomes
Health primar Trainee Trainee Training
Profession y Care Level LevelYear
Focus
Specific
Progra
m
(Select
Focus
one)

Total # of # of Expanded # of FTEs by
# of
# of FTEs Attritio
Filled
Positions
Training Year URM
Receiving
n by
Positions
Added by
FTEs by
BHPrTrainin
by
Training Year
Trainin Financial
g Year
Training
g Year Assistance
Year
(by training
year)

Attrition
Among
URMs by
Training
Year

Prepopulat Prepopu Prepopu Prepopu
ed from
lated
lated
lated
PC-1a.1
from
from
from
PC-1a.1 PC-1a.1 PC-1a.1

Instructions: This table is continued from table PC-1a.1. All other columns in the table must be answered for each trainee level.
Complete each column as described below for the reporting period. The glossary contains clarifications and/or definitions of key terms.
Training Year: Select training year 1, 2, 3, or 4.
Total Number of Filled Positions by Training Year: Enter the total number of filled positions by the training year (i.e., Training year 1, 2, 3,
etc.). Count each trainee only once
Number of Expanded Positions Added by Training Year: Enter the number of expanded positions that were added to the program by training
year (i.e., Training year 1, 2, 3, etc.). The baseline is the number of positions from the prior year.
Number of FTEs by Training Year: Enter the number of full time equivalents by training year (i.e., Training year 1, 2, 3, etc.). For physician
assistant programs, enter the number of trainees by training year. Count each trainee only once

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Number of URM FTEs by Training Year: Of the total from above, enter the number of underrepresented minority (URM) full-time equivalents
in the program by training year (i.e., Training year 1, 2, 3, etc.). For physician assistant programs, enter the number of URM trainees by training
year.
Number of FTEs Receiving BHPr Financial Assistance: Of the FTE total from above, enter the number of full-time equivalents who were
supported by BHPr in the program by training year (i.e., Training year 1, 2, 3, etc.). For the purposes of this reporting, financial assistance includes
tuition, fees, stipends and other trainee-related costs covered by the grant.
Attrition by Training Year: Enter the number of trainees who permanently left the program before completing the training year.
Attrition among URMs by Training Year: Enter the number of URM trainees who permanently left the program before completing the training
year.

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Table PC-R: Primary Care Curriculum Content
Table purpose: To capture the characteristics of the training curriculum in primary care programs and how the content was delivered to trainees.

Required

Training Content Area

Research

Didactic

Elective

Experiential

Research

Didactic

Experiential

Curriculum Content
Chronic disease management
Community outreach/service learning
Comprehensiveness of care
Continuity in care
Coordination of care
Cultural competency
First contact care
Health literacy

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Required

Training Content Area

Research

Didactic

Elective

Experiential

Research

Didactic

Experiential

Health promotion and disease prevention
HIV/AIDS
Informatics
Interprofessional integrated models of care
Minority health issues
Person-focused continuous care
Patient-centered medical homes
Public health
Quality improvement and patient safety
Research techniques
Team-based care
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Required

Training Content Area

Research

Didactic

Elective

Experiential

Research

Didactic

Experiential

Other (Specify)
Teaching Strategies
Curriculum Development
Grant Writing
Leadership Development
Mentoring Techniques
Peer Teaching
Other (Specify)

Instructions: Complete each column for the appropriate content area as described below for the reporting period. The glossary contains
clarification and/or definitions of key terms. (Complete a separate table per discipline selected in the Health Profession and Discipline - Setup
form.)

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The Training Content Area column is a list of curriculum content that the program might focus on. In subsequent columns grantees can select how
the content was delivered. Only respond to content areas in which you can provide additional documentation and you could highlight during a site
visit from the agency. For all selected items, grantees must provide more detail in the progress or final report.
Required or Elective: Indicate if the training was required or elective using the following definitions: (1) Training in a required content area is
necessary for a trainee to complete the training program; and (2) Training in an elective content area is encouraged for trainees but is not a
requirement to complete the training program.
Mode: Indicate the mode of delivery for the appropriate content areas. Selections: didactic; experiential; research. Use the following definitions
to make this determination: (1) training should be considered didactic if it involves traditional classroom or virtual education forums wherein
trainees receive instruction from a designated faculty members and/or clinicians; (2) experiential training encompasses the wide array of clinical or
field experience during which trainees are supervised in practice; and (3) research training generally involves the supervision of trainees in
conducting studies in clinical and/or academic environments. Such training may involve literature reviews, development of data collection
protocols, data collection, data analysis, results interpretation, and/or the dissemination of research findings.

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Table R-1 (1a, 1b): Residency Programs: Program Level Supply Indicators
Table purpose: To provide information on the capacity of residency programs and trainee experiences, including program completion and trainee
outcomes.
R-1a: Program and Completers Description
General Program Information

Health Profession

Residency Discipline/
Type

Newly-Accredited
Residency Program

Partners/ Leveraging/
Collaborative

(Select one)

(Y/N)

(Select all that apply)

Total # of Residency Completers

(Select one)

Instructions: Complete each column as described below for the reporting period. Health Profession and Residency Discipline/Type values are
populated from the Health Profession and Disciplines – Setup form. The selection made in the Health Profession column will prompt selections in
the Residency Discipline/Type column. All other columns in the table must be answered for each residency discipline/type. Add additional rows if
you have multiple residency discipline/types in your program. The glossary contains clarifications and/or definitions of key terms.
Notes:
T91 THC- Grantees should include ALL residents in their program (i.e. THC –funded and non-funded residents).
D33/D5H and UD6 PMR grantees will report PMR graduates as completers for the purpose of BHPr reporting.

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General Program Information:
Health Profession:
Selections: Dentist; Medicine; Physician Assistant; Nursing; Behavioral Health/Public Health/Other;
Residency Discipline/Type:
Dentist Selections: FELLOWSHIP AND RESIDENCY PROGRAMS: Advanced Education In General Dentistry - AEGD 12 month
program (include optional 2nd year); AEGD 24 month program; Dental Public Health - DPH 12 month program; DPH 24 month
program; General Practice Residency - GPR 12 month program (include optional 2nd year); GPR 24 month program; Geriatric Dentistry;
Pediatric Dentistry (24 months);
OTHER PROGRAMS: Dental Assistant; Dental Hygiene; General Dentistry; Pediatric Dentistry; MPH year-General Dentistry
(Master's in Public Health); MPH year-Pediatric Dentistry; MPH year-Public Health Dentistry; MPH year-Dental Hygiene, Public Health
Dentistry; Other (specify)
Medicine Selections: Aerospace Medicine; Allopathic Medicine, Alternative/Complementary Medicine; Behavioral/Mental Health In
School Of Medicine And Osteopathic Medicine; Chiropractic; Family Medicine; General Internal Medicine; General Pediatrics; General
Preventive Medicine; General Preventive Medicine/ Family Medicine; General Preventive Medicine/ Internal Medicine; General
Preventive Medicine/ Public Health; Geriatric Medicine; Geriatric Psychiatry; Integrative Medicine; Internal Medicine /General
Pediatrics; Internal Medicine/Family Medicine; Neurology; Obstetrics/Gynecology; Occupational Medicine; Osteopathic General
Practice; Pediatrics/Family Medicine; Pharmacy, Podiatry; Psychiatry; Radiology; Veterinary Medicine;
Physician assistants: Disciplines are not applicable (N/A).
Nursing: Alternative/Complementary Nursing; CNS-Adult gerontology; CNS-Family; CNS-Geropsychiatric; CNS-Neonatal; CNSPediatrics; CNS-Psychiatric/Mental health; CNS-Women’s health; Clinical Nurse Specialist (CNS); Home Health Aide; Licensed
Practical/Vocational Nurse (LPN/LVN); NP - Other advanced nurse specialists; NP - Psychiatric/Mental health; NP –Adult gerontology;
NP –Family; NP –Neonatal; NP –Pediatrics; NP –Women’s health; NP- Acute care adult gerontology; NP- Acute care pediatric; NPEmergency care; NP- Geropsychiatric; Nurse Administrator; Nurse Anesthetist; Nurse Assistant/Patient Care Associate (PCA); Nurse
2012 BHPr Performance reporting
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Educator; Nurse Generalist; Nurse Midwife; Nurse Practitioner (NP); Nurse Researchers/Scientists; Nursing Informatics; Public Health
Nurse; Registered Nurse; Registered Nurse Student; Other (specify);
Behavioral Health/Public Health/Other Selections:
Behavioral Health Selection: Counseling Psychology; Clinical Psychology; Clinical Social Work;; Marriage and Family Therapy;
Pastoral/Spiritual Care; Other Psychology; Other Social Work, Substance Abuse/Addictions Counseling; Other (specify);
Public Health: Biostatistics; Biostatistics – Biometry; Community Health Worker Environmental Health; Environmental Health –
Environmental chemistry; Environmental Health – Environmental health planning; Environmental Health – Environmental sciences;
Environmental Health – Industrial hygiene; Environmental Health – Occupational safety and health; Environmental Health – Radiological
health; Environmental Health – Toxicology; Environmental Health – Water quality; Epidemiology; Geriatrics/Aging Populations
Global/International Health; Global/International Health – Tropical medicine; Health Education/Behavior; Health Education/Behavior –
Behavioral sciences; Health Education/Behavior – Community health sciences; Health Education/Behavior – Evaluation research; Health
Education/Behavior – Health behavior; Health Education/Behavior – Health promotion/disease prevention; Health Services Research;
Health Services/Hospital Administration; Health Services/Hospital Administration – Health management; Health Services/Hospital
Administration – Health planning; Health Services/Hospital Administration – Hospital administration; Maternal & Child Health; Maternal
& Child Health – Adolescent health; Maternal & Child Health – Infant and child health; Maternal & Child Health – Women’s health;
Nutrition; Nutrition – Dietetics; Nutrition – Public health nutrition; Occupational Health; Public Health (General Studies); Public Health
Practice; Public Health Practice – Community health practice; Public Health Practice – Program management; Urban Health; Veterinary
Science – Veterinary public health; Other (specify);
Other: Audiology; Bio-Engineering; Biomedicine; Biomedicine - Biochemistry; Biomedicine - Cancer biology; Biomedicine Immunology; Biomedicine - Microbiology; Biomedicine - Parasitology; Biomedicine - Pathobiology; Biomedicine - Biomedical and
Laboratory Sciences; Clinical Laboratory Worker; Clinical Researcher; EMT-Paramedic/First responder; Extended Care Administrator;
Forensic Science; Genetics; Health Information Systems/Data Analysis; Health Policy/Law; Lactation Consultant; Long-Term Care
Administration; Occupational Therapy; Occupational Therapy – Occupational therapy assistant; Optometry; Pharmacy; Physical Therapy;
Physical Therapy – Physical therapy assistant; Radiologic Services; Respiratory Therapy; Speech/Language Pathology; Other (specify);
Newly-Accredited Residency Program during the Reporting Period: Indicate if the program is newly accredited by the Accreditation Council
for Graduate Medical Education (ACGME), the American Osteopathic Association (AOA), or the Council on Dental Accreditation (CoDA) (‘Yes’
or ‘No’). Do not indicate programs that were re-accredited or accredited prior to the reporting period.
2012 BHPr Performance reporting
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Partners/Leveraging/Collaborative: Select each type of organization or academic unit listed that your program partners with, collaborates, or
leverages. Selections: Academic department- Other academic departments (other disciplines); Academic department -other academic institution;
Business/industry – For profit; Community Mental Health Center; Federal Government –Other; Federal Government -Veterans Affairs; Federal
Government-Centers for Disease Control and Prevention (CDC) program; Federally-qualified health center or look-alikes (FQHC – includes
health care for the homeless; primary care public housing, migrant health center, school-based health center, rural health clinic); Other community
health center (i.e. free clinic); Health department- Local; Health department- State; Health department- Tribal; Health disparities research center;
Health policy center; Hospital; Medical school; No partners; Nonprofit organization; Other HRSA program – Comprehensive Geriatric Education
Program (CGEP); Other HRSA program – Geriatric Education Center (GEC); Other HRSA program – Health Careers Opportunity Program
(HCOP); Other HRSA program – Nurse Education, Practice, Quality and Retention (NEPQR); Other HRSA program – Public Health Training
Center (PHTC); Other HRSA program– Area Health Education Center (AHEC); Other Local Government programs; Racial/ethnic population
entity or research center (e.g., Asian, Native Hawaiian/Other Pacific Islander, Black/African-American, American Indian/Alaska Native, White,
Hispanic/Latino); School of Public Health; State Governmental Programs; State public health association; Other.
Total Number of Residency Completers: Enter the total number of residency completers per program.

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R-1b: Program Positions Description and Outcomes

Accredited Positions
Health Residency Training
Profession Discipline/ Year
Type

(Select
one)

(Select
one)

Offered
Positions

Actual Positions

Attrition Attrition
of
Among
Resident URM
Resident
#
# New
#
Total #
#
#
# URM
# BHPrAccredited Accredited Residency Filled Expanded Resident Residents Supported
Residency Residency Positions Residency Resident FTEs FTEs
FTEs
Positions Positions Recruited Positions Positions
Added
Added
during
Reporting
Period

Instructions: R-1b is a continuation of R-1a. Complete this table per residency discipline/type per training year as described below for the
reporting period. The glossary contains clarifications and/or definitions of key terms.
T91 THC- Grantees should include ALL residents in their program (i.e. THC –funded and non-funded residents).
Health Profession:
Selections: Dentist; Medicine; Physician Assistant; Nursing; Behavioral Health/Public Health/Other;

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Residency/Discipline Type:
Dentist Selections: FELLOWSHIP AND RESIDENCY PROGRAMS: Advanced Education In General Dentistry - AEGD 12 month
program (include optional 2nd year); AEGD 24 month program; Dental Public Health - DPH 12 month program; DPH 24 month
program; General Practice Residency - GPR 12 month program (include optional 2nd year); GPR 24 month program; Geriatric Dentistry;
Pediatric Dentistry (24 months);
OTHER PROGRAMS: Dental Assistant; Dental Hygiene; General Dentistry; Pediatric Dentistry; MPH year-General Dentistry
(Master's in Public Health); MPH year-Pediatric Dentistry; MPH year-Public Health Dentistry; MPH year-Dental Hygiene, Public Health
Dentistry; Other (specify)
Medicine Selections: Aerospace Medicine; Allopathic Medicine, Alternative/Complementary Medicine; Behavioral/Mental Health In
School Of Medicine And Osteopathic Medicine; Chiropractic; Family Medicine; General Internal Medicine; General Pediatrics; General
Preventive Medicine; General Preventive Medicine/ Family Medicine; General Preventive Medicine/ Internal Medicine; General
Preventive Medicine/ Public Health; Geriatric Medicine; Geriatric Psychiatry; Integrative Medicine; Internal Medicine /General
Pediatrics; Internal Medicine/Family Medicine; Neurology; Obstetrics/Gynecology; Occupational Medicine; Osteopathic General
Practice; Pediatrics/Family Medicine; Pharmacy, Podiatry; Psychiatry; Radiology; Veterinary Medicine;
Physician assistants: Disciplines are not applicable (N/A).
Nursing: Alternative/Complementary Nursing; CNS-Adult gerontology; CNS-Family; CNS-Geropsychiatric; CNS-Neonatal; CNSPediatrics; CNS-Psychiatric/Mental health; CNS-Women’s health; Clinical Nurse Specialist (CNS); Home Health Aide; Licensed
Practical/Vocational Nurse (LPN/LVN); NP - Other advanced nurse specialists; NP - Psychiatric/Mental health; NP –Adult gerontology;
NP –Family; NP –Neonatal; NP –Pediatrics; NP –Women’s health; NP- Acute care adult gerontology; NP- Acute care pediatric; NPEmergency care; NP- Geropsychiatric; Nurse Administrator; Nurse Anesthetist; Nurse Assistant/Patient Care Associate (PCA); Nurse
Educator; Nurse Generalist; Nurse Midwife; Nurse Practitioner (NP); Nurse Researchers/Scientists; Nursing Informatics; Public Health
Nurse; Registered Nurse; Registered Nurse Student; Other (specify);
Behavioral Health/Public Health/Other Selections:
Behavioral Health Selection: Counseling Psychology; Clinical Psychology; Clinical Social Work;; Marriage and Family Therapy;
Pastoral/Spiritual Care; Other Psychology; Other Social Work, Substance Abuse/Addictions Counseling; Other (specify);
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Public Health: Biostatistics; Biostatistics – Biometry; Community Health Worker Environmental Health; Environmental Health –
Environmental chemistry; Environmental Health – Environmental health planning; Environmental Health – Environmental sciences;
Environmental Health – Industrial hygiene; Environmental Health – Occupational safety and health; Environmental Health – Radiological
health; Environmental Health – Toxicology; Environmental Health – Water quality; Epidemiology; Geriatrics/Aging Populations
Global/International Health; Global/International Health – Tropical medicine; Health Education/Behavior; Health Education/Behavior –
Behavioral sciences; Health Education/Behavior – Community health sciences; Health Education/Behavior – Evaluation research; Health
Education/Behavior – Health behavior; Health Education/Behavior – Health promotion/disease prevention; Health Services Research;
Health Services/Hospital Administration; Health Services/Hospital Administration – Health management; Health Services/Hospital
Administration – Health planning; Health Services/Hospital Administration – Hospital administration; Maternal & Child Health; Maternal
& Child Health – Adolescent health; Maternal & Child Health – Infant and child health; Maternal & Child Health – Women’s health;
Nutrition; Nutrition – Dietetics; Nutrition – Public health nutrition; Occupational Health; Public Health (General Studies); Public Health
Practice; Public Health Practice – Community health practice; Public Health Practice – Program management; Urban Health; Veterinary
Science – Veterinary public health; Other (specify);
Other: Audiology; Bio-Engineering; Biomedicine; Biomedicine - Biochemistry; Biomedicine - Cancer biology; Biomedicine - Immunology;
Biomedicine - Microbiology; Biomedicine - Parasitology; Biomedicine - Pathobiology; Biomedicine - Biomedical and Laboratory Sciences;
Clinical Laboratory Worker; Clinical Researcher; EMT-Paramedic/First responder; Extended Care Administrator; Forensic Science; Genetics;
Health Information Systems/Data Analysis; Health Policy/Law; Lactation Consultant; Long-Term Care Administration; Occupational Therapy;
Occupational Therapy – Occupational therapy assistant; Optometry; Pharmacy; Physical Therapy; Physical Therapy – Physical therapy assistant;
Radiologic Services; Respiratory Therapy; Speech/Language Pathology; Other (specify);Training Year: select training year 1, 2, 3, or 4
Accredited Positions
Number of Accredited Residency Positions per Year of Training: Enter the number of approved residency positions (at the beginning of the
reporting period) by the ACGME, AOA, CDA, or CODA accreditation programs per year of training (e.g., Year one, two).
Postdoctoral Training in General, Pediatric, and Public Health Dentistry programs (D88, D84, also D13 and D5G): Programs that have
discretion in the allotment of accredited residency positions among program years should enter their goals for each program year. In such
cases the total number of positions across years should equal the total number of accredited positions.

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Number of Newly Accredited Residency Positions Added during Reporting Period: Enter the number of additional residency positions that
are newly approved by the ACGME, AOA, or CODA accreditation programs. (Subset of total number from above)
Offered Positions:
Number of Residency Positions Recruited: Enter the number of residency positions recruited for per training year (e.g., Year one, two).
Actual Positions:
Total Number of Filled Residency Positions (by Training Year): Enter the total number of residency positions filled per training year (e.g.,
Year one, two).
Number of Expanded Resident Positions Added: Of the total number of positions filled, enter the number of new resident positions added per
training year (e.g., Year one, two). The baseline is the number of positions from the prior year.
Number of Resident FTEs: Enter the total number of resident full time equivalents (FTE) per training year. For PMR programs, enter data for
post-graduate year two and post-graduate year three (PGY2 and PGY3).
Number of URM Resident FTEs: Of the FTE total number from above, enter the number of URM resident full time equivalents (FTE) by
training year. For PMR programs, enter data for postgraduate year two and post-graduate year three (PGY2 and PGY3).
Number of BHPr-Supported FTEs: Enter the number of FTEs who receive BHPr financial support (e.g., tuition assistance) from this grant. For
the purposes of this reporting, financial support includes tuition, fees, and stipends.
Attrition of Resident Enrollees: Enter the number of resident enrollees who permanently left the program before completion by training year.
(Not for Oral Health Post Doctoral Program-see program specific table PDD.)
Attrition among URM Resident Enrollees: Indicate the number of URM resident enrollees who permanently left the program before completion
by training year. For PMR programs, enter the number of URM resident enrollees dropping out in PGY2 and PGY3. (Not for Oral Health Post
Doctoral Program-see program specific table PDD.)

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Table EXP-1 (1a, 1b): Experiential and/or Clinical Training (Sites/Clinic Programs)
Table purpose: To describe the experiential and/or clinical training experiences offered.
Table EXP-1a: Training Site Description
Select Discipline/specialty or role: (Select One per Row): ______
Training Training Training Training
Training
Vulnerable Partnering/ Interprofessional/
Site
Site Type Setting Objective/Description Populations Leveraging Interdisciplinary
Site/
Address
Served
Training
(Services Provided)
(Select
(Exclude
Clinical
one)
(Select all
(Select all
IMP)
(Y/N)
Program (One per
row)
that
apply)
that
apply)
Name
(Exclude IMP)
(Select up to (exclude GACA,
three)
COE)

Continuation of EXP-1a:
Primary
Secondary
Number of Undergraduate-Level
Training
Training
Trainees
Competency Competency
(NEPQR, NMHC)
Offered in
Offered in
Setting
Setting
Enrollees Completer Attrition
s
(PHTC)
(PHTC)
(Select one)

(Select one)

2012 BHPr Performance reporting

Number of Graduate-Level
Trainees

Disciplines
Number Total #
that
of Clinical Trainees
Participated Trainings at Site
in Interper Site
professional
(exclude
Training
PMR,
(exclude
IMP)
GACA, COE,
IMP)

Populations Served

Clinic
services
provided

(NEPQR, NMHC)
(NEPQR, NMHC)
Enrollee
s

Completer
s

Attritio
n

Total
Number
Served

Numbe
r of
URMs

Numb
er of
Wom
en

(NEPQR,
NMHC)
(Select all
that

Page 61 of 287

apply)

Instructions: Each row represents an experiential and/or clinical training site. Add training sites for each discipline/specialty or role. Complete
each column as described below. Discipline/specialty or role selection values are populated from the Health Profession and Disciplines – Setup
form. The glossary contains clarifications and/or definitions of key terms.
AHEC Instructions: This table is applicable only to clinical training sites.
Post-Doctoral Training in General, Pediatric, and Public Health Dentistry Instructions: Do not include continuing education.
UD6 Integrative Medicine Program (IMP)- Enter the disciplines the resident interacted with in the learning environment and practicum. for the
“Disciplines that Participated in Interprofessional Training” Column.
Discipline/specialty: Indicate the discipline/specialty or role
For Pre-doctoral Training in Primary Care, Interdisciplinary and Interprofessional Joint Graduate Degree Program, Expansion of the
Physician Assistant Training (EPAT) Program, and Physician Assistant Training in Primary Care (PAT) programs, discipline is not
applicable.
For AHEC Program, select Not Applicable (N/A) if discipline is not applicable.
Dentist Selections: FELLOWSHIP AND RESIDENCY PROGRAMS: Advanced Education In General Dentistry - AEGD 12 month
program (include optional 2nd year); AEGD 24 month program; Dental Public Health - DPH 12 month program; DPH 24 month
program; General Practice Residency - GPR 12 month program (include optional 2nd year); GPR 24 month program; Geriatric Dentistry;
Pediatric Dentistry (24 months);

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OTHER PROGRAMS: Dental Assistant; Dental Hygiene; General Dentistry; Pediatric Dentistry; MPH year-General Dentistry
(Master's in Public Health); MPH year-Pediatric Dentistry; MPH year-Public Health Dentistry; MPH year-Dental Hygiene, Public Health
Dentistry; Other (specify)
Medicine Selections: Aerospace Medicine; Allopathic Medicine, Alternative/Complementary Medicine; Behavioral/Mental Health In
School Of Medicine And Osteopathic Medicine; Chiropractic; Family Medicine; General Internal Medicine; General Pediatrics; General
Preventive Medicine; General Preventive Medicine/ Family Medicine; General Preventive Medicine/ Internal Medicine; General
Preventive Medicine/ Public Health; Geriatric Medicine; Geriatric Psychiatry; Integrative Medicine; Internal Medicine /General
Pediatrics; Internal Medicine/Family Medicine; Neurology; Obstetrics/Gynecology; Occupational Medicine; Osteopathic General
Practice; Pediatrics/Family Medicine; Pharmacy, Podiatry; Psychiatry; Radiology; Veterinary Medicine;
Physician assistants: Disciplines are not applicable (N/A).
Nursing: Alternative/Complementary Nursing; CNS-Adult gerontology; CNS-Family; CNS-Geropsychiatric; CNS-Neonatal; CNSPediatrics; CNS-Psychiatric/Mental health; CNS-Women’s health; Clinical Nurse Specialist (CNS); Home Health Aide; Licensed
Practical/Vocational Nurse (LPN/LVN); NP - Other advanced nurse specialists; NP - Psychiatric/Mental health; NP –Adult gerontology;
NP –Family; NP –Neonatal; NP –Pediatrics; NP –Women’s health; NP- Acute care adult gerontology; NP- Acute care pediatric; NPEmergency care; NP- Geropsychiatric; Nurse Administrator; Nurse Anesthetist; Nurse Assistant/Patient Care Associate (PCA); Nurse
Educator; Nurse Generalist; Nurse Midwife; Nurse Practitioner (NP); Nurse Researchers/Scientists; Nursing Informatics; Public Health
Nurse; Registered Nurse; Registered Nurse Student; Other (specify);
Behavioral Health/Public Health/Other Selections:
Behavioral Health Selection: Counseling Psychology; Clinical Psychology; Clinical Social Work;; Marriage and Family Therapy;
Pastoral/Spiritual Care; Other Psychology; Other Social Work, Substance Abuse/Addictions Counseling; Other (specify);
Public Health: Biostatistics; Biostatistics – Biometry; Community Health Worker Environmental Health; Environmental Health –
Environmental chemistry; Environmental Health – Environmental health planning; Environmental Health – Environmental sciences;
Environmental Health – Industrial hygiene; Environmental Health – Occupational safety and health; Environmental Health – Radiological
health; Environmental Health – Toxicology; Environmental Health – Water quality; Epidemiology; Geriatrics/Aging Populations
Global/International Health; Global/International Health – Tropical medicine; Health Education/Behavior; Health Education/Behavior –
Behavioral sciences; Health Education/Behavior – Community health sciences; Health Education/Behavior – Evaluation research; Health
2012 BHPr Performance reporting
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Education/Behavior – Health behavior; Health Education/Behavior – Health promotion/disease prevention; Health Services Research;
Health Services/Hospital Administration; Health Services/Hospital Administration – Health management; Health Services/Hospital
Administration – Health planning; Health Services/Hospital Administration – Hospital administration; Maternal & Child Health; Maternal
& Child Health – Adolescent health; Maternal & Child Health – Infant and child health; Maternal & Child Health – Women’s health;
Nutrition; Nutrition – Dietetics; Nutrition – Public health nutrition; Occupational Health; Public Health (General Studies); Public Health
Practice; Public Health Practice – Community health practice; Public Health Practice – Program management; Urban Health; Veterinary
Science – Veterinary public health; Other (specify);
Other: Audiology; Bio-Engineering; Biomedicine; Biomedicine - Biochemistry; Biomedicine - Cancer biology; Biomedicine Immunology; Biomedicine - Microbiology; Biomedicine - Parasitology; Biomedicine - Pathobiology; Biomedicine - Biomedical and
Laboratory Sciences; Clinical Laboratory Worker; Clinical Researcher; EMT-Paramedic/First responder; Extended Care Administrator;
Forensic Science; Genetics; Health Information Systems/Data Analysis; Health Policy/Law; Lactation Consultant; Long-Term Care
Administration; Occupational Therapy; Occupational Therapy – Occupational therapy assistant; Optometry; Pharmacy; Physical Therapy;
Physical Therapy – Physical therapy assistant; Radiologic Services; Respiratory Therapy; Speech/Language Pathology; Other (specify);
Training Site/Clinical Program Name: Enter the Site name.
Training Site Address: Enter the street address (Do not enter a P.O Box), city, state, and nine-digit zip code of the training site.
Training Site Type:
Selections: Academic institution; Acute care services; Aerospace operations setting; Ambulatory practice sites (e.g. Geriatric ambulatory
care; designated by State governor); Community Health Center (CHC) (i.e. Migrant health center; rural); Other community health center
(i.e. free clinic); Community Behavioral Health Center; (i.e. Geriatric behavioral/mental health units; Community care programs for
elderly mentally challenged individuals); Community-based organization; Day and home care programs (i.e. Home Health); Dental
services; Extended care facilities; Federal and State Bureau of Prisons; Hospice; Hospital-academic center; Hospital-community;
Hospital-federal; Hospital-non-profit; Hospital- for profit; Indian Health Service (IHS) or Tribal health site; International
nonprofit/nongovernmental organization; Local health department, Mobile unit; National health association; Physician Office; Schoolbased clinic; Specialty clinics (e.g. mental health practice, rehabilitation, substance abuse clinic); State Health department; Surgery clinic;
Long-term Care Facility; Veterans Affairs Healthcare (e.g. VA hospital); Other (specify).

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Training Setting:
Selections: Federally-qualified health center and look-like (FQHC – health care for the homeless; primary care public housing, migrant
health center, school-based health center, rural health clinic); Frontier location; HPSA and dental HPSA; Medically Underserved
Communities (MUC); Rural location; Not Applicable.
Training Objective/Description (Services Provided) (not applicable to IMP program): Briefly describe the primary objective of the training
offered.
Vulnerable Populations Served: Selections: Adolescents; Children; Chronically ill; College students; Homeless individuals; Individuals with
HIV/AIDS; Individuals with mental health or substance abuse disorders; Migrant workers; Military and/or military families; Older adults; People
with disabilities; Pregnant women and infants; Unemployed; Returning war veterans (Iraq or Afghanistan); Veterans; Victims of abuse or trauma;
Other(Specify).
Partnering/Leveraging (not applicable to IMP program): Select each type of organization or academic unit listed that your program partners
with, collaborates, or leverages.
Selections: Academic department- Other academic departments (other disciplines); Academic department -other academic institution;
Business/industry – For profit; Community Mental Health Center; Federal Government –Other; Federal Government -Veterans Affairs;
Federal Government-Centers for Disease Control and Prevention (CDC) program; Federally-qualified health center or look- alike (FQHC
– includes health care for the homeless; primary care public housing, migrant health center, school-based health center, rural health clinic);
Other community health center (i.e. free clinic); Health department- Local; Health department- State; Health department- Tribal; Health
disparities research center; Health policy center; Hospital; Medical school; No partners; Nonprofit organization; Other HRSA program –
Comprehensive Geriatric Education Program (CGEP); Other HRSA program – Geriatric Education Center (GEC); Other HRSA program
– Health Careers Opportunity Program (HCOP); Other HRSA program – Nurse Education, Practice, Quality and Retention (NEPQR);
Other HRSA program – Public Health Training Center (PHTC); Other HRSA program– Area Health Education Center (AHEC); Other
Local Government programs; Racial/ethnic population entity or research center (e.g., Asian, Native Hawaiian/Other Pacific Islander,
Black/African-American, American Indian/Alaska Native, White, Hispanic/Latino); School of Public Health; State Governmental
Programs; State public health association; Other.
Interprofessional/Interdisciplinary Education (not applicable to GACA and COE programs): Indicate if trainees’ learning outcomes
pertained to interprofessional/interdisciplinary teamwork (‘Yes’ or ‘No’).
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Disciplines that Participated in Inter-professional Training (not applicable to GACA, COE, and IMP programs):
For Pre-doctoral Training in Primary Care, Interdisciplinary and Interprofessional Joint Graduate Degree Program, Expansion of the
Physician Assistant Training (EPAT) Program, and Physician Assistant Training in Primary Care (PAT) programs, discipline is not
applicable.
For AHEC Program, select Not Applicable (N/A) if discipline is not applicable.
Dentist Selections: FELLOWSHIP AND RESIDENCY PROGRAMS: Advanced Education In General Dentistry - AEGD 12 month
program (include optional 2nd year); AEGD 24 month program; Dental Public Health - DPH 12 month program; DPH 24 month
program; General Practice Residency - GPR 12 month program (include optional 2nd year); GPR 24 month program; Geriatric Dentistry;
Pediatric Dentistry (24 months);
OTHER PROGRAMS: Dental Assistant; Dental Hygiene; General Dentistry; Pediatric Dentistry; MPH year-General Dentistry
(Master's in Public Health); MPH year-Pediatric Dentistry; MPH year-Public Health Dentistry; MPH year-Dental Hygiene, Public Health
Dentistry; Other (specify)
Medicine Selections: Aerospace Medicine; Allopathic Medicine, Alternative/Complementary Medicine; Behavioral/Mental Health In
School Of Medicine And Osteopathic Medicine; Chiropractic; Family Medicine; General Internal Medicine; General Pediatrics; General
Preventive Medicine; General Preventive Medicine/ Family Medicine; General Preventive Medicine/ Internal Medicine; General
Preventive Medicine/ Public Health; Geriatric Medicine; Geriatric Psychiatry; Integrative Medicine; Internal Medicine /General
Pediatrics; Internal Medicine/Family Medicine; Neurology; Obstetrics/Gynecology; Occupational Medicine; Osteopathic General
Practice; Pediatrics/Family Medicine; Pharmacy, Podiatry; Psychiatry; Radiology; Veterinary Medicine;
Physician assistants: Disciplines are not applicable (N/A).
Nursing: Alternative/Complementary Nursing; CNS-Adult gerontology; CNS-Family; CNS-Geropsychiatric; CNS-Neonatal; CNSPediatrics; CNS-Psychiatric/Mental health; CNS-Women’s health; Clinical Nurse Specialist (CNS); Home Health Aide; Licensed
Practical/Vocational Nurse (LPN/LVN); NP - Other advanced nurse specialists; NP - Psychiatric/Mental health; NP –Adult gerontology;
NP –Family; NP –Neonatal; NP –Pediatrics; NP –Women’s health; NP- Acute care adult gerontology; NP- Acute care pediatric; NPEmergency care; NP- Geropsychiatric; Nurse Administrator; Nurse Anesthetist; Nurse Assistant/Patient Care Associate (PCA); Nurse
2012 BHPr Performance reporting

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Educator; Nurse Generalist; Nurse Midwife; Nurse Practitioner (NP); Nurse Researchers/Scientists; Nursing Informatics; Public Health
Nurse; Registered Nurse; Registered Nurse Student; Other (specify);
Behavioral Health/Public Health/Other Selections:
Behavioral Health Selection: Counseling Psychology; Clinical Psychology; Clinical Social Work;; Marriage and Family Therapy;
Pastoral/Spiritual Care; Other Psychology; Other Social Work, Substance Abuse/Addictions Counseling; Other (specify);
Public Health: Biostatistics; Biostatistics – Biometry; Community Health Worker Environmental Health; Environmental Health –
Environmental chemistry; Environmental Health – Environmental health planning; Environmental Health – Environmental sciences;
Environmental Health – Industrial hygiene; Environmental Health – Occupational safety and health; Environmental Health – Radiological
health; Environmental Health – Toxicology; Environmental Health – Water quality; Epidemiology; Geriatrics/Aging Populations
Global/International Health; Global/International Health – Tropical medicine; Health Education/Behavior; Health Education/Behavior –
Behavioral sciences; Health Education/Behavior – Community health sciences; Health Education/Behavior – Evaluation research; Health
Education/Behavior – Health behavior; Health Education/Behavior – Health promotion/disease prevention; Health Services Research;
Health Services/Hospital Administration; Health Services/Hospital Administration – Health management; Health Services/Hospital
Administration – Health planning; Health Services/Hospital Administration – Hospital administration; Maternal & Child Health; Maternal
& Child Health – Adolescent health; Maternal & Child Health – Infant and child health; Maternal & Child Health – Women’s health;
Nutrition; Nutrition – Dietetics; Nutrition – Public health nutrition; Occupational Health; Public Health (General Studies); Public Health
Practice; Public Health Practice – Community health practice; Public Health Practice – Program management; Urban Health; Veterinary
Science – Veterinary public health; Other (specify);
Other: Audiology; Bio-Engineering; Biomedicine; Biomedicine - Biochemistry; Biomedicine - Cancer biology; Biomedicine Immunology; Biomedicine - Microbiology; Biomedicine - Parasitology; Biomedicine - Pathobiology; Biomedicine - Biomedical and
Laboratory Sciences; Clinical Laboratory Worker; Clinical Researcher; EMT-Paramedic/First responder; Extended Care Administrator;
Forensic Science; Genetics; Health Information Systems/Data Analysis; Health Policy/Law; Lactation Consultant; Long-Term Care
Administration; Occupational Therapy; Occupational Therapy – Occupational therapy assistant; Optometry; Pharmacy; Physical Therapy;
Physical Therapy – Physical therapy assistant; Radiologic Services; Respiratory Therapy; Speech/Language Pathology; Other (specify);
Number of clinical Trainings per Site (not applicable to PMR and IMP programs): Enter the total number of clinical trainings that occurred
at each site.
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Total Number of Trainees at Site: Enter the total number of trainees.
Primary Training Competency Offered in Setting (PHTC): Selections: Analytical/assessment skills; Policy development program planning
skills; Communication skills; Cultural competency skills; Community dimensions of practice skills; Public health sciences skills; Financial
planning and management skills; or Leadership and systems thinking skills.
Secondary Training Competency Offered in Setting (PHTC): Selections: See competency selections above, if applicable.
Number of Undergraduate-Level Trainees (NEPQR and NMHC): Enter the number of Undergraduate-level enrollees; completers and attrition
in each clinical program.
Number of Graduate-Level Trainees (NEPQR and NMHC): Enter the number of Graduate-level enrollees, completers and attrition in each
clinical program.
Populations Served (NEPQR and NMHC): For each clinical program offered, enter the following information:
Total Number Served: Enter the total number of people served.
Number URMs: Of the total, enter the number of URMs served.
Number of Women: Of the total, enter the number of women served.
Clinic Services Provided (NEPQR and NMHC): Selections: Disease prevention/health promotion; Disease management; Mental/behavioral
health (includes substance abuse); Primary care.

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Table EXP-1b: Experiential/Clinical Training – Disciplines of Staff Trained (GACA only)
Table Purpose: To capture number of number of clinical staff trained per discipline.
Discipline/Specialty

Training Site/Clinical Program
Name

Disciplines of Staff
Trained

Number of Clinical Staff Members
Trained per Discipline

(Select one)
Populated from EXP-1a

Populated from EXP-1a

Instructions: This table is a continuation of Table EXP-1a. Each row represents combination of discipline/specialty and training site/clinical
program name identified in EXP-1a. Complete each column as described below for the reporting period. The glossary contains clarifications
and/or definitions of key terms.
Disciplines of Staff Trained: Select the health professional discipline(s) of clinical staff trained. Selections: allopathic medicine; osteopathic
medicine; nursing; social work; psychology; dentistry; pharmacy; public health;; or Other (specify).
Number of Clinical Staff Members Trained: Enter the number of clinical staff members trained per discipline.

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Table EXP-2: Experiential Training -Type and Number of Training Sites per Training Year (outcome)
Table Purpose: To classify the type and number of clinical or experiential training sites offered.
Select Role: (Drop down)
Training Site Type

Number of Training Sites

Number of Trainees

(Select one)

Instructions: Each row represents a type of clinical or experiential training site for the role selected. Enter the number of training sites for the
reporting period. The glossary contains definitions of key terms.
Role:
Selections for the registered nurse role include: BSN; CNL; Diploma; ADN; Trainees completing an AS;
Selections for the APRN roles include: Clinical nurse specialist; Nurse administrator; Nurse anesthetist; Nurse educator; Nurse
informaticist; Nurse midwife; Nurse practitioner; Public health nurse.
Select ‘N/A’ if role is not applicable.
Training Site Types:
Selections: Academic institution; Acute care services; Aerospace operations setting; Ambulatory practice sites (e.g. Geriatric ambulatory
care; designated by State governor); Community Health Center (CHC) (i.e. Migrant health center; rural); Other community health center
(i.e. free clinic); Community Behavioral Health Center; (i.e. Geriatric behavioral/mental health units; Community care programs for
elderly mentally challenged individuals); Community-based organization; Day and home care programs (i.e. Home Health); Dental
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services; Extended care facilities; Federal and State Bureau of Prisons; Hospice; Hospital-academic center; Hospital-community;
Hospital-federal; Hospital-non-profit; Hospital- for profit; Indian Health Service (IHS) or Tribal health site; International
nonprofit/nongovernmental organization; Local health department, Mobile unit; National health association; Physician Office; Schoolbased clinic; Specialty clinics (e.g. mental health practice, rehabilitation, substance abuse clinic); State Health department; Surgery clinic;
Long-term Care Facility; Veterans Affairs Healthcare (e.g. VA hospital); Other (specify).
Number of Training Sites: Enter the number of sites where experiential and/or clinical training occurred.
Number of Trainees: Enter the number of trainees.

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Table IND-GEN: Individual Trainee General Characteristics

Table purpose: To describe the individual trainee’s general characteristics.
Table IND-GEN: Individual Trainee General Characteristics
Trainee Educational Gender Age Ethnicity Race Rural/Urban/ Disadvantaged Discipline/Specialty Trainee Type of BHPr
Unique Level/Highest
Suburban/
Background
Status Support/Financial
ID
Degree
Frontier
Award
Earned
Background
(Select one)

(M/F) (Select (Select (Select (Select one) (Y/N/Unknown)
one)
one)
one)

(Select one)

(Select
one)

(AHEC- Clinical
Trainees Only)

Continuation of IND-GEN:
BHPr
Did the
Did the
Financial
Trainee
Trainee
Award
Leave the complete the
Amount
Program
Program?
Before
(exclude Completion?
(Y/N)
AHEC)
(Y/N)

2012 BHPr Performance reporting

If Yes, Next Completer Applied
Step after
the Training to
completion?
Certification or
Credentialing
(Select one)
(Y/N/Unknown)
(GPE)
(exclude CGEP,
DFLRP, GPE)

Did the trainee pass
the ProfessionSpecific Certifying
Exam or Boards?

(exclude AHEC)

Did the
If Yes, Next Training Program
Trainee
Step after
Graduate? Graduation (ANEE, AENT,
NAT, NFLP)
(Y/N)
(Select one)

(Y/N/Unknown)
(GPE)
(exclude DFLRP,
HCOP)

(Select all that
apply)

(GPE)

Role Population
Foci

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Continuation of IND-GEN:
Trainee
Earned
Degree?

Clinical
Training?
(Y/N)

(Y/N)

(AENT,
ANEE,
NAT,
NEPQR,
NFLP)

(AENT,
AHEC,
ANEE,
COE,
NAT,
NEPQR,
NFLP,
NWD,
Pre-doc
training
in
Primary
Care)

If
Completed
, Intent to
Pursue
Health
Profession
s
Training?

Did the
Trainee
Receive a
Degree or
Diploma?

(Y/N)

(Y/N)
(AHEC –
Health
Careers
Trainees
only,
COE,
HCOP,
NWD)

(exclude
AENT,
ANEE,
GPE,
NAT,
NEPQR,
NFLP)

If Received a
Degree or
Diploma,
Accepted
into Health
Professions
Program
(Y/N/Unkno
wn)

If
Accepted,
Select
Health
Profession
s Program
(Select
one)

Type of
Degree
Earned

(Select
one)

Grant
Purpose

Applied the
Training to
National Cert
in Geriatrics?

Applied the
Training to
State Cert in
Geriatrics?

(Select
all that
apply)

(Select one)

(Select one)

(CGEP)

(CGEP)

(CGEP)
(AHECHealth
Careers
Trainees
only, COE,
HCOP,
NWD)

(AHECHealth
Careers
Trainees
only, COE,
HCOP,
NWD)

(PHT)

Instructions: Add a row for each individual trainee: Complete each column in the row as described below for the reporting period. The glossary
contains clarifications and/or definitions of key terms.

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U76/U77 AHEC Instructions: This table will capture individual-level data for health careers enrichment/training participants and clinical training
participants. However, refer to column-specific instructions which indicate columns that are applicable only to health careers enrichment/training
participants or only to clinical training participants.
D88/D84/D5G/D13 Postdoctoral Training in General, Pediatric, or Public Health Dentistry and Dental Public Health: Report on only
trainees receiving direct support (Tuition and Fees and Stipends) from the grant.
Trainee Unique ID: Enter a seven digit numeric unique identifier for each trainee.
Education Level/ Highest degree earned: Select the trainee’s highest educational level. If in a non-degree program (e.g. K-12; postbaccalaureate, residencies/fellowships) select the highest degree earned. If HRSA grant is supporting a degree, diploma, or certification then select
degree in progress.
Selections: Grades K-6; Grades 7-8; Grades 9-12; Post-high school/pre-college; Certificate; Two-year college/community college;
Associates; Diploma (Nursing); Four-year college; Bachelors; Twelve-month post-baccalaureate; Pre-matriculation/pre-graduate school; Masters
(MHA, MS, MSN, MSW, MPH, MSPH); Post-Masters Certificate; Doctorate (PhD, DNP, DNSc; DC, DPT); Post-Doctorate; Resident; Fellow;
Faculty member; Post-graduate; Medicine Doctor (M.D.); Doctor of Osteopathy (D.O.); Doctor of Dental Surgery (D.D.S., D.M.D.); Doctor of
Pharmacy (Pharm.D.); Doctor of Veterinary Medicine (D.V.M.); Doctor of Psychology (Psy.D.); Doctor of Public Health (Dr.P.H.), ScD (Doctor
of Science), Doctor of Veterinary Medicine (D.V.M. or V.M.D.), Adult learner; Dislocated worker; Other (Specify).
Gender: Indicate Male or Female.
Age: Selections: Under 20 years; 20-29 years; 30-39 years; 40-49 years; 50-59 years; 60-69 years; 70 years or older; Unknown.
Ethnicity: Selections: Hispanic/Latino or Non-Hispanic/Non-Latino.
Race:
Selections: American Indian or Alaska Native; Asian (Not Underrepresented); Asian (Underrepresented); Black or African-American;
Native Hawaiian or Other Pacific Islander; White; More Than One Race; and Unknown.
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Rural/Urban/Suburban/Frontier background: Indicate if trainee is from a rural, urban, suburban, frontier background or unknown.
Disadvantaged Background: Indicate if the trainee is from a disadvantaged background (‘Yes’ or ‘No’ or ‘Unknown’.).
Discipline/Specialty: Indicate the discipline.
For Pre-doctoral Training in Primary Care, Interdisciplinary and Interprofessional Joint Graduate Degree Program, Expansion of the
Physician Assistant Training (EPAT) Program, and Physician Assistant Training in Primary Care (PAT) programs, discipline is not
applicable.
For AHEC Program, select Not Applicable (N/A) if discipline is not applicable.
Dentist Selections: FELLOWSHIP AND RESIDENCY PROGRAMS: Advanced Education In General Dentistry - AEGD 12 month
program (include optional 2nd year); AEGD 24 month program; Dental Public Health - DPH 12 month program; DPH 24 month
program; General Practice Residency - GPR 12 month program (include optional 2nd year); GPR 24 month program; Geriatric Dentistry;
Pediatric Dentistry (24 months);
OTHER PROGRAMS: Dental Assistant; Dental Hygiene; General Dentistry; Pediatric Dentistry; MPH year-General Dentistry
(Master's in Public Health); MPH year-Pediatric Dentistry; MPH year-Public Health Dentistry; MPH year-Dental Hygiene, Public Health
Dentistry; Other (specify)
Medicine Selections: Aerospace Medicine; Allopathic Medicine, Alternative/Complementary Medicine; Behavioral/Mental Health In
School Of Medicine And Osteopathic Medicine; Chiropractic; Family Medicine; General Internal Medicine; General Pediatrics; General
Preventive Medicine; General Preventive Medicine/ Family Medicine; General Preventive Medicine/ Internal Medicine; General
Preventive Medicine/ Public Health; Geriatric Medicine; Geriatric Psychiatry; Integrative Medicine; Internal Medicine /General
Pediatrics; Internal Medicine/Family Medicine; Neurology; Obstetrics/Gynecology; Occupational Medicine; Osteopathic General
Practice; Pediatrics/Family Medicine; Pharmacy, Podiatry; Psychiatry; Radiology; Veterinary Medicine;
Physician assistants: Disciplines are not applicable (N/A).
Nursing: Alternative/Complementary Nursing; CNS-Adult gerontology; CNS-Family; CNS-Geropsychiatric; CNS-Neonatal; CNSPediatrics; CNS-Psychiatric/Mental health; CNS-Women’s health; Clinical Nurse Specialist (CNS); Home Health Aide; Licensed
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Practical/Vocational Nurse (LPN/LVN); NP - Other advanced nurse specialists; NP - Psychiatric/Mental health; NP –Adult gerontology;
NP –Family; NP –Neonatal; NP –Pediatrics; NP –Women’s health; NP- Acute care adult gerontology; NP- Acute care pediatric; NPEmergency care; NP- Geropsychiatric; Nurse Administrator; Nurse Anesthetist; Nurse Assistant/Patient Care Associate (PCA); Nurse
Educator; Nurse Generalist; Nurse Midwife; Nurse Practitioner (NP); Nurse Researchers/Scientists; Nursing Informatics; Public Health
Nurse; Registered Nurse; Registered Nurse Student; Other (specify);
Behavioral Health/Public Health/Other Selections:
Behavioral Health Selection: Counseling Psychology; Clinical Psychology; Clinical Social Work;; Marriage and Family Therapy;
Pastoral/Spiritual Care; Other Psychology; Other Social Work, Substance Abuse/Addictions Counseling; Other (specify);
Public Health: Biostatistics; Biostatistics – Biometry; Community Health Worker Environmental Health; Environmental Health –
Environmental chemistry; Environmental Health – Environmental health planning; Environmental Health – Environmental sciences;
Environmental Health – Industrial hygiene; Environmental Health – Occupational safety and health; Environmental Health – Radiological
health; Environmental Health – Toxicology; Environmental Health – Water quality; Epidemiology; Geriatrics/Aging Populations
Global/International Health; Global/International Health – Tropical medicine; Health Education/Behavior; Health Education/Behavior –
Behavioral sciences; Health Education/Behavior – Community health sciences; Health Education/Behavior – Evaluation research; Health
Education/Behavior – Health behavior; Health Education/Behavior – Health promotion/disease prevention; Health Services Research;
Health Services/Hospital Administration; Health Services/Hospital Administration – Health management; Health Services/Hospital
Administration – Health planning; Health Services/Hospital Administration – Hospital administration; Maternal & Child Health; Maternal
& Child Health – Adolescent health; Maternal & Child Health – Infant and child health; Maternal & Child Health – Women’s health;
Nutrition; Nutrition – Dietetics; Nutrition – Public health nutrition; Occupational Health; Public Health (General Studies); Public Health
Practice; Public Health Practice – Community health practice; Public Health Practice – Program management; Urban Health; Veterinary
Science – Veterinary public health; Other (specify);
Other: Audiology; Bio-Engineering; Biomedicine; Biomedicine - Biochemistry; Biomedicine - Cancer biology; Biomedicine Immunology; Biomedicine - Microbiology; Biomedicine - Parasitology; Biomedicine - Pathobiology; Biomedicine - Biomedical and
Laboratory Sciences; Clinical Laboratory Worker; Clinical Researcher; EMT-Paramedic/First responder; Extended Care Administrator;
Forensic Science; Genetics; Health Information Systems/Data Analysis; Health Policy/Law; Lactation Consultant; Long-Term Care
Administration; Occupational Therapy; Occupational Therapy – Occupational therapy assistant; Optometry; Pharmacy; Physical Therapy;
Physical Therapy – Physical therapy assistant; Radiologic Services; Respiratory Therapy; Speech/Language Pathology; Other (specify);
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Pipeline Selection: Refer to all discipline selections above.
Trainee Status: Indicate the status of each trainee (part-time faculty; full-time faculty; part-time trainee; full-time trainee) as defined by
institution. Select part-time or full-time trainee only for non-faculty member.
Postdoctoral Training in General, Pediatric, or Public Health Dentistry and Dental Public Health program: Full time or part-time trainees
in a residency program should be counted as a trainee regardless of if they hold a faculty appointment at an educational institution or
program.
Type of BHPr Financial Award (Not applicable for AHEC Program):
Selections: Fellowships; Scholarships; Stipend; Traineeship; Loan. If the trainee did not receive a financial award, select ‘N/A’
BHPr Financial award amount (Not applicable for AHEC Program): Enter the financial award amount from this BHPr grant supporting the
trainee.
Did the Trainee Leave the Program Before Completion? Selections: Yes, No.
Did the trainee complete the Program: Indicate if the trainee completed the program. Selections: Yes, No
GPE: Indicate if the trainee successfully met the didactic and/or clinical requirements of a course of study or training program.
If Yes, Next Step after Completion(GPE program only): If select yes, please select appropriate option that best represents next steps for trainee
upon completion of the Graduate Psychology Education program: continued on to next level training; internship; residency; post doctoral
fellowship; next level degree program; other (specify). If the trainee did not complete the program, leave field blank or select ‘N/A’. If left blank,
system will populate the field with ‘N/A’ once form is saved.
Completer Applied the Training to Certification or Credentialing (Not applicable for DFLRP, CGEP, and GPE programs): Indicate if the
completer applied the training to National, State certification, continuing education, or employment requirements (‘Yes’, ‘No’, or ‘Unknown’). If
the trainee did not complete the program, leave field blank or select ‘N/A’. If left blank, system will populate the field with ‘N/A’ once form is
saved.
Did the trainee pass the Profession-Specific Certifying Exam or Boards? (Not applicable for HCOP and DFLRP programs): Indicate if the
trainee passed the Profession-Specific Certifying Exam or Boards (‘Yes’, ‘No’, ‘Unknown’, or ‘N/A’ ).
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If certification, credentialing, or Board examinations is only known on a percentage basis for your program indicate “Unknown” for each
trainee and report the percentage in a comment section.”
Did the Trainee Graduate? (GPE only) Indicate if the trainee graduated (‘Yes’ or ‘No’). Graduate refers to a trainee who has successfully
completed all educational requirements for a specified academic program of study culminating in a degree or program.
If Yes, Next Step after Graduation (GPE only): If select yes to “Did the Trainee Graduate?”, please select appropriate option that best
represents next steps for graduate trainee upon graduation: next level training; internship; residency; post doctoral fellowship; next level degree
program; other (specify). ). If the trainee did not graduate, leave field blank or select ‘N/A’. If left blank, system will populate the field with ‘N/A’
once form is saved.
Training Program (AENT, AENT, NAT, and NFLP only): For each trainee, select the role and population foci.
Role: The roles should be mutually exclusive.
Selections for the registered nurse role include: BSN; CNL; Diploma; ADN; Trainees completing an AS;
Selections for the APRN roles include: Clinical nurse specialist; Nurse administrator; Nurse anesthetist; Nurse educator; Nurse
informaticist; Nurse midwife; Nurse practitioner; Public health nurse.
Select ‘N/A’ if role is not applicable.
Population Foci: Selections: Acute care adult-gerontology nurse practitioner; Acute-care pediatric nurse practitioner; Adult Gerontology;
Adult-Gerontology Primary Care Nurse Practitioner; Family Nurse Practitioner; Family/Individual Across Lifespan; Neonatal; Neonatal Nurse
Practitioner; Pediatric Primary Care Nurse Practitioner; Pediatrics; Psychiatric/Mental Health Nurse ; Practitioner; Women’s Health/Gender
Related And Psychiatric Mental Health; Women’s Health/Gender-Related Nurse Practitioner.
Trainee Earned a Degree (ANEE, AENT, NAT, NFLP, NEPQR, and NWD programs only): Did the trainee earn a degree? (Y/N)
Clinical Training? (AHEC, COE, NWD, NFLP, AENT, ANEE, NAT, NEPQR, Pre-doc training in Primary Care programs only): For
each program, indicate if clinical training was used (‘Yes’ or ‘No’). For purposes of this reporting, clinical training involves trainee-patient
encounters.

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If Completed, Intent to Pursue Health Professions Training? (HCOP, AHEC- Health Careers Trainees, NWD, and COE programs only):
Indicate whether the trainee who completed the program intends to pursue health professions training (‘Yes’ or ‘No’). If the trainee did not
complete, leave field blank or select ‘N/A’. If left blank, system will populate the field with ‘N/A’ once form is saved. For COE Completers,
“intent to purse health professions training” refers to residency or fellowship.
Did the Trainee Receive a Degree or Diploma? (not applicable for GPE, ANEE, AENT, NAT, NFLP, NEPQR programs) Indicate if the
trainee graduated (‘Yes’ or ‘No’). For AHEC, this column is applicable for Health Careers Trainees only.
If Received Degree/Diploma, Accepted Into Health Professions Program (HCOP, AHEC- Health Careers Trainees, NWD, and COE
programs only): Indicate if the graduate was accepted into a health professions school (Y/N/ Unknown). If the trainee did not graduate, leave
field blank or select ‘N/A’. If left blank, system will populate the field with ‘N/A’ once form is saved.
U76/U77 AHEC: Only applicable to health careers enrichment participants.
If Accepted, select Health Professions Program (HCOP, AHEC- Health Careers Trainees, NWD, and COE programs only): If graduate
was accepted into health profession program, Select the program. Health professions programs include: Allopathic medicine; Osteopathic
Medicine; Chiropractic; Clinical psychology (HCOP and COE only); Clinical social work (HCOP and COE only); Community health worker;
Dental hygiene; General dentistry; Epidemiology; First responder (EMP, paramedic, fire rescue, HazMat); Health administration; Pharmacy;
Mental/Behavioral Health; Podiatry; Veterinary Medicine; Optometry; Marriage and Family Therapy; Professional Counseling; Physician
Assistant.
U76/U77 AHEC: Only applicable to health careers enrichment participants.
Type of degree earned (PHT program only): Select the type of degree the graduate earned. Selections: MPH; MSPH; MS; MHA; DrPH; PhD;
ScD; Other (specify); N/A. If trainee did not complete the program, leave field blank or select ‘N/A’. If left blank, system will populate the field
with ‘N/A’ once form is saved.
Grant Purpose (CGEP program only): Select the grant purpose(s) for which the trainee serves: CGEP-1 (Provide training to individuals who
will provide geriatric care for the elderly); CGEP-3 (Train faculty members in geriatrics); and CGEP-5 (Establish traineeships for individuals
preparing for advanced education nursing degrees in geriatric nursing, long-term care, gero-psychiatric nursing, or other nursing areas that
specialize in the care of the elderly population.)

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Applied the Training to National Certification in Geriatrics? (CGEP program only) Indicate if the completer applied the training to a
national certification in geriatrics (‘Yes’ or ‘No’). If the trainee did not complete, select N/A.
Applied the Training to State Cert in Geriatrics? (CGEP program only) Indicate if the completer applied the training to a State certification in
geriatrics (‘Yes’ or ‘No’). If the trainee did not complete, select N/A.

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Table IND-FAC: Individual Faculty Trainee Characteristics
Table purpose: To describe the individual faculty trainee characteristics.
Table IND-FAC: Individual Faculty Characteristics
Trainee Unique
ID

Was the Faculty
Promoted?

Promotion
Position

(Y/N)
(Select one)

Intent to Teach? Course Title Completed
Additional Degree
by Faculty Trainee
(PFD and Joint Degree)
(Y/N)
(GACA, GEC, Faculty
Degree
Discipline/Specialty
(exclude DFLRP) Development: Integrated
Technology into Nursing (Select one)
(Select one)
Education and Practice)

Populated from
IND-GEN

Instructions: Each row refers to a faculty trainee identified in IND-GEN. Complete each column in the row as described below for the reporting
period. The glossary contains clarifications and/or definitions of key terms.
Was the Faculty Promoted? Indicate if the faculty trainee was promoted including first appointments (‘Yes’ or ‘No’). If trainee was not a
faculty trainee, leave field blank or select ‘N/A’. If left blank, system will populate the field with ‘N/A’ once form is saved.
Promotion Position: If the faculty was promoted, select the position to which the faculty was promoted. Selections: Assistant professor; Associate
professor; Professor. If trainee was not promoted, leave field blank or select ‘N/A’. If left blank, system will populate the field with ‘N/A’ once
form is saved.
Intent to Teach? (not applicable for DFLR program): Does the trainee express an intention to teach? (‘Yes’ or ‘No’)
D86 FDD: Does the current or non-current faculty trainee who participated in the faculty development program plans to teach in General,
Pediatric or Public Health dentistry at any institution? (‘Yes’ or ‘No’)

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Course Title completed by faculty trainee (GACA, GEC, and Faculty Development: Integrated Technology into Nursing Education and
Practice programs only): Select the applicable courses completed by the individual faculty trainee. The list of courses is pre-populated from
faculty development courses in CE-1.
Additional Degree (if applicable) (PFD and Joint Degree program only):
Degree selections: DrPH; EdD; MPH; MSPH; MCR; MS; ScD; N/A.
Discipline/specialty: Indicate the discipline.
For Pre-doctoral Training in Primary Care, Interdisciplinary and Interprofessional Joint Graduate Degree Program, Expansion of the
Physician Assistant Training (EPAT) Program, and Physician Assistant Training in Primary Care (PAT) programs, discipline is not
applicable.
Dentist Selections: FELLOWSHIP AND RESIDENCY PROGRAMS: Advanced Education In General Dentistry - AEGD 12 month
program (include optional 2nd year); AEGD 24 month program; Dental Public Health - DPH 12 month program; DPH 24 month
program; General Practice Residency - GPR 12 month program (include optional 2nd year); GPR 24 month program; Geriatric Dentistry;
Pediatric Dentistry (24 months);
OTHER PROGRAMS: Dental Assistant; Dental Hygiene; General Dentistry; Pediatric Dentistry; MPH year-General Dentistry
(Master's in Public Health); MPH year-Pediatric Dentistry; MPH year-Public Health Dentistry; MPH year-Dental Hygiene, Public Health
Dentistry; Other.
Medicine Selections: Aerospace Medicine; Allopathic Medicine, Alternative/Complementary Medicine; Behavioral/Mental Health In
School Of Medicine And Osteopathic Medicine; Chiropractic; Family Medicine; General Internal Medicine; General Pediatrics; General
Preventive Medicine; General Preventive Medicine/ Family Medicine; General Preventive Medicine/ Internal Medicine; General
Preventive Medicine/ Public Health; Geriatric Medicine; Geriatric Psychiatry; Integrative Medicine; Internal Medicine /General
Pediatrics; Internal Medicine/Family Medicine; Neurology; Obstetrics/Gynecology; Occupational Medicine; Osteopathic General
Practice; Pediatrics/Family Medicine; Pharmacy, Podiatry; Psychiatry; Radiology; Veterinary Medicine;
Physician assistants: Disciplines are not applicable (N/A).
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Nursing: Alternative/Complementary Nursing; CNS-Adult gerontology; CNS-Family; CNS-Geropsychiatric; CNS-Neonatal; CNSPediatrics; CNS-Psychiatric/Mental health; CNS-Women’s health; Clinical Nurse Specialist (CNS); Home Health Aide; Licensed
Practical/Vocational Nurse (LPN/LVN); NP - Other advanced nurse specialists; NP - Psychiatric/Mental health; NP –Adult gerontology;
NP –Family; NP –Neonatal; NP –Pediatrics; NP –Women’s health; NP- Acute care adult gerontology; NP- Acute care pediatric; NPEmergency care; NP- Geropsychiatric; Nurse Administrator; Nurse Anesthetist; Nurse Assistant/Patient Care Associate (PCA); Nurse
Educator; Nurse Generalist; Nurse Midwife; Nurse Practitioner (NP); Nurse Researchers/Scientists; Nursing Informatics; Public Health
Nurse; Registered Nurse; Registered Nurse Student; Other.
Behavioral Health/Public Health/Other Selections:
Behavioral Health Selection: Counseling Psychology; Clinical Psychology; Clinical Social Work;; Marriage and Family Therapy;
Pastoral/Spiritual Care; Other Psychology; Other Social Work, Substance Abuse/Addictions Counseling; Other.
Public Health: Biostatistics; Biostatistics – Biometry; Community Health Worker Environmental Health; Environmental Health –
Environmental chemistry; Environmental Health – Environmental health planning; Environmental Health – Environmental sciences;
Environmental Health – Industrial hygiene; Environmental Health – Occupational safety and health; Environmental Health – Radiological
health; Environmental Health – Toxicology; Environmental Health – Water quality; Epidemiology; Geriatrics/Aging Populations
Global/International Health; Global/International Health – Tropical medicine; Health Education/Behavior; Health Education/Behavior –
Behavioral sciences; Health Education/Behavior – Community health sciences; Health Education/Behavior – Evaluation research; Health
Education/Behavior – Health behavior; Health Education/Behavior – Health promotion/disease prevention; Health Services Research;
Health Services/Hospital Administration; Health Services/Hospital Administration – Health management; Health Services/Hospital
Administration – Health planning; Health Services/Hospital Administration – Hospital administration; Maternal & Child Health; Maternal
& Child Health – Adolescent health; Maternal & Child Health – Infant and child health; Maternal & Child Health – Women’s health;
Nutrition; Nutrition – Dietetics; Nutrition – Public health nutrition; Occupational Health; Public Health (General Studies); Public Health
Practice; Public Health Practice – Community health practice; Public Health Practice – Program management; Urban Health; Veterinary
Science – Veterinary public health; Other.
Other: Audiology; Bio-Engineering; Biomedicine; Biomedicine - Biochemistry; Biomedicine - Cancer biology; Biomedicine Immunology; Biomedicine - Microbiology; Biomedicine - Parasitology; Biomedicine - Pathobiology; Biomedicine - Biomedical and
Laboratory Sciences; Clinical Laboratory Worker; Clinical Researcher; EMT-Paramedic/First responder; Extended Care Administrator;
Forensic Science; Genetics; Health Information Systems/Data Analysis; Health Policy/Law; Lactation Consultant; Long-Term Care
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Administration; Occupational Therapy; Occupational Therapy – Occupational therapy assistant; Optometry; Pharmacy; Physical Therapy;
Physical Therapy – Physical therapy assistant; Radiologic Services; Respiratory Therapy; Speech/Language Pathology; Other.

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Table IND-INTPRACT: Individual Intent to Practice Characteristics
Table purpose: Describe the individual trainee’s intention to practice in specific settings
Trainee
Unique ID

If Completed the Program, Intent to
Practice?

If Graduated, Intent to Practice?

If Received a Degree or Diploma, Intent to
Practice?

(GPE)
(Exclude AHEC, COE, GPE, HCOP,
NWD)
(Y/N)
Primary
Care
Setting

(Select one)

( AHEC, COE, HCOP, NWD)
(Y/N)
(Y/N)

Medically Rural Setting Primary
Medically
Rural
Primary
Medically
Underserved
Care Setting Underserved Setting
Care
Underserved
Community
Community
Setting
Community
(Select one) (Select one)
(Select
(Select one)
(Select one)
one) (Select one) (Select one)

Rural Setting
(Select one)

Populated
from INDGEN

Continuation of IND-INTPRACT :
Practice Setting Practice Setting
Post Graduation Post Program
Completion
(GPE)
Federally Qualified
(GPE)
(Select one)
Health Centers
(Select one)
2012 BHPr Performance reporting

Contact Hours per Clinical Setting
( AENT, ANEE, NAT, NFLP)
Health
Medically Underserved
Professional
Community
Shortage Areas

Rural
Locations

Nurse Managed
Health Clinic

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Instructions: Complete this table for trainees who participated in programs identified in IND-GEN for the reporting period, as appropriate. Each
row refers to one trainee. The glossary contains clarifications and/or definitions of certain terms.
If Completed the Program, Intent to Practice in Primary Care Setting? Indicate whether the completer intends to enter practice in a primary
care setting (‘Yes’ or ‘No’). If the trainee did not complete the program, leave field blank or select ‘N/A’. If left blank, system will populate the
field with ‘N/A’ once form is saved. (Not applicable for HCOP, AHEC, NWD, COE, and GPE Program Grantees)
If Completed the Program, Intent to Practice in MUC? Indicate whether the completer intends to practice in a medically underserved
community (‘Yes’ or ‘No’). If the trainee did not complete the program, leave field blank or select ‘N/A’. If left blank, system will populate the
field with ‘N/A’ once form is saved. (Not applicable for HCOP, AHEC, NWD, COE, and GPE Program Grantees)
If Completed the Program, Intent to Practice in a Rural Setting? Indicate whether the completer intends to enter practice in a rural setting
(‘Yes’ or ‘No’). If the trainee did not complete the program, leave field blank or select ‘N/A’. If left blank, system will populate the field with
‘N/A’ once form is saved. (Not applicable for HCOP, AHEC, NWD, COE, and GPE Program Grantees)
If Graduated the Program, Intent to Practice in Primary Care Setting? (GPE program only) Indicate whether the graduate intends to enter
practice in a primary care setting (‘Yes’ or ‘No’). If the trainee did not graduate, leave field blank or select ‘N/A’. If left blank, system will
populate the field with ‘N/A’ once form is saved.
If Graduated the Program, Intent to Practice in MUC? (GPE program only) Indicate whether the graduate intends to practice in a medically
underserved community (‘Yes’ or ‘No’). If the trainee did not graduate, leave field blank or select ‘N/A’. If left blank, system will populate the
field with ‘N/A’ once form is saved.
If Graduated the Program, Intent to Practice in a Rural Setting? (GPE program only) Indicate whether the graduate intends to enter practice
in a rural setting (‘Yes’ or ‘No’). If the trainee did not graduate, leave field blank or select ‘N/A’. If left blank, system will populate the field with
‘N/A’ once form is saved.
If Received a Degree or Diploma, Intent to Practice in Primary Care Setting? (HCOP, AHEC, NWD, and COE programs only) Indicate
whether the trainee who received a degree or diploma intends to enter practice in a primary care setting (‘Yes’ or ‘No’). If the trainee did not
receive a degree or diploma, leave field blank or select ‘N/A’. If left blank, system will populate the field with ‘N/A’ once form is saved.
If Received a Degree or Diploma, Intent to Practice in MUC? (HCOP, AHEC, NWD, and COE programs only) Indicate whether the trainee
who received a degree or diploma intends to enter practice in a medically underserved community (‘Yes’ or ‘No’). If the trainee did not receive a
degree or diploma, leave field blank or select ‘N/A’. If left blank, system will populate the field with ‘N/A’ once form is saved.

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If Received a Degree or Diploma, Intent to Practice in Rural Setting? (HCOP, AHEC, NWD, and COE programs only) Indicate whether
the trainee who received a degree or diploma intends to enter practice in a rural setting (‘Yes’ or ‘No’). If the trainee did not receive a degree or
diploma, leave field blank or select ‘N/A’. If left blank, system will populate the field with ‘N/A’ once form is saved.
Practice Setting Post Graduation? (GPE only) Indicate where the trainee graduate, post-graduation will enter or has entered practice. Selections
include: primary care, medically underserved community (MUC), rural area; other (please specify). If the trainee did not graduate, leave field
blank or select ‘N/A’. If left blank, system will populate the field with ‘N/A’ once form is saved.
Practice Setting Post Program Completion? (GPE only) Indicate where the trainee post- GPE program completion will enter or has entered
practice. Selections include: primary care, medically underserved community (MUC), rural area; other (please specify). If the trainee did not
complete the program, leave field blank or select ‘N/A’. If left blank, system will populate the field with ‘N/A’ once form is saved.
Contact Hours per Clinical Setting (ANEE, AENT, NAT, and NFLP only): If the trainee received clinical training in any of the designated
clinical settings (i.e., FQHCs, HPSAs, MUC, rural locations and NMHC. enter the number of clinical hours per setting for the reporting period. If
the trainee did not receive clinical training, leave the field blank.

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Table INDGEN-EXP: Trainee-to-Site Association
Table Purpose: To link training site related information (provided in the EXP-1a table) for each trainee (identified in the IND-Gen table).
Select Training Site/Clinical Program: (Drop down)
Trainee unique
ID

Contact Hours

# of Patient Encounters

(AHEC , COE,
NMHC, NWD)

(exclude AHEC, COE, IMP, NMHC,
NEPQR, NWD, PHTC, PMR)

Completed
Residency
Placement

Accepted
Employment at
Placement Site

Trainee Associated
to Site?
(NEPQR, PHTC)

(Y/N)

(Y/N)

(IMP, PDD,
PMR,
SOHWP)

(IMP, PDD, PMR,
SOHWP)

Populated from
IND-GEN

Instructions: Each row represents one trainee. For each training site/clinical program, specify trainees who are trained at the site. Then enter data
for each trainee associated to the training site/clinical program. Number of trainees for each site must match the total number of trainees per site in
EXP-1a. The glossary contains clarifications and/or definitions of key terms.
AHEC Instructions: This table is applicable only for clinical training participants.
Postdoctoral Training in General, Pediatric, or Public Health Dentistry and Dental Public Health: Contact Hours and Patient Encounters
may not be applicable to Dental Public Health residency programs.
Training Site/Clinical Program: Select training site/clinical program as specified in EXP-1a.
Contact Hours (NWD, NMHC, COE, and AHEC only): Enter the number of contact hours with patients. If trainee is not associated to
the site/program, leave the field blank.
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Number of Patient Encounters by Trainee: Enter the number of patient encounters by the trainee per training site. Faculty preceptors should
provide patient encounters. If trainee is not associated to the site/program, leave the field blank. (Not applicable for NWD, COE, AHEC, PHTC,
NMHC, NEPQR, PMR, and IMP program grantees)
Completed Residency Placement (SOHWP, PDD, PMR, and IMP programs only): Indicate whether the trainee completed the residency
placement described in EXP-1a (‘Yes’ or ‘No’). If trainee is not associated to the site/program, leave the field blank.
Accepted employment at placement site or similar site (SOHWP, PDD, PMR, IMP programs only): Indicate whether the completer accepted
employment at the placement site described in EXP-1a (‘Yes’ or ‘No’). If trainee is not associated to the site/program, leave the field blank.
Trainee Associated to Site? (PHTC and NEPQR programs only): Indicate whether the trainee is associated to the site/program. If trainee is
not associated to the site/program, leave the field blank.

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Table CLSET-1: Clinical Settings per Training Year
Table Purpose: To classify the clinical or experiential training offered in designated settings.
Select Discipline/Population Foci: (Drop down)
Training Year

Total # of Trainees by Clinical Setting
Federally Qualified
Health Centers
(FQHC)

Health Profession
Shortage Area and
Dental (HPSA)

Medically
Underserved
Community (MUC)

Nurse Managed
Health Clinics

Rural Setting

Instructions: Complete a separate table for each Discipline/Population Foci. For each table complete one row per training year. For each
Discipline/Population Foci selected complete each column as described below for the reporting period. For non-nursing programs, Discipline
selection values are populated from the Health Profession and Disciplines – Setup form. The glossary contains clarifications and/or definitions of
certain terms.
Discipline/Population Foci:
Discipline Selections:
For Pre-doctoral Training in Primary Care, Interdisciplinary and Interprofessional Joint Graduate Degree Program, Expansion of the
Physician Assistant Training (EPAT) Program, and Physician Assistant Training in Primary Care (PAT) programs, discipline is not
applicable.
For AHEC Program, select Not Applicable (N/A) if discipline is not applicable.
Dentist Selections: FELLOWSHIP AND RESIDENCY PROGRAMS: Advanced Education In General Dentistry - AEGD 12 month
program (include optional 2nd year); AEGD 24 month program; Dental Public Health - DPH 12 month program; DPH 24 month
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program; General Practice Residency - GPR 12 month program (include optional 2nd year); GPR 24 month program; Geriatric Dentistry;
Pediatric Dentistry (24 months);
OTHER PROGRAMS: Dental Assistant; Dental Hygiene; General Dentistry; Pediatric Dentistry; MPH year-General Dentistry
(Master's in Public Health); MPH year-Pediatric Dentistry; MPH year-Public Health Dentistry; MPH year-Dental Hygiene, Public Health
Dentistry; Other (specify)
Medicine Selections: Aerospace Medicine; Allopathic Medicine, Alternative/Complementary Medicine; Behavioral/Mental Health In
School Of Medicine And Osteopathic Medicine; Chiropractic; Family Medicine; General Internal Medicine; General Pediatrics; General
Preventive Medicine; General Preventive Medicine/ Family Medicine; General Preventive Medicine/ Internal Medicine; General
Preventive Medicine/ Public Health; Geriatric Medicine; Geriatric Psychiatry; Integrative Medicine; Internal Medicine /General
Pediatrics; Internal Medicine/Family Medicine; Neurology; Obstetrics/Gynecology; Occupational Medicine; Osteopathic General
Practice; Pediatrics/Family Medicine; Pharmacy, Podiatry; Psychiatry; Radiology; Veterinary Medicine;
Physician assistants: Disciplines are not applicable (N/A).
Nursing: Alternative/Complementary Nursing; CNS-Adult gerontology; CNS-Family; CNS-Geropsychiatric; CNS-Neonatal; CNSPediatrics; CNS-Psychiatric/Mental health; CNS-Women’s health; Clinical Nurse Specialist (CNS); Home Health Aide; Licensed
Practical/Vocational Nurse (LPN/LVN); NP - Other advanced nurse specialists; NP - Psychiatric/Mental health; NP –Adult gerontology;
NP –Family; NP –Neonatal; NP –Pediatrics; NP –Women’s health; NP- Acute care adult gerontology; NP- Acute care pediatric; NPEmergency care; NP- Geropsychiatric; Nurse Administrator; Nurse Anesthetist; Nurse Assistant/Patient Care Associate (PCA); Nurse
Educator; Nurse Generalist; Nurse Midwife; Nurse Practitioner (NP); Nurse Researchers/Scientists; Nursing Informatics; Public Health
Nurse; Registered Nurse; Registered Nurse Student; Other (specify);
Behavioral Health/Public Health/Other Selections:
Behavioral Health Selection: Counseling Psychology; Clinical Psychology; Clinical Social Work;; Marriage and Family Therapy;
Pastoral/Spiritual Care; Other Psychology; Other Social Work, Substance Abuse/Addictions Counseling; Other (specify);
Public Health: Biostatistics; Biostatistics – Biometry; Community Health Worker Environmental Health; Environmental Health –
Environmental chemistry; Environmental Health – Environmental health planning; Environmental Health – Environmental sciences;
Environmental Health – Industrial hygiene; Environmental Health – Occupational safety and health; Environmental Health – Radiological
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health; Environmental Health – Toxicology; Environmental Health – Water quality; Epidemiology; Geriatrics/Aging Populations
Global/International Health; Global/International Health – Tropical medicine; Health Education/Behavior; Health Education/Behavior –
Behavioral sciences; Health Education/Behavior – Community health sciences; Health Education/Behavior – Evaluation research; Health
Education/Behavior – Health behavior; Health Education/Behavior – Health promotion/disease prevention; Health Services Research;
Health Services/Hospital Administration; Health Services/Hospital Administration – Health management; Health Services/Hospital
Administration – Health planning; Health Services/Hospital Administration – Hospital administration; Maternal & Child Health; Maternal
& Child Health – Adolescent health; Maternal & Child Health – Infant and child health; Maternal & Child Health – Women’s health;
Nutrition; Nutrition – Dietetics; Nutrition – Public health nutrition; Occupational Health; Public Health (General Studies); Public Health
Practice; Public Health Practice – Community health practice; Public Health Practice – Program management; Urban Health; Veterinary
Science – Veterinary public health; Other (specify);
Other: Audiology; Bio-Engineering; Biomedicine; Biomedicine - Biochemistry; Biomedicine - Cancer biology; Biomedicine Immunology; Biomedicine - Microbiology; Biomedicine - Parasitology; Biomedicine - Pathobiology; Biomedicine - Biomedical and
Laboratory Sciences; Clinical Laboratory Worker; Clinical Researcher; EMT-Paramedic/First responder; Extended Care Administrator;
Forensic Science; Genetics; Health Information Systems/Data Analysis; Health Policy/Law; Lactation Consultant; Long-Term Care
Administration; Occupational Therapy; Occupational Therapy – Occupational therapy assistant; Optometry; Pharmacy; Physical Therapy;
Physical Therapy – Physical therapy assistant; Radiologic Services; Respiratory Therapy; Speech/Language Pathology; Other (specify);
Population Foci Selections:
Acute care adult-gerontology nurse practitioner; Acute-care pediatric nurse practitioner; Adult Gerontology; Adult-Gerontology Primary Care
Nurse Practitioner; Family Nurse Practitioner; Family/Individual Across Lifespan; Neonatal; Neonatal Nurse Practitioner; Pediatric Primary
Care Nurse Practitioner; Pediatrics; Psychiatric/Mental Health Nurse ; Practitioner; Women’s Health/Gender Related And Psychiatric Mental
Health; Women’s Health/Gender-Related Nurse Practitioner.
Training Year: Select a Training Year from the dropdown list. Selections: 1, 2, 3, 4
Total Number of Trainees by clinical setting: Enter the total number of trainees per setting for each training year.

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Table CE-1: Educational Offering/Continuing Education offerings
Table purpose: To identify and describe the continuing education and course offerings as well as trainee experiences.
CE-1: Educational Course Offering Description
Educati Course
Primary
Secondary Partners/ Interprofess If Yes, List Program Number Hours of
Total
Delivery
Training
onal Accredit Educational Educational Leveraging
ional/
the
Compete
of
Instructi
Hours
Mode
Length per
Offerin ation
Offering
Offering
Interdiscipli Disciplines ncy per Offering on per
of
Delivery Mode
g Title
Topic
Topic
nary
Represente Offering
s
Offering Instruction
(hours)
Education
d
(exclude
(PHCAS
(Select
GPE)
(PHCAST,
(One
(Select one) (Select one) (Select up
T,
all that
NAHHA)
per
to three)
NAHHA)
apply)
(Y/N)
row)
(Y/N)
Calculated

Total
Trainees

Trainees
by
Discipline
Specialty
(exclude
PHCAST,
NAHHA,
GPE)

# of Trainees
Applied
Training to
National
Certification or
Continuing
Educational
Requirements
(exclude GPE)

Grant
Purpose

Public Health Core
Competency

Competency Level Offered

Faculty Development
Training

(PHTC)
(CGEP)

(PHTC)

(GACA, CGEP, GEC,
Faculty Development:
Integrated Technology
into Nursing Education
and Practice)

(Select one)
(Select
one)

(Select one)

Primary
Domain

Secondary
Domain

Prima
ry

Secondar
y

Tertiar
y

Suppleme
ntal
funding
used for
Alzheimer
’s Disease
training?
(GEC)

(Y/N)
(Y/N)

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Instructions: Each row represents one educational/course offering. Complete each column described below for the reporting period. The glossary
contains clarifications and/or definitions of key terms.
U76, U77/ (AHEC) UB4 (GEC), UB6 (PHTC) Instruction: For grantees that jointly sponsor continuing educational trainings with other
HRSA/BHPr-funded programs, both programs should report same number in “Total Trainee” column for that training and select other entity
under “Partners/Leveraging: Selections”.
D40 (GPE) Instruction: Each row represents one educational course offering provided by this grant program. Educational Offering
Title: Enter the title of the educational course offering. If more than one educational course offering was provided, add additional rows to expand
the table.
Course Accreditation (not applicable for GPE program): Indicate whether the course was accredited for continuing education (‘Yes’ or ‘No’).
Primary Educational Offering Topic: Select the primary topic of the educational course offerings.
GEC Selections: Alzheimer’s disease; Alternative/complementary medicine; Chronic disease management; Cultural competencies;
Depression; Dementia; Delirium; Extended care; Ethics/bioethics; Elder abuse; Emergency preparedness; Evidence Based Medicine;
Geriatric medicine; Home health care; Health literacy; Healthy aging; HIV/AIDS; Health information technology; Health promotion and
disease prevention; Improving communication skills; Informatics; Interprofessional integrated models of care; Injury prevention; Longterm care; Long-term care; Minority health; Managed Care; Pastoral/Spiritual Care; Mental health; Nutrition; Oral health; Palliative
care; Primary care; Pain management; Pharmacology; Quality improvement and patient safety; Research; Rehabilitation Therapies;
Substance abuse; Transitional care; Women’s health; Wound care; Women’s health issues; Veterans Health; Suicide; Other (specify).
CGEP Selections: Alzheimer’s disease; Community health nursing; Cultural competence in nursing; Long-term care nursing;
Gerontological nursing; Geriatric education for direct care providers (e.g., registered nurse, licensed practical nurse, allied health
professionals, nursing assistants); Health literacy; Home health care; Injury prevention; Mental health (e.g., delirium, depression, and
dementia); Mental health and older adults; Nursing leadership and management; Nursing care for vulnerable populations; Nutrition; Oral

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health; Palliative and end of life care; Health care and older adults; Pain management; Research; Wound care; Women’s health issues;
Substance abuse; Other (specify).
AHEC Selections: Adolescent health; Advocacy/health policy; African-Americans; Alcohol substance misuse/prevention;
Alternative/complementary medicine; Alzheimer’s disease/dementia; Ambulatory care; American Indian/Alaska Natives; Asthma;
Behavioral health; Bioterrorism/preparedness; Border health activities; Cancer; Cultural competencies; Clinical preventive services;
Community-based continuity of care; Diabetes; Domestic violence/interpersonal violence; Drug-resistant diseases; Environmental health;
Evidence-based medicine/practice; Food borne disease; Genetics; geriatrics; Health disparities; Health promotion and disease prevention;
Heart disease; Hepatitis; Hispanics; HIV/AIDS; Home health; Homelessness; Hypertension; Influenza; Informatics; Injury prevention;
Interdisciplinary training; Interprofessional integrated models of care; Leadership training; Long-term care; Managed care; Maternal and
child health; Medical economics; Mental health; Migrant health initiatives; Minority health issues; Native Hawaiian/Pacific Islander;
Nutrition/healthy eating; Obesity; Oral health; Patient safety (medical errors); Physical activity/active lifestyles; Public health
infrastructure; Quality improvement and patient safety; Research; Rural health; Sexual health; Sexually transmitted infections; Stroke;
Telemedicine/telehealth; Tobacco cessation; Tuberculosis; Urban health; Veterans Health; Women’s health; Other (specify).
Faculty Development Integrated Technology into Nursing Education and Practice Selections: Advanced 3D graphics; Computerbased instructions; E-Learning technology; Informatics; Interactive simulated case studies; Mannequin-based and patient simulators;
Telehealth; Virtual simulation; Other simulated or virtual methods to enhance nursing education and practice.
Graduate Psychology Education Program Selections: Acute care; Ambulatory care; Alzheimer’s disease; Alternative/complementary
medicine; Behavioral assessment and consultation in primary care; Behavioral interventions for primary care; Chronic disease
management; Cultural competencies; communication skills; Delirium; Depression; Dementia; Extended care; Ethics/bioethics; Elder
abuse; Geriatric medicine; Home health care; HIV/AIDS; Healthy aging; Health information technology; Health literacy; Health
promotion and disease prevention; Injury prevention; Improving Informatics; Interprofessional integrated models of care; Long-term care;
Long-term care; Minority health; Medications/drugs; Nutrition; Oral health; Palliative care; Primary care; Perioperative care; Pain
management; Quality improvement and patient safety; Rehabilitation; Research; Substance abuse; Telehealth; Transitional care; Trauma;
Urgent care; Women’s health; Wound care; Women’s health issues; Other (specify).
Personal and Home Care Aides State Training (PHCAST) Selections: Basic restorative skills (e.g., transferring patients, ambulation,
bowel/bladder training, prosthetic and orthotic device usage); Consumers’ rights; Crisis intervention; Chronic disease management; Elder
abuse; Emergency training; Ethics and confidentiality; HIV/AIDS and other infectious diseases; Medication basics (e.g., side effects of
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drugs, possible behavior changes associated with the drug(s), medication administration, if applicable); Home health care; Extended care;
Health literacy; Health information technology; Infection control; Interpersonal skills (e.g., time and stress management, coping
mechanisms, cultural sensitivity, improving communication skills);Long-term care; Needs-specific training (e.g., individuals with
developmental/mental disabilities, dementia, delirium, depression, Alzheimer’s disease); Professional development; Personal care skills
(e.g., basic housekeeping, bathing, grooming, wound care, nutrition); Worker and patient safety; Other (specify).
Nurse Education Practice Quality and Retention Program and ANE Selections: Clinical Practice Information; Ethics/bioethics ;
Leadership/Management; Prevention/Primary care; Quality of care; Research; Secondary care; Technology; Tertiary care; Training;
Nursing Assistants and Home Health Aides Selections: See ‘Personal and Home Care Aides State Training (PHCAST) Selections.’
PHTC Selections: Adolescent health; Advocacy/health policy; African-Americans; Alcohol and substance misuse/prevention;
Alternative/complementary medicine; Alzheimer’s disease/dementia; Ambulatory care; American Indian/Alaska Natives; Asthma;
Behavioral health; Bioterrorism/preparedness; Border health activities; Cancer; Chronic disease; Clinical preventive services; Communitybased continuity of care; Cultural competencies; Communications; Communication skills; Community needs assessment; Community
collaboration; Cultural competency; Diabetes; Domestic Violence/Interpersonal violence; Drug-resistant diseases; Data collection and
analysis; Environmental health; Experiences; Evidence Based Medicine/Practice; Epidemiology; Food borne Disease; Focus groups;
Financial planning and management (including budgeting); Genetics; Genomics; Geriatrics; Grant writing; health disparities; Health
promotion and disease prevention; Heart disease; Hepatitis; Hispanics; HIV/AIDS; Home health; Homelessness; Hypertension; Influenza;
Informatics; Injury prevention; Interdisciplinary training; Interprofessional integrated models of care; Leadership training; Lesbian, gay,
bisexual, transgender individuals; Long-term Care; Managed care; Maternal and child health; Medical economics; Mental health; Migrant
health initiatives; Minority health issues; Meeting facilitation; Native Hawaiian/Pacific Islander; Nutrition/healthy eating; Obesity; Oral
health; Patient safety (medical errors); Physical activity/active lifestyles; Public health infrastructure; Public health law; Public health
science; Quality improvement and patient safety; Research; Rural health; Sexual health; Sexually transmitted infections; Skills-based
training (including coalition building); Negotiations; Program evaluation; Program design; Program planning; Program management;
Project management; Public health policy development; Social marketing; Survey design; Sustainability; Stroke; Telemedicine/telehealth;
Tobacco cessation; Tuberculosis; Urban health; Veteran Related; Women’s health; Workforce development; Youth development; Other
(specify)
GACA Selections: Acute care; Alternative/complementary medicine; Alzheimer’s disease; Ambulatory care; Chronic disease
management; Cultural competence; Delirium; Dementia; Depression; Elder abuse; Ethics/bioethics; Extended care; Geriatric medicine;
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Health information technology; Health literacy; Healthy aging; HIV/AIDS; Home health care; Improving communication skills;
Information technology; Injury prevention; Interprofessional team training; Long-term care; Long-term care; Medications/drugs; Minority
health; Nutrition; Oral health; Pain management; Palliative care; Perioperative care; Primary care; Rehabilitation; Research; Substance
abuse; Substance abuse; Telehealth; Transitional care; Urgent care; Women’s health; Women’s health issues; Wound care; Other (specify)
SOHWP Selections: Evidence-Based Practices; Health Disparities; Health promotion; Homeless; Leadership Training; Quality
Improvement; Rural Health; Teledentistry; Geriatrics; Communication Skills; Information Technology; Interprofessional Education;
Minority Health; Research; Cultural Competence; Long-Term Care; Chronic Disease; Substance Abuse; HIV/AIDS; Adolescent Health;
Infant Health, Behavioral Health; Border Health; Cancer; Community-Based Care; Diabetes; Domestic Violence; Veteran related; Other
(specify)
Secondary Educational Offering Topic: Select the secondary topic that the educational course offering covered. See selections from above.
Partners/Leveraging: Select each type of organization or academic unit listed that your program partners with, collaborates, or leverages.
Selections: Academic department- Other academic departments (other disciplines); Academic department -other academic institution;
Business/industry – For profit; Community Mental Health Center; Federal Government –Other; Federal Government -Veterans Affairs;
Federal Government-Centers for Disease Control and Prevention (CDC) program; Federally-qualified health center or look-alike (FQHC –
includes health care for the homeless; primary care public housing, migrant health center, school-based health center, rural health clinic);
Other community health center (i.e. free clinic); Health department- Local; Health department- State; Health department- Tribal; Health
disparities research center; Health policy center; Hospital; Medical school; No partners; Nonprofit organization; Other HRSA program –
Comprehensive Geriatric Education Program (CGEP); Other HRSA program – Geriatric Education Center (GEC); Other HRSA program
– Health Careers Opportunity Program (HCOP); Other HRSA program – Nurse Education, Practice, Quality and Retention (NEPQR);
Other HRSA program – Public Health Training Center (PHTC); Other HRSA program– Area Health Education Center (AHEC); Other
Local Government programs; Racial/ethnic population entity or research center (e.g., Asian, Native Hawaiian/Other Pacific Islander,
Black/African-American, American Indian/Alaska Native, White, Hispanic/Latino); School of Public Health; State Governmental
Programs; State public health association; Other. Interprofessional/Interdisciplinary Education: Indicate if trainees’ learning outcomes
pertained to interprofessional/interdisciplinary teamwork (‘Yes’ or ‘No’).
If Yes, List the Disciplines Represented:
Selections (Discipline):
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For AHEC Program, select Not Applicable (N/A) if discipline is not applicable.
Dentist Selections: FELLOWSHIP AND RESIDENCY PROGRAMS: Advanced Education In General Dentistry - AEGD 12 month
program (include optional 2nd year); AEGD 24 month program; Dental Public Health - DPH 12 month program; DPH 24 month
program; General Practice Residency - GPR 12 month program (include optional 2nd year); GPR 24 month program; Geriatric Dentistry;
Pediatric Dentistry (24 months);
OTHER PROGRAMS: Dental Assistant; Dental Hygiene; General Dentistry; Pediatric Dentistry; MPH year-General Dentistry
(Master's in Public Health); MPH year-Pediatric Dentistry; MPH year-Public Health Dentistry; MPH year-Dental Hygiene, Public Health
Dentistry; Other (specify)
Medicine Selections: Aerospace Medicine; Allopathic Medicine, Alternative/Complementary Medicine; Behavioral/Mental Health In
School Of Medicine And Osteopathic Medicine; Chiropractic; Family Medicine; General Internal Medicine; General Pediatrics; General
Preventive Medicine; General Preventive Medicine/ Family Medicine; General Preventive Medicine/ Internal Medicine; General
Preventive Medicine/ Public Health; Geriatric Medicine; Geriatric Psychiatry; Integrative Medicine; Internal Medicine /General
Pediatrics; Internal Medicine/Family Medicine; Neurology; Obstetrics/Gynecology; Occupational Medicine; Osteopathic General
Practice; Pediatrics/Family Medicine; Pharmacy, Podiatry; Psychiatry; Radiology; Veterinary Medicine;
Physician assistants: Disciplines are not applicable (N/A).
Nursing: Alternative/Complementary Nursing; CNS-Adult gerontology; CNS-Family; CNS-Geropsychiatric; CNS-Neonatal; CNSPediatrics; CNS-Psychiatric/Mental health; CNS-Women’s health; Clinical Nurse Specialist (CNS); Home Health Aide; Licensed
Practical/Vocational Nurse (LPN/LVN); NP - Other advanced nurse specialists; NP - Psychiatric/Mental health; NP –Adult gerontology;
NP –Family; NP –Neonatal; NP –Pediatrics; NP –Women’s health; NP- Acute care adult gerontology; NP- Acute care pediatric; NPEmergency care; NP- Geropsychiatric; Nurse Administrator; Nurse Anesthetist; Nurse Assistant/Patient Care Associate (PCA); Nurse
Educator; Nurse Generalist; Nurse Midwife; Nurse Practitioner (NP); Nurse Researchers/Scientists; Nursing Informatics; Public Health
Nurse; Registered Nurse; Registered Nurse Student; Other (specify);
Behavioral Health/Public Health/Other Selections:
Behavioral Health Selection: Counseling Psychology; Clinical Psychology; Clinical Social Work;; Marriage and Family Therapy;
Pastoral/Spiritual Care; Other Psychology; Other Social Work, Substance Abuse/Addictions Counseling; Other (specify);
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Public Health: Biostatistics; Biostatistics – Biometry; Community Health Worker Environmental Health; Environmental Health –
Environmental chemistry; Environmental Health – Environmental health planning; Environmental Health – Environmental sciences;
Environmental Health – Industrial hygiene; Environmental Health – Occupational safety and health; Environmental Health – Radiological
health; Environmental Health – Toxicology; Environmental Health – Water quality; Epidemiology; Geriatrics/Aging Populations
Global/International Health; Global/International Health – Tropical medicine; Health Education/Behavior; Health Education/Behavior –
Behavioral sciences; Health Education/Behavior – Community health sciences; Health Education/Behavior – Evaluation research; Health
Education/Behavior – Health behavior; Health Education/Behavior – Health promotion/disease prevention; Health Services Research;
Health Services/Hospital Administration; Health Services/Hospital Administration – Health management; Health Services/Hospital
Administration – Health planning; Health Services/Hospital Administration – Hospital administration; Maternal & Child Health; Maternal
& Child Health – Adolescent health; Maternal & Child Health – Infant and child health; Maternal & Child Health – Women’s health;
Nutrition; Nutrition – Dietetics; Nutrition – Public health nutrition; Occupational Health; Public Health (General Studies); Public Health
Practice; Public Health Practice – Community health practice; Public Health Practice – Program management; Urban Health; Veterinary
Science – Veterinary public health; Other (specify);
Other: Audiology; Bio-Engineering; Biomedicine; Biomedicine - Biochemistry; Biomedicine - Cancer biology; Biomedicine Immunology; Biomedicine - Microbiology; Biomedicine - Parasitology; Biomedicine - Pathobiology; Biomedicine - Biomedical and
Laboratory Sciences; Clinical Laboratory Worker; Clinical Researcher; EMT-Paramedic/First responder; Extended Care Administrator;
Forensic Science; Genetics; Health Information Systems/Data Analysis; Health Policy/Law; Lactation Consultant; Long-Term Care
Administration; Occupational Therapy; Occupational Therapy – Occupational therapy assistant; Optometry; Pharmacy; Physical Therapy;
Physical Therapy – Physical therapy assistant; Radiologic Services; Respiratory Therapy; Speech/Language Pathology; Other (specify);
Program Competency per Offering (PHCAST and NAHHA programs only): Select all of the competencies covered in the program offering.
Selections:
Roles and responsibilities of a personal and home care aide (including differences between a personal or home care aide employed by an
agency and a personal or home care aide employed directly by the health care consumer or an independent provider)
Consumer rights, ethics, and confidentiality (including the role of proxy decision makers in the case where a health care consumer has
impaired decision-making capacity)
Communication, culture, and linguistic competence and sensitivity, problem solving, behavior management, and relationship skills
Personal care skills
Health care support
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Nutritional support
Infection control
Safety and emergency training
Training specific to an individual consumer’s needs (including older individuals, younger individuals with disabilities, individuals with
developmental disabilities, individuals with dementia, and individuals with mental and behavioral health needs).
Self-care
Number of Offerings Provided: Enter the number of times the educational offering was provided.
Hours of Instruction: Enter the total number of instruction hours per offering.
Total Hours of Instruction: Calculated as (Number of Offerings Provided * Hours of Instruction)
Delivery Mode: Selections: Hands-on; Live lecture and Web-based; Live lecture/Seminar/Class room; Live lecture and Hands-on; Observation;
Research; Simulation; Video conference/Webinar/Web-based; Video/DVD/CD ROM; Other.
Total Trainees: Enter the total number of trainees.
Trainees per Discipline/Specialty (not applicable for PHCAST, NAHHA, and GPE programs): select discipline/specialty/trainee profession
types of those trained and provide number of trainees per employment location for the selected discipline/specialty/trainee profession type. This
information is to be completed CE-TTY table.
Number of Trainees Applied Training to National Certification or Continuing Educational Requirements (not applicable for GPE
program): Enter the number of completers who reported intent to apply the training toward employment requirements, continuing education
credit, certification, or credentialing.
Grant Purpose (CGEP program only): Select CGEP grant purposes for which the continuing education offering serves.
Public Health Core Competency (PHTC Primary Domain): Select the primary public health core competency addressed in the course.
Selections: Analytical/assessment skills; Communication skills; Cultural competency skills; Community dimensions of practice skills; Financial
planning and management skills; Leadership and systems thinking skills ; Public health sciences skills; Policy development/program planning
skills.

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Public Health Core Competency (PHTC Secondary Domain): Select the secondary public health core competency addressed in the course, if
applicable. Selections: See the selections above.
Note: The core competencies for public health professionals noted above were established by the Council on Linkages between Academia and
Public Health Practice.
Competency Level Offered (PHTC program only): Select the core competency level addressed. Selections:
Tier 1 core competencies - entry level public health professionals;
Tier 2 core competencies - public health professionals with management supervisory responsibilities; or
Tier 3 core competencies - senior managers and leaders of public health organizations.
Faculty Development Training (GACA, CGEP, GEC, and Faculty Development: Integrated Technology into Nursing Education and
Practice programs only): Is this training for faculty Development? Yes or No.
Training Length per Delivery Mode (PHCAST and NAHHA programs only): Enter the length of time spent using different training modes.
Training Modes include the following: Hands-on; Live lecture and Web-based; Live lecture/Seminar/Class room; Live lecture and Hands-on;
Observation; Research; Simulation; Video conference/Webinar/Web-based; Video/DVD/CD ROM; Other.
Supplemental funding used for Alzheimer’s Disease training? (GEC program only) Selection: Yes or No.

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Table CE-TTY: Educational Offering/Continuing Education Trainee Type
Table purpose: Identify continuing education trainee professions and employment locations
Select Educational Offering Title: (Drop down)

Trainee Profession Type

Trainee Employment Location

(Select one)

(Select all that apply)

# of Trainees

Instructions: For each educational offering title identified in CE-1, indicate the type and number of trainees per employment location. Complete
each column as described below for the reporting period. The glossary contains clarifications and/or definitions of key terms.
Trainee Profession Types:
For AHEC Program, select Not Applicable (N/A) if discipline is not applicable.
Dentist Selections: FELLOWSHIP AND RESIDENCY PROGRAMS: Advanced Education In General Dentistry - AEGD 12 month
program (include optional 2nd year); AEGD 24 month program; Dental Public Health - DPH 12 month program; DPH 24 month
program; General Practice Residency - GPR 12 month program (include optional 2nd year); GPR 24 month program; Geriatric Dentistry;
Pediatric Dentistry (24 months);
OTHER PROGRAMS: Dental Assistant; Dental Hygiene; General Dentistry; Pediatric Dentistry; MPH year-General Dentistry
(Master's in Public Health); MPH year-Pediatric Dentistry; MPH year-Public Health Dentistry; MPH year-Dental Hygiene, Public Health
Dentistry; Other (specify)
Medicine Selections: Aerospace Medicine; Allopathic Medicine, Alternative/Complementary Medicine; Behavioral/Mental Health In
School Of Medicine And Osteopathic Medicine; Chiropractic; Family Medicine; General Internal Medicine; General Pediatrics; General
Preventive Medicine; General Preventive Medicine/ Family Medicine; General Preventive Medicine/ Internal Medicine; General
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Preventive Medicine/ Public Health; Geriatric Medicine; Geriatric Psychiatry; Integrative Medicine; Internal Medicine /General
Pediatrics; Internal Medicine/Family Medicine; Neurology; Obstetrics/Gynecology; Occupational Medicine; Osteopathic General
Practice; Pediatrics/Family Medicine; Pharmacy, Podiatry; Psychiatry; Radiology; Veterinary Medicine;
Physician assistants: Disciplines are not applicable (N/A).
Nursing: Alternative/Complementary Nursing; CNS-Adult gerontology; CNS-Family; CNS-Geropsychiatric; CNS-Neonatal; CNSPediatrics; CNS-Psychiatric/Mental health; CNS-Women’s health; Clinical Nurse Specialist (CNS); Home Health Aide; Licensed
Practical/Vocational Nurse (LPN/LVN); NP - Other advanced nurse specialists; NP - Psychiatric/Mental health; NP –Adult gerontology;
NP –Family; NP –Neonatal; NP –Pediatrics; NP –Women’s health; NP- Acute care adult gerontology; NP- Acute care pediatric; NPEmergency care; NP- Geropsychiatric; Nurse Administrator; Nurse Anesthetist; Nurse Assistant/Patient Care Associate (PCA); Nurse
Educator; Nurse Generalist; Nurse Midwife; Nurse Practitioner (NP); Nurse Researchers/Scientists; Nursing Informatics; Public Health
Nurse; Registered Nurse; Registered Nurse Student; Other (specify);
Behavioral Health/Public Health/Other Selections:
Behavioral Health Selection: Counseling Psychology; Clinical Psychology; Clinical Social Work;; Marriage and Family Therapy;
Pastoral/Spiritual Care; Other Psychology; Other Social Work, Substance Abuse/Addictions Counseling; Other (specify);
Public Health: Biostatistics; Biostatistics – Biometry; Community Health Worker Environmental Health; Environmental Health –
Environmental chemistry; Environmental Health – Environmental health planning; Environmental Health – Environmental sciences;
Environmental Health – Industrial hygiene; Environmental Health – Occupational safety and health; Environmental Health – Radiological
health; Environmental Health – Toxicology; Environmental Health – Water quality; Epidemiology; Geriatrics/Aging Populations
Global/International Health; Global/International Health – Tropical medicine; Health Education/Behavior; Health Education/Behavior –
Behavioral sciences; Health Education/Behavior – Community health sciences; Health Education/Behavior – Evaluation research; Health
Education/Behavior – Health behavior; Health Education/Behavior – Health promotion/disease prevention; Health Services Research;
Health Services/Hospital Administration; Health Services/Hospital Administration – Health management; Health Services/Hospital
Administration – Health planning; Health Services/Hospital Administration – Hospital administration; Maternal & Child Health; Maternal
& Child Health – Adolescent health; Maternal & Child Health – Infant and child health; Maternal & Child Health – Women’s health;
Nutrition; Nutrition – Dietetics; Nutrition – Public health nutrition; Occupational Health; Public Health (General Studies); Public Health

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Practice; Public Health Practice – Community health practice; Public Health Practice – Program management; Urban Health; Veterinary
Science – Veterinary public health; Other (specify);
Other: Audiology; Bio-Engineering; Biomedicine; Biomedicine - Biochemistry; Biomedicine - Cancer biology; Biomedicine Immunology; Biomedicine - Microbiology; Biomedicine - Parasitology; Biomedicine - Pathobiology; Biomedicine - Biomedical and
Laboratory Sciences; Clinical Laboratory Worker; Clinical Researcher; EMT-Paramedic/First responder; Extended Care Administrator;
Forensic Science; Genetics; Health Information Systems/Data Analysis; Health Policy/Law; Lactation Consultant; Long-Term Care
Administration; Occupational Therapy; Occupational Therapy – Occupational therapy assistant; Optometry; Pharmacy; Physical Therapy;
Physical Therapy – Physical therapy assistant; Radiologic Services; Respiratory Therapy; Speech/Language Pathology; Other (specify);
Trainee Employment Location Selections: Academia; HRSA-Area Health Education Center Community-Based Training Site; Ambulatory
Practice Site Designated by State Governor; Community-Based Organizations/Non-profit; Local health department; HRSA-Geriatric Education
Center (GEC); Public Housing Primary Care; National Health Service Corp (NHSC) Site; HHS (US Department of Health and Human Services);
HHS-CDC (Centers for Disease Control and Prevention);HHS-HRSA (Health Resources and Services Administration); HHS-IHS (Indian Health
Service);HHS-NIH (National Institutes of Health ); Hospitals; Tribal Government; State Health Department; Other State Government; Other City
Government; Other County Government; Indian Health/Tribal Health Department; Other Federal Government; Veteran’s Administration (VA);
Health Care for the Homeless; Federally-qualified health center (FQHC – includes health care for the homeless; primary care public housing,
migrant health center, school-based health center, rural health clinic);Nursing Home; Other (specify).
Number of Trainees: Enter the number of trainees in each employment location per trainee profession.

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Table CE-2: Educational Offering Trainee Employment Settings
Table Purpose: To describe the employment locations of trainees in continuing education programs.
Does your program have data to report for employment of trainees in designated settings? Yes/No

Employment Settings of Trainees

Total Number of Trainees

Employment Setting in a Medically Underserved Community (MUC)
Employment Location in a Rural Setting

Supplemental funding for Alzheimer’s disease training (GEC only)

Employment Settings of Trainees

Total Number of Trainees

Employment Setting in a Medically Underserved Community (MUC)
Employment Location in a Rural Setting

Instructions: Each row represents one type of employment setting. Complete the table as described below for the reporting period only if your
program has data to report. The glossary contains clarifications and/or definitions of key terms.
Does your program have data to report for employment of trainees in designated settings? Select ‘Yes’ or ‘No’.
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Employment Setting in a Medically Underserved Community: Enter the total number of trainees that work in an employment setting located in
a Medically Underserved Community (MUC). For GEC program, do not double count trainees under supplemental funding for Alzheimer’s
Disease training.
Employment Location in a Rural Setting: Enter the total number of trainees that work in an employment setting located in a rural setting. For
GEC program, do not double count trainees under supplemental funding for Alzheimer’s Disease training.

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Diversity and Pipeline Program
Table DP-1 (1a.1, 1a.2): Diversity/Pipeline Content
Table purpose: To provide information about the training and trainee experiences, including the type of training received, program completion,
and subsequent acceptance into a health professions program.
DP-1a.1: Diversity/Pipeline/ Program Content

Diversity/ Length Education
Pipeline
of
Level
Program Program

(One per
Row)

(Select
one)

Program
Content

Partners

Public Clinical Practicum
Cultural
Total Attrition
Total
Health Training Training Competency Number
Program
Careers
Training
of
Completers
Content
Trainees
(HCOP,
(Select all
(AHEC (COE,
AHEC,
that
(Brief
(Select all only)
NWD)
COE)
apply) Description) that apply)
(Y/N)
(Y/N)
(Y/N)
(Y/N)

Instructions: Each row represents one Diversity/Pipeline program. Complete each column as described below for the reporting period. The
glossary contains clarifications and/or definitions of key terms.
U76/U77 AHEC Instruction: This table is applicable only for health careers enrichment/training activities.
Diversity/Pipeline Program: Select the Diversity/Pipeline program. If more than one program was offered, add additional rows to expand the
table to include all programs. Refer to the tables below for descriptions of the activities and definitions of the programs and activities offered by
Nursing Workforce Diversity (NWD) and), Health Careers Opportunity Program (HCOP), Centers of Excellence (COE) and Area Health
Education Centers (AHEC) programs - (See definition below).

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Program Activities and Definitions for NWD Program
NWD Activity

Definition

Summer Program
(Pre-entry Preparation)

A curriculum or set of activities for a minimum of 25 trainees per educational level that provides at least 20 hours
of structured learning activities per week for a minimum of 6 weeks.

Summer Program
(Academic Retention)
High School Academy

A curriculum or set of educational enrichment and academic support activities conducted during the academic
year for a minimum of 10 high school trainees that provides at least 8 hours of structured learning activities per
week for a minimum of 12 weeks.

Saturday Academy
(Pre-entry Preparation)

A curriculum or set of activities for a minimum of 25 trainees per educational level that provides at least 6 hours
of structured learning activities per day for a minimum of 20 Saturdays.

Saturday Academy
(Academic Retention)
Pre-matriculation

A curriculum or set of activities for a minimum of 10 diploma or associate degree RNs or pre-nursing trainees
that provides at least 8 hours of structured learning activities per week for a minimum of 4 weeks.

Nursing Preparation
Program
(Pre-entry Preparation)

A comprehensive, conditional admission program for a minimum of three diploma or associate degree RNs to gain
admission into a baccalaureate-level nursing program.

Nursing Preparation
Program
(Academic Retention)
Post Baccalaureate
Program

A comprehensive, conditional admission program for a minimum of three trainees with undergraduate degrees in
nursing to gain admission into a graduate nursing program.

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Definitions for HCOP Program
HCOP Program

Definition

Summer Program

A curriculum or set of activities for a minimum of 25 trainees per educational level that provides 6 hours of
structured learning activities per day for a minimum of 6 weeks.

Health Professions
Academy

A curriculum for a minimum of 25 trainees per grade level that integrates HCOP educational activities into existing
school settings. These programs offer trainees from disadvantaged backgrounds who are interested in health
professions advanced math and science education, health professions exposure activities, and mentoring and
counseling activities to increase their competitiveness to enter health and allied health professions programs. A
Health Professions Academy provides programming for 9th-12th grade trainees during the school year and is
designed as a multiyear intensive pipeline program that follows trainees throughout secondary education. Note: If
trainees are offered stipends to participate in a Health Professions Academy program, each trainee may only receive
12 months of stipend support.

Saturday Academy

A curriculum or set of activities for a minimum of 25 trainees per educational level (see ‘Definition’ in Section
VIII) that provides 6 hours of structured learning activities per day for a minimum of 20 Saturdays. These programs
offer educational enrichment and career support activities conducted on the weekend during the academic year for
participating trainees. These activities may include field trips to health professions schools or health care delivery
facilities, group study sessions, preparation for prerequisite examinations, shadowing, tutorial assistance, improving
test taking skills, career clubs, and volunteer efforts at health care delivery sites.

Pre-matriculation

A curriculum or set of activities for a minimum of 10 trainees per educational level that provides 6 hours of
structured learning activities per day for a minimum of 4 weeks. This program offers a summer program especially
designed to prepare HCOP matriculates for the rigors of the first year of professional school and to ease their
transition into the health professions curriculum.

Post-baccalaureate
Program

A comprehensive program for a minimum number of seven trainees for health professions school and five trainees
for allied health programs designed to facilitate the entry of disadvantaged trainees with an undergraduate degree
who have applied and been denied admission to a health or allied health professions school. The program should
include an initial diagnostic summer session, post-baccalaureate level academic year, pre-matriculation summer

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HCOP Program

Definition
session, academic counseling, tutoring, and psycho-social support. Trainees who successfully complete the
program requirements should be guaranteed admission into the health or allied health professions school.

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Definition for COE Program

COE Program

Definition

COE Program

A curriculum or set of activities of a specified length in which designated underrepresented minority (URM) COE
trainees (trainees and faculty members) enhance their academic performance and career development

Faculty Development
Program

A program that provides assistance in the recruitment, retention, training, and HRSA-funded financial support of
under-represented minority (URM) faculty, through career enhancement activities such as career and professional
development, curriculum development, mentorship trainings, leadership development, and interpersonal skills,
time, and stress management training. This can be accomplished in part by allowing the URM faculty participants
the necessary available time for development or expansion of their teaching, writing, mentorship, communication,
and research and leadership skills through various workshops, grant writing courses, mini-sabbaticals, cultural
competence training activities, and seminars pertaining to their faculty development and career goals.

Post-Baccalaureate
Conditional Admissions
Program

The purpose of these programs is to provide an avenue for eligible URM students to gain admission into designated
health professions schools. To be eligible for the program, a student should have an undergraduate degree and have
applied and been denied admission to a health professions school. Each program must select a cohort of at least
seven students for health professions schools, who- - providing they meet the program’s requirements- -will be
guaranteed admission into the health professions school, or admission into another health professions.

Pre-matriculation
Program

A 4- to 8- week summer program designed to prepare COE matriculants for the rigors of the first year of
professional school and to ease their transit into the health professions curriculum.

Saturday Academies

Educational enrichment and career support activities conducted on the weekend during the academic year for
participating URM students. These activities may include but are not limited to field trips to health professions
schools or health care delivery facilities, group study sessions, preparation for pre-requisite examinations,
shadowing, tutorial assistance, improving test taking skills, career clubs, volunteer efforts at health care delivery
sites, etc.

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Definitions for AHEC Program
AHEC Program

Definition

AHEC Health Careers
Enrichment Activities

A curriculum or set of educational enrichment and academic support activities of a specified length.

Length of Program: Select from the drop down:
Length of Time

Definition

0-39 hours

A curriculum or set of educational enrichment and academic support activities of a specified length.

40-79 hours

A curriculum or set of educational enrichment and academic support activities of a specified length.

80-119 hours

A curriculum or set of educational enrichment and academic support activities of a specified length.

120-179 hours

A curriculum or set of educational enrichment and academic support activities of a specified length.

≥180 hours

A curriculum or set of educational enrichment and academic support activities of a specified length.

Educational Level: Select the trainee’s highest educational level. If in a non-degree program (e.g. K-12; post-baccalaureate,
residencies/fellowships) select the highest degree earned.
Selections: Grades K-6; Grades 7-8; Grades 9-12; Post-high school/pre-college; Certificate; Two-year college/community college;
Associates; Diploma (Nursing); Four-year college; Bachelors; Twelve-month post-baccalaureate; Pre-matriculation/pre-graduate school;
Masters (MHA, MS, MSN, MSW, MPH, MSPH); Post-Masters Certificate; Doctorate (PhD, DNP, DNSc; DC, DPT); Post-Doctorate;
Resident; Fellow; Faculty member; Post-graduate; Medicine Doctor (M.D.); Doctor of Osteopathy (D.O.); Doctor of Dental Surgery
(D.D.S., D.M.D.); Doctor of Pharmacy (Pharm.D.); Doctor of Veterinary Medicine (D.V.M.); Doctor of Psychology (Psy.D.); Doctor of
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Public Health (Dr.P.H.), ScD (Doctor of Science), Doctor of Veterinary Medicine (D.V.M. or V.M.D.), Adult learner; Dislocated worker;
Other.
Describe Program Content: Enter a brief description of program content/activities. Descriptions may include but are not limited to the following
key words: Recruitment; Education and training; Counseling; Mentoring; Academic support services; Academic advising, tutoring, career
planning; Leadership training; Clinic tours/study trips; Health career clubs; Simulations, camps; Social media outreach; Health workforce
presentation; College success programs; Community service; Youth health service corps; Collegiate health service corps; Professional
development.
Partners: Selections: Elementary school; Middle school; High school; Two-year community college; Four-year undergraduate college/university;
Graduate school; Health professional school; Community-based entity; Health care provider; Other (specify).
AHEC Program (in addition to general selections): Workforce Investment Board/Department of Labor; Health Careers Opportunity
Program (HCOP); Community Health Center; National Health Service Corps; Veterans Health Administration; Indian Health Service;
Health Department; Federally Qualified Health Center (FQHC); Student/Resident Experiences in Community Health (SEARCH); Other
(specify).
Public Health Careers Content (AHEC program only): Indicate if public health careers content (e.g., information, materials, or experience
related to public health careers) was used (‘Yes’ or ‘No’).
Clinical Training (COE and NWD programs only): For each program, indicate if clinical training was used (‘Yes’ or ‘No’). For purposes of
this reporting, clinical training involves trainee-patient encounters.
Practicum Training (HCOP, AHEC, and COE programs only): Indicate if practicum training is used (‘Yes’ or ‘No’). For purposes of this
reporting, practicum training refers to practical experiences (not didactic or clinical) that are hands-on field training without clinical patient
encounters, such as shadowing and observations.
Cultural Competency Training: Indicate if the program provides cultural competency training (‘Yes’ or ‘No’).
Total Number of Trainees: Enter the total number of trainees in each program. Count trainees only once. Complete Table IND-GEN to describe
each trainee.
Attrition: Enter the total number of trainees who permanently left the program before program completion.
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Total Number of Program Completers: Enter the total number of trainees who completed the Diversity/Pipeline program. Count completers
only once. Complete Table IND-GEN to describe each completer.

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DP-1a.2: Diversity/Pipeline Practicum and Cultural Competency Training
If Yes to Practicum Training, Then…
Diversity/
Pipeline
Program
(Pre-populated
from DP-1a.1)

Length of
Program

(Prepopulated
from DP1a.1)

(exclude NWD)
MUC Training
Setting

Contact with
Underserved
Populations

(Y/N)

(Y/N)

Primary
Communit
Care Setting
y-Based
Setting
(Y/N)

(Y/N)

(Continuation of DP-1a.2)

If Yes to Cultural Competency Training, Then…
Didactic Training

Clinical Training

Practicum Training

Research Training

(Y/N)

(Y/N)

(NWD, COE)
(Y/N)

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(Y/N)

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Instructions: Each row represents one Diversity/Pipeline program identified in table DP-1a.1. Complete each column as described below for the
reporting period. The glossary contains clarifications and/or definitions of key terms.
If ‘Yes’ to Practicum Training, then:
MUC Training Setting: Indicate if practicum experiences were provided in a medically underserved community (MUC) (‘Yes’ or ‘No’).
If practicum training is not used, leave field blank or enter ‘N/A’. If left blank, system will populate the field with ‘N/A’ once form is
saved.
Contact with Underserved Populations: Indicate if practicum experiences involved contact with underserved populations (‘Yes’ or
‘No’). If practicum training is not used, leave field blank or enter ‘N/A’. If left blank, system will populate the field with ‘N/A’ once form
is saved.
Primary Care Setting: Indicate if practicum experiences occurred in a primary care setting (‘Yes’ or ‘No’). If practicum training is not
used, leave field blank or enter ‘N/A’. If left blank, system will populate the field with ‘N/A’ once form is saved.
Community-Based Setting: Indicate if practicum experiences occurred in a community-based setting (‘Yes’ or ‘No’). If practicum
training is not used, leave field blank or enter ‘N/A’. If left blank, system will populate the field with ‘N/A’ once form is saved.
If ‘Yes’ to Cultural Competency Training, then:
Didactic Training: Indicate if the program provides didactic training (‘Yes’ or ‘No’). For purposes of this reporting, training is
considered didactic if it involves traditional classroom or virtual education forums wherein trainees receive instruction from designated
faculty members and/or clinicians. If cultural competency training is not provided, leave field blank or enter ‘N/A’. If left blank, system
will populate the field with ‘N/A’ once form is saved.
Clinical Training: Indicate if the program provides cultural competency in a clinical training setting (‘Yes’ or ‘No’). For purposes of this
reporting, clinical training refers to trainee patient encounters. This column applies to NWD and COE programs. If cultural competency
training is not provided, leave field blank or enter ‘N/A’. If left blank, system will populate the field with ‘N/A’ once form is saved.
Practicum Training: Indicate if the program provides cultural competency in a practicum training setting (‘Yes’ or ‘No’). For purposes
of this reporting, practicum training refers to practical experiences (not didactic or clinical) that are hands-on, field training without

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clinical patient encounters, such as shadowing and observations. . This column applies to NWD, HCOP, COE, and AHEC. If cultural
competency training is not provided, leave field blank or enter ‘N/A’. If left blank, system will populate the field with ‘N/A’ once form is
saved.
Research Training: Indicate if the program provided cultural competency in a research training setting (‘Yes’ or ‘No’). For the purposes
Of this reporting, research training involves the supervision of trainees in conducting research in a clinical or academic environments.
Such training may involve literature reviews, development of data collection protocols, data collection, data analysis, results
interpretation or the dissemination of research findings. If cultural competency training is not provided, leave field blank or enter ‘N/A’. If
left blank, system will populate the field with ‘N/A’ once form is saved.

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Table OH-1: Oral Health Curriculum Content
Table purpose: To capture the key curriculum content areas, and the teaching and program strategies, addressed by the oral health training grant.

Oral Health Content Area

Required

Research

Didactic

Elective

Experiential

Research

Didactic

Experiential

Curriculum Content
Advocacy
Community-based service
Cultural competency
Curriculum development
Health Promotion and disease prevention
Informatics
Interprofessional integrated models of care
Oral health disparities
Oral health home
Oral health literacy
Pediatric population
Public health
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Oral Health Content Area

Required

Research

Didactic

Elective

Experiential

Research

Didactic

Experiential

Risk-based care
Special populations
Teledentistry
Quality improvement and patient safety
Other (specify)
Teaching and Program Strategies
Mentoring techniques
Grant writing
Peer teaching
Leadership development
Curriculum development
Innovative teaching strategies
Faculty recruitment and retention
Faculty development
Distance Learning
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Oral Health Content Area

Required

Research

Didactic

Elective

Experiential

Research

Didactic

Experiential

Other (specify)
Instructions: Complete each column for the appropriate content area as described below for the reporting period. The glossary contains
clarification and/or definitions of key terms. The Oral Health Content Area column is a list of curriculum content that the program might focus on.
In subsequent columns grantees can select how the content was delivered. Only respond to content areas in which you can provide additional
documentation. For example, only respond to delivery of content areas that you would be comfortable highlighting during a site visit from the
agency or information that could be used by the agency in identifying activities above and beyond standard curriculum content. For all selected
items, grantees must provide more detail in the progress or final report.
Required or Elective: Indicate if the training was required or elective using the following definitions: (1) Training in a required content area is
necessary for a trainee to complete the training program; and (2) Training in an elective content area is encouraged for trainees but is not a
requirement to complete the training program.
Mode: Indicate the mode of delivery for the appropriate content areas. Selections: didactic; experiential; and/or research. Use the following
definitions to make this determination: (1) training should be considered didactic if it involves traditional classroom or virtual education forums
wherein trainees receive instruction from a designated faculty members and/or clinicians; (2) experiential training encompasses the wide array of
clinical or field experience during which trainees are supervised in practice; and (3) research training generally involves the supervision of trainees
in conducting studies in clinical and/or academic environments. Such training may involve literature reviews, development of data collection
protocols, data collection, data analysis, results interpretation, and/or the dissemination of research findings.

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Geriatric Academic Career Award
Table GACA-1: Other Activities
Table purpose: To describe the additional development experiences of GACA Awardees, including their administrative and research experiences.
Table GACA-1: Geriatric Academic Career Award: Other Activities Descriptions
Type of Activity

Description of Activity

Administrative duties
Research activities
Publications and presentations
Other professional activities

Instructions: Each row represents a type of activity other than clinical training. Complete each column as described below for the reporting
period. The glossary contains clarifications and/or definitions of key terms. This table must be completed in the progress report.
Type of Activity: Briefly describe the type of activities using the definitions below.
Administrative duties - Committee and administrative assignments at the medical school or other facilities where GACA activities occurred.
Research activities - Any research activities in which the Awardee was involved with, including all educational research. Enter sponsors,
research titles, and grant numbers of any research grants from which the Awardee received support.
Publications and presentations - Any publications and formal presentations completed.
Other professional activities - Any professional association leadership roles, community activities, or memberships the Awardee was involved
in.
Description of Activity: Enter a description of the activity as defined above for all applicable.
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Comprehensive Geriatric Education Programs
Table CGEP-1 (1a, 1b): Comprehensive Geriatric Education Programs: Grant Purpose and Trainee Characteristics and Outcomes
Table purpose: To describe the number and type of trainees and trainee experiences, including knowledge gained and intent to practice by setting
and population served.
CGEP-1a: Purpose of Grant

CGEP Grant Purposes

Additional CGEP Tables

(Select all that apply)
CGEP-1 Provide training to individuals who will provide geriatric care for the elderly
CGEP-2 Develop and disseminate curricula relating to the treatment of the health problems of elderly individuals
CGEP-3 Train faculty members in geriatrics

IND-GEN; IND-INTPRAC
CE-1; CE-TTY; CE-2
CE-1; CE-TTY; CE-2; INDGEN; IND-FAC

CGEP-4 Provide continuing education to individuals who provide geriatric care

CE-1; CE-TTY; CE-2

CGEP-5 Establish traineeships for individuals preparing for advanced education nursing degrees in geriatric
nursing, long-term care, gero-psychiatric nursing, or other nursing areas that specialize in the care of the elderly
population

IND-GEN; CGEP-1b
(Attrition)

Instructions: Each row represents a purpose of the CGEP grant. Select each grant purpose as described below for the reporting period. Based on
the selected grant purpose(s), the appropriate tables will be displayed. The glossary contains clarifications and/or definitions of key terms.
Grant Purpose: Selections: CGEP-1 Provide training to individuals who will provide geriatric care for the elderly; CGEP-2 Develop and
disseminate curricula relating to the treatment of the health problems of elderly individuals; CGEP-3 Train faculty members in geriatrics; CGEP-4
Provide continuing education to individuals who provide geriatric care; and CGEP-5 Establish traineeships for individuals preparing for advanced

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education nursing degrees in geriatric nursing, long-term care, gero-psychiatric nursing, or other nursing areas that specialize in the care of the
elderly population.

CGEP-1b: Program Attrition

Attrition in Nursing School

Total Number:______

Attrition in the BHPr CGEP Program

Total Number:______

Instructions: This table is only to be completed for the CGEP-5 grant purpose. Each row represents a type of program attrition among trainees as
described below for the reporting period. The glossary contains clarifications and/or definitions of key terms.
Attrition in Nursing School: Enter the number of trainees who permanently left the nursing school program before completion.
Attrition in the BHPr CGEP Program: Enter the number of trainees who permanently left the CGEP program before completion.

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Geriatric Training Program for Physicians, Dentists, and Behavioral and Mental Health Professions
Table GTPD-1: Geriatric Training Program for Physicians, Dentists, and Behavioral and Mental Health Professions - Description of
Trainees and Completers
Table purpose: To describe the characteristics of program completers as well as their subsequent employment positions.
GTPD-1a: One-Year Retraining Programs
Did your program offer One-Year Retraining Programs? (Yes/ No)
Health Profession

Discipline

Number of Completers
Part-Time Faculty

populated

Full-Time Faculty

Total

populated

Total

Instructions: GTPD grantees that offered One-Year Retraining Programs should complete this table. Complete one row for each health profession
and discipline populated from the Health Profession and Disciplines – Setup form. The glossary contains clarifications and/or definitions of key
terms.
Health Profession:
Selections: Dentist; Medicine; Physician Assistant; Nursing; Behavioral Health/Public Health/Other;
Discipline/Specialty: Indicate the discipline.
Dentist Selections: FELLOWSHIP AND RESIDENCY PROGRAMS: Advanced Education In General Dentistry - AEGD 12 month
program (include optional 2nd year); AEGD 24 month program; Dental Public Health - DPH 12 month program; DPH 24 month
program; General Practice Residency - GPR 12 month program (include optional 2nd year); GPR 24 month program; Geriatric Dentistry;
Pediatric Dentistry (24 months);

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OTHER PROGRAMS: Dental Assistant; Dental Hygiene; General Dentistry; Pediatric Dentistry; MPH year-General Dentistry
(Master's in Public Health); MPH year-Pediatric Dentistry; MPH year-Public Health Dentistry; MPH year-Dental Hygiene, Public Health
Dentistry; Other (specify)
Medicine Selections: Aerospace Medicine; Allopathic Medicine, Alternative/Complementary Medicine; Behavioral/Mental Health In
School Of Medicine And Osteopathic Medicine; Chiropractic; Family Medicine; General Internal Medicine; General Pediatrics; General
Preventive Medicine; General Preventive Medicine/ Family Medicine; General Preventive Medicine/ Internal Medicine; General
Preventive Medicine/ Public Health; Geriatric Medicine; Geriatric Psychiatry; Integrative Medicine; Internal Medicine /General
Pediatrics; Internal Medicine/Family Medicine; Neurology; Obstetrics/Gynecology; Occupational Medicine; Osteopathic General
Practice; Pediatrics/Family Medicine; Pharmacy, Podiatry; Psychiatry; Radiology; Veterinary Medicine;
Physician assistants: Disciplines are not applicable (N/A).
Nursing: Alternative/Complementary Nursing; CNS-Adult gerontology; CNS-Family; CNS-Geropsychiatric; CNS-Neonatal; CNSPediatrics; CNS-Psychiatric/Mental health; CNS-Women’s health; Clinical Nurse Specialist (CNS); Home Health Aide; Licensed
Practical/Vocational Nurse (LPN/LVN); NP - Other advanced nurse specialists; NP - Psychiatric/Mental health; NP –Adult gerontology;
NP –Family; NP –Neonatal; NP –Pediatrics; NP –Women’s health; NP- Acute care adult gerontology; NP- Acute care pediatric; NPEmergency care; NP- Geropsychiatric; Nurse Administrator; Nurse Anesthetist; Nurse Assistant/Patient Care Associate (PCA); Nurse
Educator; Nurse Generalist; Nurse Midwife; Nurse Practitioner (NP); Nurse Researchers/Scientists; Nursing Informatics; Public Health
Nurse; Registered Nurse; Registered Nurse Student; Other (specify);
Behavioral Health/Public Health/Other Selections:
Behavioral Health Selection: Counseling Psychology; Clinical Psychology; Clinical Social Work;; Marriage and Family Therapy;
Pastoral/Spiritual Care; Other Psychology; Other Social Work, Substance Abuse/Addictions Counseling; Other (specify);
Public Health: Biostatistics; Biostatistics – Biometry; Community Health Worker Environmental Health; Environmental Health –
Environmental chemistry; Environmental Health – Environmental health planning; Environmental Health – Environmental sciences;
Environmental Health – Industrial hygiene; Environmental Health – Occupational safety and health; Environmental Health – Radiological
health; Environmental Health – Toxicology; Environmental Health – Water quality; Epidemiology; Geriatrics/Aging Populations
Global/International Health; Global/International Health – Tropical medicine; Health Education/Behavior; Health Education/Behavior –
Behavioral sciences; Health Education/Behavior – Community health sciences; Health Education/Behavior – Evaluation research; Health
Education/Behavior – Health behavior; Health Education/Behavior – Health promotion/disease prevention; Health Services Research;
Health Services/Hospital Administration; Health Services/Hospital Administration – Health management; Health Services/Hospital
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Administration – Health planning; Health Services/Hospital Administration – Hospital administration; Maternal & Child Health; Maternal
& Child Health – Adolescent health; Maternal & Child Health – Infant and child health; Maternal & Child Health – Women’s health;
Nutrition; Nutrition – Dietetics; Nutrition – Public health nutrition; Occupational Health; Public Health (General Studies); Public Health
Practice; Public Health Practice – Community health practice; Public Health Practice – Program management; Urban Health; Veterinary
Science – Veterinary public health; Other (specify);
Other: Audiology; Bio-Engineering; Biomedicine; Biomedicine - Biochemistry; Biomedicine - Cancer biology; Biomedicine Immunology; Biomedicine - Microbiology; Biomedicine - Parasitology; Biomedicine - Pathobiology; Biomedicine - Biomedical and
Laboratory Sciences; Clinical Laboratory Worker; Clinical Researcher; EMT-Paramedic/First responder; Extended Care Administrator;
Forensic Science; Genetics; Health Information Systems/Data Analysis; Health Policy/Law; Lactation Consultant; Long-Term Care
Administration; Occupational Therapy; Occupational Therapy – Occupational therapy assistant; Optometry; Pharmacy; Physical Therapy;
Physical Therapy – Physical therapy assistant; Radiologic Services; Respiratory Therapy; Speech/Language Pathology; Other (specify);
Number of Part-Time Faculty Members: Enter the number of faculty completers with part-time status for each category of health professional.
Count trainees once
Number of Full-Time Faculty Members: Enter the number of faculty completers with full-time status for each category of health professional.
Count trainees once
Total Number of Completers: Calculated. Sum of full-time and Part-Time Faculty Members.

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GTPD-1b: Two-Year Fellowship Programs
Did your program offer two-year fellowship program? Yes/No
Health
profession

Discipline

Number of Enrollees
Attained Part- Attained Fulltime Academic Time Academic
Appointment
Appointment

populated

Number of Completers
Total

Attained PartTime
Academic
Appointment

Attained Fulltime Academic
Appointment

Total

populated

Total

Instructions: GTPD grantees that offered Two-Year Fellowship Programs should complete this table. Complete one row for each health
profession populated from the Health Profession and Disciplines – Setup form.. The glossary contains clarifications and/or definitions of key
terms.
Health Profession:
Selections: Dentist; Medicine; Physician Assistant; Nursing; Behavioral Health/Public Health/Other;
Discipline/Specialty: Indicate the discipline.
Dentist Selections: FELLOWSHIP AND RESIDENCY PROGRAMS: Advanced Education In General Dentistry - AEGD 12 month
program (include optional 2nd year); AEGD 24 month program; Dental Public Health - DPH 12 month program; DPH 24 month
program; General Practice Residency - GPR 12 month program (include optional 2nd year); GPR 24 month program; Geriatric Dentistry;
Pediatric Dentistry (24 months);
OTHER PROGRAMS: Dental Assistant; Dental Hygiene; General Dentistry; Pediatric Dentistry; MPH year-General Dentistry
(Master's in Public Health); MPH year-Pediatric Dentistry; MPH year-Public Health Dentistry; MPH year-Dental Hygiene, Public Health
Dentistry; Other (specify)

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Medicine Selections: Aerospace Medicine; Allopathic Medicine, Alternative/Complementary Medicine; Behavioral/Mental Health In
School Of Medicine And Osteopathic Medicine; Chiropractic; Family Medicine; General Internal Medicine; General Pediatrics; General
Preventive Medicine; General Preventive Medicine/ Family Medicine; General Preventive Medicine/ Internal Medicine; General
Preventive Medicine/ Public Health; Geriatric Medicine; Geriatric Psychiatry; Integrative Medicine; Internal Medicine /General
Pediatrics; Internal Medicine/Family Medicine; Neurology; Obstetrics/Gynecology; Occupational Medicine; Osteopathic General
Practice; Pediatrics/Family Medicine; Pharmacy, Podiatry; Psychiatry; Radiology; Veterinary Medicine;
Physician assistants: Disciplines are not applicable (N/A).
Nursing: Alternative/Complementary Nursing; CNS-Adult gerontology; CNS-Family; CNS-Geropsychiatric; CNS-Neonatal; CNSPediatrics; CNS-Psychiatric/Mental health; CNS-Women’s health; Clinical Nurse Specialist (CNS); Home Health Aide; Licensed
Practical/Vocational Nurse (LPN/LVN); NP - Other advanced nurse specialists; NP - Psychiatric/Mental health; NP –Adult gerontology;
NP –Family; NP –Neonatal; NP –Pediatrics; NP –Women’s health; NP- Acute care adult gerontology; NP- Acute care pediatric; NPEmergency care; NP- Geropsychiatric; Nurse Administrator; Nurse Anesthetist; Nurse Assistant/Patient Care Associate (PCA); Nurse
Educator; Nurse Generalist; Nurse Midwife; Nurse Practitioner (NP); Nurse Researchers/Scientists; Nursing Informatics; Public Health
Nurse; Registered Nurse; Registered Nurse Student; Other (specify);
Behavioral Health/Public Health/Other Selections:
Behavioral Health Selection: Counseling Psychology; Clinical Psychology; Clinical Social Work;; Marriage and Family Therapy;
Pastoral/Spiritual Care; Other Psychology; Other Social Work, Substance Abuse/Addictions Counseling; Other (specify);
Public Health: Biostatistics; Biostatistics – Biometry; Community Health Worker Environmental Health; Environmental Health –
Environmental chemistry; Environmental Health – Environmental health planning; Environmental Health – Environmental sciences;
Environmental Health – Industrial hygiene; Environmental Health – Occupational safety and health; Environmental Health – Radiological
health; Environmental Health – Toxicology; Environmental Health – Water quality; Epidemiology; Geriatrics/Aging Populations
Global/International Health; Global/International Health – Tropical medicine; Health Education/Behavior; Health Education/Behavior –
Behavioral sciences; Health Education/Behavior – Community health sciences; Health Education/Behavior – Evaluation research; Health
Education/Behavior – Health behavior; Health Education/Behavior – Health promotion/disease prevention; Health Services Research;
Health Services/Hospital Administration; Health Services/Hospital Administration – Health management; Health Services/Hospital
Administration – Health planning; Health Services/Hospital Administration – Hospital administration; Maternal & Child Health; Maternal
& Child Health – Adolescent health; Maternal & Child Health – Infant and child health; Maternal & Child Health – Women’s health;
Nutrition; Nutrition – Dietetics; Nutrition – Public health nutrition; Occupational Health; Public Health (General Studies); Public Health
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Practice; Public Health Practice – Community health practice; Public Health Practice – Program management; Urban Health; Veterinary
Science – Veterinary public health; Other (specify);
Other: Audiology; Bio-Engineering; Biomedicine; Biomedicine - Biochemistry; Biomedicine - Cancer biology; Biomedicine - Immunology;
Biomedicine - Microbiology; Biomedicine - Parasitology; Biomedicine - Pathobiology; Biomedicine - Biomedical and Laboratory Sciences;
Clinical Laboratory Worker; Clinical Researcher; EMT-Paramedic/First responder; Extended Care Administrator; Forensic Science; Genetics;
Health Information Systems/Data Analysis; Health Policy/Law; Lactation Consultant; Long-Term Care Administration; Occupational Therapy;
Occupational Therapy – Occupational therapy assistant; Optometry; Pharmacy; Physical Therapy; Physical Therapy – Physical therapy assistant;
Radiologic Services; Respiratory Therapy; Speech/Language Pathology; Other (specify);Number of Enrollees:
Attained Part-Time Academic Appointment: Enter the number of trainees who attained part-time academic appointment.
Attained Full-Time Academic Appointment: Enter the number of trainees who attained full-time academic appointment.
Total: Total numbers will calculate automatically.
Number of Completers :
Attained Part-Time Academic Appointment: Enter the number of trainees who attained part-time academic appointment.
Attained Full-Time Academic Appointment: Enter the number of trainees who attained full-time academic appointment.
Total: Total numbers will calculate automatically.

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Geriatric Education Centers
Table GEC-1: Geriatric Education Centers - Identify Evidence-Based Practice
Table purpose: To describe the evidence-based practices that were offered by GECs and the number and type of providers involved.
Table GEC-1: Descriptions of Evidence-Based Practices
Evidence-Based Practice

Level of Practice

Primary Discipline

(Select one)

(Select all that apply)

(Select one)

Number of Providers
Other Disciplines:
in Primary Discipline Number of Providers in
Other Discipline

(Select all that apply)

Instructions: Each row represents each level of practice for the evidence-based practice. Complete each column as described below for the
reporting period. The glossary contains clarifications and/or definitions of key terms.
Evidence-Based Practice (EBP): Selections: Delirium; Depression; Diabetes; Falls prevention; Palliative care.
Level of Practice: Selections: Assessment; Intervention.
Primary Discipline: Selections: Medicine; Nursing; Social work; Physical therapy; Pharmacy; Psychology; Public health; Dentistry;
Occupational therapy; Speech language pathology; Allied health.
Number of Providers in Primary Discipline: For each level of practice, enter the number of providers in the primary discipline who were trained
to implement the EBP.
Other Disciplines: For each level of practice, select any additional disciplines which implement the EBP. Selections: See discipline selections
above.
Number of Providers in Other Disciplines: For each level of practice, enter the number of providers in the other disciplines trained to implement
the EBP
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Table GEC-2: Geriatric Education Centers: Implementation of Evidence-Based Practice
Table purpose: To describe the practice settings in which the evidence-based practices were offered and the patient sample.
Table GEC-2: Practice Settings Descriptions
EvidenceLevel of Primary # of Sites # of Providers
Based Practice Practice Practice
Implementing
Setting
EBP
(Select one)

(Select
one)

(Select
one)

Pre-training
# of Patients
Received EBP
Assessment or
Intervention

Total Patient
Sample

(Baseline)

(Baseline)

Post-training
# of Patients
Received EBP
Assessment or
Intervention

Total
Patient
Sample

Percentage
of Change
in Practice
(%)
(AutoCalculated)

Instructions: Each row represents a primary practice setting. Complete each column as described below for the primary practice setting in which
evaluation of the EBP implementation was conducted. Grantees should communicate with their project officer for specific reporting periods for
EBP assessment or intervention. The glossary contains clarifications and/or definitions of key terms.
Evidence-Based Practice:
Selections: Delirium; Depression; Diabetes; Falls prevention; Palliative care. Selections should match EBPs as reported in GEC-1.
Identify Level of Practice:
Selections: Assessment; Intervention. Selections should match level of practice for each EBP as reported in GEC-1. (If Assessment and
Intervention are both selected in GEC-1 then both Assessment and Intervention must be completed on GEC-2)
Primary Practice Setting:
Selections: Assisted living; Continuing care retirement community; Ambulatory care; Hospice; Nursing home; Home care; Hospital;
Senior center; Other (specify).
Number of Sites : Enter the number of sites per primary practice setting.
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Number of Providers Implementing EBP: Enter the number of providers in the primary discipline implementing evidence-based practices.
Pre-training: Number of Patients Received EBP Assessment or Intervention: Enter the number of patients receiving EBP assessment or
intervention during a single incident before the training. Count only one assessment or intervention per patient.
Pre-training: Total Patient Sample: Enter the total number of patients in the sample (i.e., the number of patients considered appropriate for use
of the EBP) before the training.
Post-training: Number of Patients Received EBP Assessment or Intervention: Enter the number of patients receiving the EBP assessment or
intervention during a single incident after the training was completed. Count only one assessment or intervention per patient.
Post-training: Total Patient Sample: Enter the total number of possible patients in the sample (i.e., the number of patients considered
appropriate for use of the EBP) after the training.
Percentage of Change in Practice: This column will automatically calculate based on data entered in previous cells using the following formula:
([post-training with EBP divided by post-training sample] minus [pre-training with EBP divided by pre-training sample]) multiplied by 100.

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Table PHTC-1 (1a, 1b): Public Health Training Centers: Partnership Accreditation Activities
Table purpose: To identify the formal and informal partnership agreements in place within each training center.
PHTC- 1a: Partnerships
Partner

Agreement Type
(select all that apply)

Academic department
CDC program
Other HRSA program-GEC
Other HRSA program- AHEC
Other HRSA program- NEPQR
Other HRSA program- CGEP
Other HRSA program- HCOP
Other HRSA program- PHTC
State health department
Local health department
State public health association
Other Federal program
Other (specify)
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Instruction: Please indicate partners with whom you have informal and/or formal agreement by selecting options under Agreement Type column.
The glossary contains clarifications and/or definitions of key terms.
Agreement Type: Selections: Formal; Informal

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PHTC-1b: Accreditation Activities
Instruction: Please answer the question below and provide required data. The glossary contains clarifications and/or definitions of key terms.
Has your PHTC provided training to assist local health departments prepare for Public Health Accreditation Board (PHAB) accreditation? (Yes/
No)
If yes, please select activities or collaborations with a local health department that is intended to assist in meeting criteria for accreditation.
Accreditation activity
1.

Assessment of learning needs of health department staff.

2.

Development of continuing education to meet the identified needs.

3.

Provision of onsite workshops/continuing education.

4.

Consultation for collaborative projects between academia and public health practice.

5.

Provision of educational programs that meet the identified needs through distance learning.

6.

Preparation of public health personnel to prepare for sitting for the public health certification examination.

7.

Assistance with program evaluation design.

8.

Other (specify)

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Preventive Medicine Residency
Table PMR-1: Preventive Medicine Residency - Curriculum Content
Table purpose: To capture the characteristics of the training curriculum content as well as how the content was delivered to PMR trainees.
Select: Discipline (Complete a separate table for each discipline selected in the Health Profession and Disciplines – Setup form.)
Training Content Areas

(Curriculum Content)

Required

Research

Didactic

Elective

Experiential

Research

Didactic

Experiential

Aerospace medicine
Clinical preventive services
Communicable diseases
Community health
planning/assessments
Cultural Competencies
Disease prevention/health promotion
Environmental health

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Epidemiology
Evidence-based medicine
Food safety and inspection
Health administration and management
Health communications (media)
Health disparities reduction
Injury prevention
Leadership advocacy
Occupational medicine
Policy development/analysis
Program planning and evaluation
Public health systems and services
research
Quality improvement/assurance
Risk assessment and communication

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Surveillance
Other (Specify)

Instructions: Complete each column for the appropriate content area as described below for the reporting period. The glossary contains
clarification and/or definitions of key terms.
Discipline: Selections: Aerospace; General preventive medicine/public health; General preventive medicine/occupational medicine ;
Occupational ; Preventive medicine/internal medicine ; Other (specify).
The Training Content Area column is a list of curriculum content that the program might focus on. In subsequent columns grantees can select
how the content was delivered. Only respond to content areas in which you can provide additional documentation. For example, only respond to
delivery of content areas that you would be comfortable highlighting during a site visit from the agency or information that could be used by the
agency in identifying activities above and beyond standard curriculum content. For all selected items, grantees must provide more detail in the
progress or final report.
Required or Elective: Indicate if the training was required or elective using the following definitions: (1) Training in a required content area is
necessary for a trainee to complete the training program; and (2) Training in an elective content area is encouraged for trainees but is not a
requirement to complete the training program.
Mode: Indicate the mode of delivery for the selected content area. Selections: didactic; experiential; and/or research. Use the following
definitions to make this determination: (1) training should be considered didactic if it involves traditional classroom or virtual education forums
wherein trainees receive instruction from a designated faculty members and/or clinicians; (2) experiential training encompasses the wide array of
clinical or field experience during which trainees are supervised in practice; and (3) research training generally involves the supervision of trainees
in conducting studies in clinical and/or academic environments. Such training may involve literature reviews, development of data collection
protocols, data collection, data analysis, results interpretation, and/or the dissemination of research findings.

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Pre-doctoral Training in General, Pediatric, and Public Health Dentistry and Dental Hygiene
Table PD-1: Pre-doctoral Training in General, Pediatric, and Public Health Dentistry and Dental Hygiene- Supply of Pre-doctoral Oral
Health Providers
Table purpose: To describe the number and type of trainees with and without direct BHPr support and trainee and graduate experiences, including
postgraduate enrollment in residency programs.
Table PD-1: Aggregate Data for Oral Health Pre-doctoral Program
Enter Degree (Select one)
Focus Area (Select one)

Type of Trainee Number of
Trainees

Number of
Trainees
Receiving
Financial
Support/Tuition
Assistance

Attrition

Number of
Graduates

Number of
Number of
Graduates
Graduates
Who Applied Accepted into
to Residency
Residency
Programs
Programs

Number
Graduates
Who
Enrolled in
Residency
Programs

Number of
Graduates
in the Same
Focus Area
for
Residency

Total Trainees
URM Trainees
Rural
Backgrounds
Disadvantaged
Backgrounds

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Instructions: Complete this table for all trainees supported by the grant. Each row represents a type of trainee. Complete each column as
described below for the reporting period. The glossary contains clarification and/or definitions of key terms. Complete a separate table for each
combination of degree and focus area.
Degree: Select the degree program.
Selections: Associate’s degree/certificate (dental hygiene); Bachelor’s degree (dental hygiene); Master’s Degree (MPH, dental therapist);
Bachelor’s degree/MPH; DDS (DMD)/MPH (dual);DDS/DMD. Select “Other” if the appropriate degree program is not provided.
Focus Area: Select the focus area.
Selections: Dental hygiene (includes dental therapy); General dentistry; Pediatric dentistry; Public health dentistry;.
Type of Trainee: Trainees may be counted in more than one category (URM, rural, or disadvantaged) but should only be counted once for “Total
Trainees”.
Total Trainees: total number of trainees in the pre-doctoral program. Count trainee only once.
URM Trainees: underrepresented minority (URM) trainees.
Rural Backgrounds: trainees from a rural background.
Disadvantaged Backgrounds: trainees from disadvantaged backgrounds.
Provide information in the remaining columns for each trainee type.
Number of Trainees: Enter the number of trainees enrolled in the pre-doctoral program for each type of trainee. .
Number of Trainees Receiving Financial Support/Tuition Assistance: Enter the number of trainees who received direct financial support from
the Predoctoral Training grant during the reporting period. For the purposes of this reporting, financial support refers to tuition support and
stipends. Complete Table PD-1b.
Attrition: Enter the number of trainees who permanently left the program before completion.
Number of Graduates: Enter the number of trainees who graduated from the program.

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Number of Graduates Who Applied to Residency Programs: Enter the number of graduates who applied to residency programs. This field does
not apply to dental hygiene programs (Leave field blank or enter ‘N/A’. If left blank, system will populate the field with ‘N/A’ once form is
saved.). Count graduates only once.
Number of Graduates Accepted into Residency Programs: Enter the number of graduates who were accepted into any residency program. This
field does not apply to dental hygiene programs (Leave field blank or enter ‘N/A’. If left blank, system will populate the field with ‘N/A’ once
form is saved.). Count graduates only once.
Number of Graduates Who Enrolled in Residency Programs: Enter the number of graduates who enrolled in a residency program. This field
does not apply to dental hygiene programs (Leave field blank or enter ‘N/A’. If left blank, system will populate the field with ‘N/A’ once form is
saved.). Count graduates only once.
Number of Graduates in the Same Focus Area for Residency: Enter the number of graduates who enrolled in the same residency focus area as
the focus area listed in the pre-doctoral training degree/focus combination. This field does not apply to dental hygiene programs (Leave field blank
or enter ‘N/A’. If left blank, system will populate the field with ‘N/A’ once form is saved.). Count graduates only once.

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Post-doctoral Training in General, Pediatric, and Public Health Dentistry
Table PYPDD-1: Oral Health Post-doctoral Training Program: Prior Academic Year Individual Completer Outcome Data
Table Purpose: To describe post training practices and settings of trainees.
Trainee
Unique
ID

Did
Trainee
Complete
the
Program?

(Y/N)

Did the
In what
Completer
Professional
Enter an Oral
Settings
Health
does the
Profession in
Completer
the Same
Practice?
Discipline as His
or Her
Program?
(Select all
(Y/N)
that apply)

% of Time per Reporting Period the Completer Spends Providing or Supervising
Clinical Services per Clinical Setting
Rural
Communities

Dental HPSAs

Federally
Qualified
Health
Centers

Area Health
Education
Centers

Total
(Automatically
calculated)

Continuation of PYPDD-1
Identify Vulnerable
Populations the
Completer spent
more than 50% of
Time Servicing

Patient Population Served by Insurance Coverage
Medicare

CHIP

Uninsured

Private Insurance

Other

(Select all that
apply)

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Instructions: Each row represents one trainee from the prior academic year. Complete each column as described below for the reporting period.
The glossary contains clarification and/or definitions of key terms. Include only trainees in fellowship and residency programs including master
years in public health.
Trainee Unique ID: Enter a seven-digit unique identifier for each trainee. Use each trainee’s unique ID consistently in all reports, including PDD-1b,
throughout the duration of the grant.
Did Trainee Complete the Program? Indicate whether the trainee completed the program (‘Yes’ or ‘No’).
Did the Program Completer Enter an Oral Health Profession in the Same Discipline as His or Her Program? Indicate whether each program
completer entered an oral health profession in the same discipline (general, pediatric, or public health dentistry) as their post-doctoral program (‘Yes’
or ‘No’). If the trainee did not complete the program, leave field blank or select ‘N/A’. If left blank, system will populate the field with ‘N/A’ once
form is saved.
In What Professional Settings Does the Program Completer Practice? (Select all that apply): Select the professional setting(s) for each
program completer.
Selections: Dental faculty; Direct clinical service; Federal, state, or local government; Program or policy development; Research; Select
“Other” if the appropriate setting is not provided and enter the professional setting(s) that apply to the program completer. Select all that
apply. For example, if a program completer is both an adjunct faculty member and also provides clinical services at a community health
center check both “Direct clinical service” and “Dental faculty.” If the trainee did not complete the program, leave field blank or select
‘N/A’. If left blank, system will populate the field with ‘N/A’ once form is saved.
% of Time per Reporting Period the Completer Spends Providing or Supervising Clinical Services per Clinical Setting: Enter the percentage
of time the program completer spends in each setting listed. Settings include: Area health education centers (AHEC); Dental HPSAs; Federally
qualified health centers (FQHC); Rural communities. Calculate the percentage based on a full-time equivalent. For example, if a program completer
only works half time (50 percent) and spends 50 percent of that time providing services in a dental HPSA, then the percentage time entered for
“Dental HPSA” is 25%.
Identify Vulnerable Populations the Completer spent more than 50% of Time Servicing : Select all the vulnerable populations where the
completer spent more than 50% of time providing or supervising clinical services. Vulnerable populations include Adolescents; Children;
Chronically ill; College students; Homeless individuals; Individuals with HIV/AIDS; Individuals with mental health or substance abuse disorders;
Migrant workers; Military and/or military families; Older adults; People with disabilities; Pregnant women and infants; Unemployed; Returning war
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veterans (Iraq or Afghanistan); Veterans; Victims of abuse or trauma. Calculate the percentage based on a full-time equivalent. For example, if a
program completer only works half time (50 percent) and spends 50 percent of that time providing services to clients with HIV/AIDS, then the
percentage of time entered for “Individuals with HIV/AIDS” should only be 25%. If the trainee did not complete the program, leave field blank or
select ‘N/A’. If left blank, system will populate the field with ‘N/A’ once form is saved.
Patient Population Served by Insurance Coverage: Enter the percentage range of the patient population served by the program completer with
each of the following types of insurance coverage: CHIP; Medicare; Private insurance; Uninsured; Other.
Selections: Less than 5%; 6–25%; 26–50%; 51–75%; or 76–100%. If the trainee did not complete the program, leave field blank or select
‘N/A’. If left blank, system will populate the field with ‘N/A’ once form is saved.

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Faculty Development in General, Pediatric, and Public Health Dentistry and Dental Hygiene
Table FDD-1 (1a, 1b): Oral Health Faculty Development Supply- Faculty Development in General, Pediatric, and Public Health Dentistry
and Dental Hygiene
Table purpose: To describe the faculty trainees and program outcomes, including subsequent teaching status.
FDD-1a.1: Current Faculty Trainees
Health
Profession

Field of
Study

(One per
row)

(One per
row)

Total
Number Number of
Number of of URM
Trainees
Faculty
from Rural
Trainees
Background

Number of
Trainees from
Disadvantaged
Background

Number of
Graduates

Number of
Graduates
Who Will
Continue to
Teach

Number of
Completers

Number of
Completers
Who Will
Continue to
Teach

Instructions: Each row represents an oral health faculty development program that trains current faculty members. Complete each column in the
row as described below for the reporting period. The glossary contains clarification and/or definitions of key terms.
Health Profession: Select each type of oral health profession trained per program.
Selections: Dentist; Dental hygienist.
Field: For each health profession, select the field of dentistry as it applies to the program.
Selections: Dental Hygiene; General dentistry; Pediatric dentistry, Public Health dentistry;. If more than one field of study is offered, add
additional rows as necessary.
Total Number of Faculty Trainees: Enter the total number of faculty trainees per field of study. Count trainees only once.
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Number of URM: Enter the number of Underrepresented Minority (URM) faculty members.
Number of Trainees from a Rural Background: Enter the number of trainees from a rural background.
Number of Trainees from a Disadvantaged Background: Enter the number of trainees from a disadvantaged background.
Number of Graduates: Enter the total number of graduates who are faculty members.
Number of Graduates Who Will Continue to Teach: Enter the number of graduates who will continue to teach for three years.
Number of Completers: Enter the total number of completers who are faculty members.
Number of Completers Who Will Continue to Teach: Enter the number of completers who will continue to teach for three years.

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FDD-1a.2: Current Faculty Trainees per Training Type
Health
Profession

Field of Study

Training Offered

(populated)
(populated)

Type

Topic

Number of
Trainees

Number of
Hours

Health Profession: These values are prepopulated from FDD1a.1.
Field: These values are prepopulated from FDD1a.1
Training Offered: Enter the following information per field of study:
Type of Training: Select one type of training offered. Selections: PhD; DrPH; DNP; PsyD; ScD; Master’s degree; Certificate course;
Continuing education course; Mini-residencies; Case studies; Clinical; Fellowship. If more than one type of training is offered, add
additional rows
Topic of Training: Select one topic for the training offered. Topics may include: fellowship in AEGD, Master of Public Health, and other
topics.
Number of Trainees: Enter the number of trainees for the type of training selected.
Number of Hours: Enter the approximate number of hours completed for the type of training by the trainee.
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FDD-1b.1: Trainees Not Current Faculty
Health
Profession

(One per
row)

Field of
Study

Total
Numbe Number of Number of
Number Number Number of Number of
Number
r of
Trainees
Trainees
of
of
Completers Completers
of Non
URM from Rural
from
Graduates Graduates
Hired to
Faculty
Backgroun Disadvantage
Hired to
Teach
Trainees
d
d
Teach
(One per
Background
row)

Instructions: Each row represents an oral health faculty development program that trains health professionals who are not current faculty
members. Complete each column as described below for the reporting period. The glossary contains definitions of key terms.
Health Profession: Select each type of oral health profession trained per program. Selections: Dentist; Dental hygienist; Resident.
Field of Study: For each health profession, select the field of study as it applies to the program. Selections: General dentistry; Pediatric dentistry;
Public health dentistry; Dental Hygiene. If more than one field of study is offered, add additional rows.
Total Number of Non-faculty Trainees: Enter the number of non-faculty trainees per field of study. Count trainees only once.
Number of URM: Enter the number of non-faculty underrepresented minority trainees.
Number of Trainees from a Rural Background: Enter the number of non-faculty trainees from a rural background.
Number of Trainees from a Disadvantaged Background: Enter the number of non-faculty trainees from a disadvantaged background.
Number of Graduates: Enter the total number of graduates who are not faculty members.
Number of Graduates Hired to Teach: Enter the number of non-faculty graduates who were hired to teach in an educational institution.
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Number of Completers: Enter the total number of completers who are not faculty members.
Number of Completers Hired to Teach: Enter the number of non-faculty completers who were hired to teach in an educational institution.

FDD-1b.2: Trainees Not Current Faculty Per Training Type
Health
Profession

Field of Study

Training Offered

(populated)
(populated)

Type

Topic

Number of
Trainees

Number of
Hours

Health Profession: These values are prepopulated from FDD1b.1.
Field: These values are prepopulated from FDD1b.1
Training Offered: Enter the following information per field of study:
Type of Training: Enter the type of training offered. Selections: PhD; DrPH; ScD; PsyD; DNP; Master’s degree; Certificate course;
Continuing education course; Mini-residencies; case studies; Clinical; Fellowship.
Topic of Training: Enter the topic of the training offered for the training type selected. Topics may include: Master of Public Health,
fellowship in AEGD, and other topics.
Number of Trainees: Enter the number of trainees for the type of training.
Number of Hours: Enter the number of hours for the type of training.

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Table FDD-2: Oral Health Faculty Development - Curriculum Content
Table purpose: To describe the training content offered by oral health faculty development programs and trainee experiences.
Training
Type

Training
Description

Delivery
Mode

Number of
Instruction
Hours

(Select up to two) (Select all
that apply)

Percentage of
Trainees Who
Received
Interprofessional/
Interdisciplinary
Education

Number of Trainees Who
Received Experiential Training
in Community-Based Settings

Vulnerable/
Special
Populations
(Select all
that apply)

Instructions: Each row represents one oral health faculty development training program as identified in Table FDD 1a and 1b. Complete each
column as described below for the reporting period. The glossary contains clarification and/or definitions of key terms.
Training Type: Select all types of training offered that were selected in FDD-1a.2 and FDD-1b.2.
Selections: PhD; DrPH; ScD; PsyD; DNP; Master’s degree; Certificate course; Continuing education course; Mini-residencies; Case
studies; Clinical; Fellowship. If more than one type of training is offered, add additional rows.
Training Description: Selections: Community-based care; Care of vulnerable populations; Cultural competencies; Dental critical areas; Distance
learning; Hospital dentistry; health promotion and disease prevention; informatics; Interdisciplinary; Interprofessional integrated models of care;
Leadership; Public health; Pediatric dentistry; quality improvement and patient safety; Research methods; Teaching methodology; “Other”
(specify the topic).
Delivery Mode: Select the main mode of training delivery.
Selections: Didactic; Clinical/experiential; Research. For purposes of this reporting, use the following definitions of the training delivery
modes: (1) training should be considered didactic if it involves traditional classroom or virtual education forums wherein trainees receive
instruction from a designated faculty members and/or clinicians; (2) experiential training encompasses the wide array of clinical or field
experience during which trainees are supervised in practice; and (3) research training generally involves the supervision of trainees in
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conducting studies in clinical and/or academic environments. Such training may involve literature reviews, development of data collection
protocols, data collection, data analysis, results interpretation, and/or the dissemination of research findings.
Number of Instruction Hours (non-degree programs only): Enter the total number of instruction hours completed for the specific type and
description of training.
Percentage of Trainees Who Received Interprofessional/Interdisciplinary Education: For each type of training, enter the percentage of
trainees who received interprofessional/interdisciplinary education through the combination of the training delivery modes selected.
Number of Trainees Who Received Experiential Training in Community-Based Settings: For each type of training, enter the number of
trainees who received experiential training in a community-based setting.
Vulnerable Populations Served:
Selections: Adolescents; Children; Chronically ill; College students; Homeless individuals; Individuals with HIV/AIDS; Individuals with
mental health or substance abuse disorders; Migrant workers; Military and/or military families; Older adults; People with disabilities;
Pregnant women and infants; Unemployed; Returning war veterans (Iraq or Afghanistan); Veterans; Victims of abuse or trauma; Other.
.

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State Oral Health Workforce Program (SOWHP)
Table SOHWP-0 State Oral Health Workforce Legislative Activities
Table purpose: To describe the types of legislative activities provided by the State Oral Health Workforce Program (SOHWP) grantees and the
most innovative components of the activities.
Total Number of Dentists

Source of 40% Match

Single Most Innovative
Component of Your Grant

Legislative Activity Undertaken

in State
(Drop down)

(Select all that apply)
(Text box)

(Select all that apply)

Instructions: All grantees will be required to complete this table. Complete each column in the row as described below for the reporting period.
The glossary contains definitions of key terms.
Total Number of Dentists in State: Enter the number of dentists licensed in the State.
Source of 40% Match: Select from where your grant’s 40 percent match came. Selections: State funds; Private, non-profit; In-kind; Donations. If
the appropriate match source is not provided, select “Other” and specify.
Single Most Innovative Component of Your Grant: Enter a brief description of the most innovative part of your grant.
Legislative Activity Undertaken: Select the applicable legislative activities undertaken, or to be undertaken, with the grant funds using one or
more of the thirteen descriptions below.
1. Loan forgiveness and repayment programs for dentists
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2. Dental recruitment and retention efforts
3. Grants and low-interest or no-interest loans to help dentists who participate in the Medicaid program under Title XIX of the Social
Security Act to establish or expand practices in designated dental health professional shortage areas
4. The establishment or expansion of dental residency programs in coordination with accredited dental training institutions in States without
dental schools
5. Programs developed in consultation with State and local dental societies to expand or establish oral health services and facilities in dental
health professional shortage areas, including services and facilities for children with special needs.
Select type(s) of facilities supported by program. Selection: Permanent Dental Facilities; Mobile/Portable Dental Facilities.
6. Placement and support of dental students, dental residents, and advanced dentistry trainees
7. Continuing dental education, including distance-based education
8. Practice support through teledentistry
9. Community-based prevention services such as water fluoridation and dental sealant programs
10. Coordination with local educational agencies within the state to foster programs that promote children going into oral health or science
professions
11. The establishment of faculty recruitment programs at accredited dental training institutions whose mission includes community outreach
and service and that have a demonstrated record of serving the underserved
12. The development of a State dental officer position or the augmentation of a State dental office to coordinate oral health and access issues
in the State
13. Any other activities determined to be appropriate by the Secretary (provide a brief description)

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Table SOHWP-1: Activity 1 - Loan Forgiveness and Repayment Programs for Dentists
Table purpose: To describe the types of trainees receiving SOHWP loan forgiveness and repayment from grantees, and the amounts provided and
terms of obligation.
Total Number of Dentists Participating in Loan Forgiveness and Repayment Program: ____________
Trainee
Unique
ID

Gender

(One per
row)

(M/F)

Age

Ethnicity

Race

Disadvantaged
Background

Rural/Urban/Suburban/Frontier
Background

(Select one)

(Select one)

(Select one)

(Select one)
(Y/N)

(Continuation of SOHWP-1)
Current Reporting Period
Amount of Loan Forgiveness or
Repayment
Provided Through
the Grant

Provided Through
Other Sources

2012 BHPr Performance reporting

Serving Status in If Serving in Public
Public Health
Health Facility,
Facility
Serving in a Dental
HPSAs

Entire Grant Period
Total Amount of
Time Obligated to
Serve (weeks)
(Select one)

Total Amount of
Funding for Loan
Forgiveness or
Repayment to be
Provided to Dentist

(Select one)

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Legislative Activity:
1. Loan forgiveness and repayment programs for dentists who:
A. agree to practice designated dental health professions shortage areas;
B. are dental school graduates who agree to serve as public health dentists for the Federal, State, or local government; and
C. agree to:
i. provide services to patients regardless of such patients’ ability to pay; and
ii. use a sliding payment scale for patients who are unable to pay the total cost of services;
Instructions: Each grantee will complete as applicable. One row represents one participant. Complete each column in the row as described below
for the reporting period. The glossary contains clarification and/or definitions of key terms.
Total Number of Dentists Participating in Loan Forgiveness and Repayment Program: Enter the number of dentists participating in this
activity. For each dentist participating in loan forgiveness or repayment program, provide a unique id. (See below instructions)
Trainee Unique ID: Enter a seven-digit unique identifier number for each participating dentist. .See instructions for unique ID. Provide the
dentist characteristics: race; ethnicity; age; gender.
Gender: Indicate if the trainee is (‘Male’ or ’Female’).
Age: Selections: Under 20 years; 20-29 years; 30-39 years; 40-49 years; 50-59 years; 60-69 years; 70 years or older; Unknown.
Ethnicity: Selections: Hispanic/Latino; Non-Hispanic/Non-Latino.
Race: Selections: American Indian or Alaska Native; Asian (Not Underrepresented); Asian (Underrepresented); Black or African-American;
Native Hawaiian or Other Pacific Islander; White; More Than One Race, or Unknown.
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Disadvantaged Background: Indicate if the trainee is from a disadvantaged background (‘Yes’ or ‘No’).
Rural/Urban/Suburban/Frontier Background: Indicate if the trainee is from a rural, urban, suburban, frontier background or unknown.
Current Reporting Period
Amount of Loan Forgiveness and/or Repayment Provided through the Grant: Enter the amount of loan forgiveness and/or the amount of
repayment that was provided through grant funding to each participating dentist in the program.
Amount of Loan Forgiveness and/or Repayment Provided through Other Sources: Enter the amount of loan forgiveness and/or the amount of
repayment that was provided through other means to each participating dentist in the program year. Other means may include: State funding,
other grant funding, donations, etc. This amount may, or may not, be part of the 40 percent match required by the grant.
Serving Status in Public Health Facility: Indicate whether the participating dentist is working “Part-Time”, “Full-Time”, or “Not serving” in a
public health facility. For the purposes of this table, “Part-Time” is defined as less than 50 percent time and “Full-Time” is defined as 50 percent
time or greater. Types of facilities may include: Community Health Center, Migrant Health Center, Rural Health Center, Department of Health,
School-based clinic, Mobile unit(s), or Other.
If Serving in Public Health Facilities, Serving in Status in Dental HPSAs: If participating dentist is serving in public health facility, indicate
whether the participating dentist is working “Part-Time”, “Full-Time”, or “Not serving” in a Dental Health Professional Shortage Area (Dental
HPSA). Do not double-count for the same period of time at the same location. For example if the trainee is serving in a Public Health Facility that
is also classified as a Dental HPSA, indicate dental HPSA. It is possible that a trainee could serve Part-Time in a Public Health Facility AND
Part-Time in a Dental HPSA at a different location. For the purposes of this table, “Part-Time” is defined as less than 50 percent time and “FullTime” is defined as 50 percent time or greater. Refer to glossary for a definition of a HPSA. If participating dentist is not serving in a public
health facility, select “N/A”.
Entire Grant Period
Total Amount of Time obligated to Serve (months): Enter the total amount of time in months each dentist has agreed to serve in either a Public
Health Facility or a Dental HPSA as a result of the their participation in this loan forgiveness / repayment program for the entire grant period.

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Total Amt. of Funding for Loan Forgiveness or Repayment to be Provided to Dentist: Enter the total amount of funding each dentist(s) will
receive, or has received, as a result of their participation in the loan forgiveness / repayment program for the entire grant period. If the dentist is
participating in a multi-year agreement, this amount may exceed the amount provided for the current reporting year.

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Table SOHWP-2: Activity 2 – Dental Recruitment and Retention Efforts
Table purpose: To describe the number of dentists recruited and retained by SOHWP program grantees.
Number of Targeted Vacant Dentist/Dental Provider Positions
Number of Dentists/Dental Provider Positions Filled

2010-2011
2011-2012

Number of Filled Dentist/Dental Providers Retained for at Least One Year

Legislative Activity:
2. Dental recruitment and retention efforts
Instructions: Each grantee will complete as applicable. This table captures the dental recruitment and retention activity outputs and outcomes
related to the second SOHWP legislative activity by grantees. Complete the table as described below for the reporting period. The glossary
contains clarification and/or definitions of key terms.
Number of Targeted Vacant Dentist/Dental Provider Positions: Enter the number of targeted vacant dentist and/or dental provider positions
located within a Dental HPSA or a government recognized, dental underserved population or community.
Number of Dentist/Dental Provider Positions Filled: Enter the number of targeted vacant dentist and/or dental provider positions located
within a Dental HPSA or a government recognized, dental underserved population or community that were filled as a result of activities
undertaken through the grant.
Number of Filled Dentist/Dental Providers Retained for at Least One Year: For the prior reporting period, enter the number of targeted filled
dentist and/or dental provider positions located within a Dental HPSA or a government recognized, dental underserved population or community
that have retained dentists and/or dental providers for at least one year as a result of activities undertaken through the grant.

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Table SOHWP-3: Activity 3 - Grants and Low-interest or No-Interest Loans to Help Dentists Participating in the Medicaid/CHIP
Program
Table purpose: To describe dentists who received grants and low- or no-interest loans and were enrolled in the Medicaid/CHIP programs by
SOHWP program grantees, as well as the number of patient encounters.
Number of Dentists Receiving Grants and Low- or No-Interest Loans
Through Program
Did your program have dentists enrolled in Medicaid/CHIP program?

Yes/No

Number of Dentists Newly Enrolled in Medicaid/CHIP
Number of Dentists Previously Enrolled in Medicaid/CHIP Now
Accepting New Medicaid/CHIP Patients
Total Number of Patient Encounters
Number of Medicaid/CHIP Patient Encounters

Legislative Activity:
3. Grants and low-interest or no-interest loans to help dentists who participate in the Medicaid program under title XIX of the Social Security Act
to establish or expand practices in designated dental health professional shortage areas by equipping dental offices or sharing in the overhead
costs of such practices
Instructions: Each grantee will complete as applicable. The table represents the outputs and outcomes related to the third SOHWP legislative
activity by grantees. Complete each question as described below for the reporting period. The glossary contains clarification and/or definitions of
key terms.
Number of Dentists Receiving Low or No-Interest Loans through Program: Enter the number of dentists receiving grants and low- or nointerest loans as a result of activities taken through this grant.
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Did your program have dentists enrolled in Medicaid/CHIP program?: If your program has dentists enrolled in Medicaid/CHIP program
select ‘Yes’ and enter data for the remaining questions, else select ‘No’.
Number of Dentists Newly Enrolled in Medicaid/CHIP: Enter the total number of dentists newly enrolled in Medicaid/CHIP as a result of
grants and low-/no-interest loans provided through the grant.
Number of Dentists Previously Enrolled in Medicaid/CHIP Now Accepting NEW Medicaid/CHIP Patients: Enter the number of previously
Medicaid/CHIP-enrolled dentists who now accept new Medicaid/CHIP patients as a result of grants and low-/no-interest loans provided through
the grant.
Total Number of Patient Encounters: Enter the total number of patient encounters for dentists in the program.
Number of Medicaid/CHIP Patient Encounters: Enter the number of patient encounters with patients enrolled in Medicaid/CHIP among
dentists in the program.

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Table SOHWP-4 (4a, 4b): Activity 4 - Establishment or Expansion of Dental Residency Programs in States without Dental Schools
Table SOHWP-4a -Program and completer outcomes
Table purpose: To describe the number of dental residency programs established by SOHWP program grantees, as well as the number of trainees
enrolled in States without a dental school.
Is the Residency Program located in Dental HPSA? Yes / No
Residency Discipline/Type

Total Number of new programs

Total Number of Existing Programs
Expanded

(Continuation of SOHWP-4a)
Number of New or Additional Dental Trainees that COMPLETED Residency (Program completers)
Total

URM

Working in dental
HPSAs

URM program
completers Working in
dental HPSAs

Working in rural
areas

URM Program
completers
working in
rural areas

Legislative Activity:
4. The establishment or expansion of dental residency programs in coordination with accredited dental training institutions in States without
dental schools
Instructions: Each grantee will complete as applicable. Each row represents the outputs and outcomes related to the fourth SOHWP legislative
activity undertaken by grantees. Complete each column in the row as described below for the reporting period. The glossary contains clarification
and/or definitions of key terms.
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Residency Discipline/Type:
Dentist Selections: AEGD (24 months); AEGD (optional 2nd year); Advanced Education In General Dentistry (AEGD, 12 months);
Dental Assistant; Dental Hygiene; Dental Public Health (12 mths); Dental Public Health (24 mths); GPR (12 months) General Practice
Residency; GPR (24 months); GPR (optional second year); General Dentistry; General Dentistry (MPH year); Geriatric Dentistry; Other
(specify); Pediatric Dentistry; Pediatric Dentistry (24 months); Pediatric Dentistry Master's Degree In Public Health (MPH year); Public
Health Dentistry; Public Health Dentistry (DPH, 12 months);
Total Number of New Programs: Enter the number of new dental residency programs established in States without dental schools as a result of
activities undertaken through the grant.
Total Number of Expanded Programs: Enter the number of existing dental residency programs expanded in States without dental schools as a
result of activities undertaken through the grant.
Number of New or Additional Dental Trainees that COMPLETED Residency
Total Program Completers: enter number
URM Program Completers: enter number
Program Completers Working in dental HPSAs: enter number
URM Program Completers Working in dental HPSAs: enter number
Program Completers Working in rural areas: enter number
URM Program Completers Working in rural areas: enter number

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Table SOHWP-4b –Trainee Outcomes
Residency
Discipline/Type

Training year

New Dental Residency Programs

Existing Dental Residency Programs

New Trainees
Enrolled

Added Trainees

New URM
Trainees

Added URM
Trainees

Instructions: Each row represents output and outcomes related to the combination of residency/discipline type from SOHWP-4a and training year.
Complete each column in the row as described below for the reporting period. The glossary contains clarification and/or definitions of key terms.
Training Year: Selections: Training Year 1; Training Year 2.
New Dental Residency Programs Established
Number New Trainees Enrolled: Enter the number of new dental trainees (per training year) enrolled in new dental residency programs in States
without a dental school as a result of activities undertaken through the grant.
Number New URM Trainees Enrolled: Enter the number of new URM dental trainees (per training year) enrolled in new dental residency
programs in States without a dental school as a result of activities undertaken through the grant.
Existing Dental Residency Program Expanded
Number of Added Dental Trainees: Enter the number of additional dental trainees enrolled in expanded dental residency programs in States
without a dental school as a result of activities undertaken through the grant.
Number of Added URM Dental Trainees: Enter the number of additional URM dental trainees enrolled in expanded dental residency programs
in States without a dental school as a result of activities undertaken through the grant.
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Table SOHWP-5 (5a, 5b): Activity 5 - Establishment or Expansion of Oral Health Services and Facilities in Dental Health Professional
Shortage Areas
Table purpose: To describe the types of facilities established or expanded by SOHWP program grantees and the types of services provided and
patient encounters in health professional shortage areas.
Legislative Activity:
5. Programs developed in consultation with State and local dental societies to expand or establish oral health services and facilities in dental
health professional shortage areas, including services and facilities for children with special needs, such as:
a. the expansion or establishment of a community-based dental facility, free-standing dental clinic, consolidated health center dental
facility, school-linked dental facility, or United States dental school-based facility;
b. the establishment of a mobile or portable dental clinic; and
c. the establishment or expansion of private dental services to enhance capacity through additional equipment or hours of operation;
Instructions: Each grantee will complete SOHWP-5a and/or SOHWP-5b as applicable per answers provided in SOHWP-0. These tables capture
the outputs and outcomes related to the fifth SOHWP legislative activity undertaken by grantees. Complete each column in the row as described
below for the reporting period. The glossary contains clarification and/or definitions of key terms.
SOHWP-5a: Characteristics of Permanent Dental Facilities
Did your program establish new dental facilities in a HPSA/Underserved Area?: Select ‘Yes’ and complete SOHWP-5a.1 if your program
established new dental facilities in a HPSA/Underserved Area, otherwise, select ‘No’.
Did your program expand existing dental facilities in a HPSA/Underserved Area?: Select ‘Yes’ and complete SOHWP-5a.2 if your program
expand existing dental facilities in a HPSA/Underserved Area, otherwise, select ‘No’.
Instructions: Each grantee will complete as applicable. Each row represents the outputs and outcomes related to the fifth SOHWP legislative
activity undertaken by grantees. Select appropriate options that describe your program and provide corresponding data for the reporting period.
Complete each column in the row as described below for the reporting period. The glossary contains clarification and/or definitions of key terms.
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SOHWP-5a.1: New Dental Facilities Established in a HPSA/Underserved Area

Types of Facilities

Number of
Permanent
Facilities

Types of Oral Health Services

Number of Patient
Encounters

(Select all that apply)
Community health centers
Departments of health
Migrant health centers
Private
Rural health centers
School-based clinic
Other (specify)

Types of Facilities: Select the type(s) of new facilities that were established as a result of activities undertaken by the grant. Selections:
Community health centers; Migrant health centers; Rural health centers; Departments of health; School-based clinic; Private. If the appropriate
type of facility type is not provided, select “Other” and enter the facility type. For each type address the remaining columns.
Number of Permanent Facilities: For applicable types of facilities, enter the number of new dental facilities in a permanent structure established
in designated Dental HPSAs or government-recognized underserved populations/communities as a result of activities undertaken by the grant.

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Type of Oral Health Services: For applicable types of facilities, select the type(s) of oral health services offered at the newly established facility
as a result of activities undertaken by the grant. Selections: Prevention; Restoration; Education; Interprofessional training. If the appropriate type
of oral health service is not provided, select “Other” and enter the type of oral health service.
Number of Patient Encounters: For applicable types of facilities, enter the number of patient encounters in new dental facilities in a permanent
structure established in designated dental HPSAs or government-recognized underserved populations/communities as a result of activities
undertaken by the grant.

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SOHWP-5a.2: Existing Dental Facilities Expanded in a HPSA/Underserved Area
Types of Facilities

Number
of
Permanen
t Facilities

Types of Oral Health
Services

Number of Patient
Encounters Prior to
Expansion

Number of Patient
Encounters Post
Expansion

(Select all that apply)
Community health centers
Departments of health
Migrant health centers
Private
Rural health centers
School-based clinic
Other (specify)

Types of Facilities: For applicable types of facilities, select the type, or types, of existing facilities that were expanded as a result of activities
undertaken by the grant. Selections: Community health centers; Migrant health centers; Rural health centers; Departments of health; School-based
clinic; Private. If the appropriate type of facility type is not provided, select “Other” and enter the facility type. For each type address the
remaining columns.
Number of Permanent Facilities: For applicable types of facilities, enter the number of existing dental facilities in a permanent structure located
in designated Dental HPSAs or government-recognized underserved populations/communities that were expanded as a result of activities
undertaken by the grant.
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Type of Oral Health Services: For applicable types of facilities, select the type, or types of oral health services offered at the existing facility that
were expanded as a result of activities undertaken by the grant. Selections: Prevention; Restoration; Education; Interprofessional training. If the
appropriate type of oral health service is not provided, select “Other” and enter the type of oral health service.
Number of Patient Encounters Prior to Expansion: For applicable types of facilities, enter the average number of patient encounters for 12month period in existing dental facilities in a permanent structure that occurred 12 months prior to expansion in designated dental HPSAs or
government-recognized underserved populations/communities as a result of activities undertaken by the grant.
Number of Patient Encounters Post Expansion: For applicable types of facilities, enter the number of patient encounters (during the reporting
period) in existing dental facilities in a permanent structure that occurred after expansion in designated dental HPSAs or government-recognized
underserved populations/communities as a result of activities undertaken by the grant.
SOHWP-5b: Characteristics of Mobile/Portable Dental Facilities
Did your program establish new dental facilities in a HPSA/Underserved Area? Select ‘Yes’ and complete SOHWP-5b.1 if your program
established new dental facilities in a HPSA/Underserved Area, otherwise, select ‘No’.
Did your program expand existing dental facilities in a HPSA/Underserved Area? Select ‘Yes’ and complete SOHWP-5b.2 if your program
expands existing dental facilities in a HPSA/Underserved Area, otherwise, select ‘No’.

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SOHWP-5b.1: New mobile/portable dental facilities in a HPSA/underserved area
Types of Oral Health Services

Number of Patient Encounters

Type of Oral Health Services: Select the type, or types of oral health services offered at the newly established mobile/portable dental facility as a
result of activities undertaken by the grant. Selections: Education; Interprofessional training; Prevention; Restoration. If the appropriate type of
oral health service is not provided, select “Other” and enter the type of oral health service.
Number of Patient Encounters: Enter the number of patient encounters in new mobile/portable dental facilities in designated Dental HPSAs or
government-recognized underserved populations/communities that occurred as a result of activities undertaken by the grant.

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SOHWP-5b.2: Existing mobile/portable dental facilities in a HPSA/underserved Area
Types of Oral Health Services

Number of Patient Encounters Prior to
Expansion

Number of Patient Encounters Post Expansion

Type of Oral Health Services: Select the type, or types of oral health services offered at the existing mobile/portable dental facility that were
expanded as a result of activities undertaken by the grant.
Selections: Education; Interprofessional training; Prevention; Restoration. If the appropriate type of oral health service is not provided,
select “Other” and enter the type of oral health service.
Number of Patient Encounters Prior to Expansion: Enter the number of patient encounters at existing mobile/portable dental facilities that
occurred prior to expansion in designated dental HPSAs or government-recognized underserved populations/communities as a result of activities
undertaken by the grant.
Number of Patient Encounters Post Expansion: Enter the number of patient encounters at existing mobile/portable dental facilities that
occurred after expansion in designated dental HPSAs or government-recognized underserved populations/communities as a result of activities
undertaken by the grant.

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Table SOHWP-8: Activity 8 - Teledentistry Practice Support
Table purpose: To describe the types of teledentistry education training experiences offered by SOHWP program grantees and the number of
patient encounters during the training.
Number of Dental Facilities with Teledentistry Capabilities
Number of Teledentistry Encounters Involving Patient Care
Number of Teledentistry Sessions Involving Training

Legislative Activity:
8. Practice support through teledentistry conducted in accordance with State laws
Instructions: Each grantee will complete as applicable. Each row represents the outputs and outcomes related to the eighth SOHWP legislative
activity undertaken by grantees. Complete each column in the row as described below for the reporting period. The glossary contains clarification
and/or definitions of key terms.
Number of Dental Facilities with Teledentistry Capabilities: Enter the number of dental facilities that have teledentistry capabilities that
were/are supported by the grant.
Number of Teledentistry Encounters Involving Patient Care: Enter the number of teledentistry encounters involving patient care.
Number of Teledentistry Sessions Involving Training: Enter the number of teledentistry sessions involving training.

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Table SOHWP-9: Activity 9 - Community-Based Prevention Services
Table purpose: To describe the types of community-based preventive services provided by SOHWP program grantees and the numbers served.
Fluoridated Water

Number of New Water Systems
Number of Replaced Water Systems
Estimated Number of Residents Served

Dental Sealant

Number of Children Receiving Sealants

Topical Fluoride

Number of Individuals Receiving Topical Fluoride

Diagnostic/Preventive Dental
Services

Number of Individuals Receiving Diagnostic or
Preventive Dental Services

Oral Health Education

Number of Recipients of Oral Health Education

Legislative Activity:
9. Community-based prevention services such as water fluoridation and dental sealant programs
Instructions: The table represents the outputs and outcomes of each grantee related to the ninth SOHWP legislative activity. Complete each row
as described below for the reporting period. The glossary contains clarification and/or definitions of key terms.
Fluoridated Water
Number of New Water Systems: Enter the number of new water systems that were installed to provide optimally fluoridated water as a result of
activities funded through the grant.
Number of Replaced Water Systems: Enter the number of water systems that were replaced to provide optimally fluoridated water as a result of
activities funded through the grant.
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Estimated Number of Residents Served: Enter the estimated number of residents served by community water systems with optimally fluoridated
water as a result of activities funded through the grant.
Dental Sealant
Number of Children Receiving Sealants: Enter the number of children that received with a sealant on at least one permanent molar tooth as a
result of activities funded through the grant.
Topical Fluoride
Number of Individuals Receiving Topical Fluoride: Enter the number of individuals who received topical fluoride as a result of activities
funded through the grant.
Diagnostic/Preventive Dental Services
Number of Individuals Receiving Diagnostic or Preventive Dental Services: Enter the number of individuals who received diagnostic or
preventive dental services as a result of activities funded through the grant.
Oral Health Education
Number of Recipients of Oral Health Education: Enter the number of individuals who received oral health education as a result of activities
funded through the grant.

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Table SOHWP-10: Activity 10 - Programs that Promote Children Going into Oral Health and Science Professions
Table purpose: To describe the number and types of oral health promotion events provided by SOHWP program grantees and the number of
children attending.

Type of Promotional
Event

# of Promotional
Events

Types of Local Organizations
Involved in Events

# of Children Attending
Promotional Event

Types of Promotional
Materials Created

(Drop down)

(By type of event)

(Drop down)

(By type of event)

(Drop down)

(Select all that apply)

(Select all that apply)

Legislative Activity:
10. Coordination with local educational agencies within the State to foster programs that promote children going into oral health or science
professions
Instructions: The table represents the outputs and outcomes of each grantee related to the tenth SOHWP legislative activity. Complete each
column in the row as described below for the reporting period. The glossary contains clarification and/or definitions of key terms.
Type of Promotional Event: Select the types of events offered that promote oral health and science professions as a result of activities taken
through the grant. Selections: School/career fair; Community fair; For-profit organization sponsored event; Government-sponsored event;
Nonprofit organization sponsored event; Lecture; Presentation. If the appropriate type of promotional event is not provided, select “Other” and
enter the type of promotional event.
Number of Promotional Events: Enter the number of events held that promote oral health and science professions as a result of activities funded
through the grant.

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Types of Local Organizations Involved in Events: Select all applicable types of local organizations involved in promoting oral health and
science professions by the type of event. Selections: Social organization; Non-profit organization; School; Recreational facility. If the appropriate
local organization is not provided, select “Other” and enter the local organization.
Number of Children Attending Promotional Event: Enter the estimated number of children reached by oral health and science professions, by
type of event, as a result of activities funded through the grant.
Types of Promotional Materials Created: Select all applicable types of promotional materials that were created as a result of activities taken
through the grant. Selections: Posters; Brochures; Curricula. If the appropriate type of promotional material created is not provided, select “Other”
and enter the type of promotional material created.

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Table SOHWP-11: Activity 11 - Establishment of Faculty Recruitment Programs
Table purpose: To describe the number of faculty recruitment programs and activities offered by SOHWP program grantees and the number and
type of attendees recruited.

Institutions that Established Faculty Recruitment Activities
Recruitment Programs
Conducted

Total Number of Dental Faculty
Recruited Through Programs

Number of Underrepresented
Minority Dental Faculty Recruited

Legislative Activity:
11. The establishment of faculty recruitment programs at accredited dental training institutions whose missions include community outreach and
service and that have a demonstrated record of serving the underserved
Instructions: The table represents the outputs and outcomes of each grantee related to the eleventh SOHWP legislative activity. Complete each
column in the row as described below for the reporting period. The glossary contains clarification and/or definitions of key terms.
Institutions that Established Faculty Recruitment Programs: Enter the name of the institutions that established a faculty recruitment programs.
Recruitment Activities Conducted: Enter a very brief description of the types of recruitment activities undertaken through this grant.
Total Number of Dental Faculty Recruited Through Programs: Enter the total number of faculty members recruited at accredited dental
training institutions whose mission includes community outreach and service and who have a demonstrated record of serving the underserved as a
result of activities undertaken through this grant.
Number of Underrepresented Minority Dental Faculty Recruited: Enter the number of underrepresented minority dental faculty members
recruited at accredited dental training institutions whose mission includes community outreach and service and who have a demonstrated record of
serving the underserved as a result of activities taken through the grant.
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Table SOHWP-12: Activity 12 - Strengthening the State’s Dental Office
Table purpose: To describe efforts to strengthen the State’s dental offices through SOHWP program grants.
Was a
new state
dental
office
created?

Was a new
state
dental
officer
position
created?

Number of New Support Staff Members Hired
Administ
rative

Dentist, Dental
hygienist, Oral
health
coordination

Fluorida
tion
expert

Epidemiologist

Statisticia
n

Other

If
‘Other’,
Specify
Type

Identify new
statewide oral
health
workforcerelated
initiatives

(Y/N)
(Y/N)

Identify
expanded
statewide
oral health
workforcerelated
initiatives

(narrative)
(narrative)

Legislative Activity:
12. The development of a State dental officer position or the augmentation of a State dental office to coordinate oral health and access issues in the
State
Instructions: The table represents the outputs and outcomes of each grantee related to the twelfth SOHWP legislative activity. Complete each
column in the row as described below for the reporting period. The glossary contains clarification and/or definitions of key terms.
Was a New State Dental Office Created?: Indicate whether a new State dental office was established as a result of activities taken through the
grant (Yes/ No).

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Was a New State Dental Officer Position Created? Indicate whether a new State dental officer position was established as a result of activities
taken through the grant (Yes/ No).
Number of New Support Staff Members Hired: For each type of support staff (Administrative; Dentist, Dental hygienist Oral health
coordination; Epidemiologist; Fluoridation expert; Statistician, other), enter the number of new staff members (.5 FTE or greater) hired to support
the State dental officer and office as a result of activities taken through the grant. If the appropriate type of new support staff member hired is not
provided, enter number under “Other” type.
If ‘Other’, Specify Type: If number of new staff members is provided under “Other” type, enter type description.
Identify New Statewide Oral Health Workforce-Related Initiatives: Enter a brief description of any new statewide oral health workforcerelated planning initiatives that were a result of new staff members hired by this grant. New initiatives may come from an existing State dental
officer or office as well as from those that are newly established. For the purpose of this column, new initiatives should not include grant-funded
activities that are included elsewhere in this report.
Identify Expanded Statewide Oral Health Workforce-Related Initiatives: Enter a brief description of any existing statewide oral health
workforce-related planning initiatives that were expanded as a result of new staff members hired by this grant. For the purpose of this column,
expanded initiatives should not include grant-funded activities that are included elsewhere in this report.

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Table SOHWP-13: Activity 13 - Other Activities
Table Purpose: To describe any other activities not previously mentioned.
Activity

Select If
Applicable

Description

Policy
Grant Contracts
Strategic Efforts
Partnership(Public/Private)
Training
Prevention
Workforce Development
Other

Instruction: Select applicable activities and provide detail in the progress report or final report on the selected activities.

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Health Careers Opportunity Program
Table DP-2: Health Careers Opportunity Program- Unstructured Pipeline Programs
(No Individual Level Data Collection for Unstructured Programs)
Table purpose: To describe the level of attendance in HCOP unstructured program activities by education level of trainee.
Unstructured
Program

Number of Hours

Total Number
of Trainees

Number of Trainees

Grades K-6
(One per Row)
(Select one)

Grades 7-8

Grades 9-12

College
Students

Graduate/
Health
Professional
Students

Instructions: Each row represents one unstructured program. Complete each column as described below for the reporting period. The glossary
contains clarifications and/or definitions of key terms. This table applies to HCOP programs.
Unstructured Program: Enter a description of the unstructured program activity. If more than one unstructured program was offered, add
additional rows to expand the table to include all programs. Unstructured programs are any program offered by the HCOP grantee that does not
meet the minimum definitions of one of the following programs: Summer Program; Health Professions Academy; Saturday Academy; PreMatriculation Program; Post-Baccalaureate Program.
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Number of Hours: Selections: 0-39 hours; 40-79 hours; 80-119 hours. Complete table DP-1a for programs that involve 120 hours or more.
Total Number of Trainees: Enter the total number of trainees. Count each trainee only once.
Subset of Total Number of Trainees: Count each trainee only once.
Number of Trainees, Grades K-6: Enter the total number of trainees in grades K-6.
Number of Trainees, Grades 7-8: Enter the total number of trainees in grades 7-8.
Number of Trainees, Grades 9-12: Enter the total number of trainees in grades 9-12.
Number of Trainees, College Students: Enter the total number of trainees in college. For purposes of this reporting, college students include
students in two-year colleges and four-year colleges. (Also includes post-high school/pre-college students)
Number of Trainees, Graduate/ Health Professional Students: Enter the total number of graduate/professional students who attended. (Also
includes post-college/pre-graduate students).

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Nursing Workforce Diversity
Table DP-3: Nursing Workforce Diversity - Unstructured Pipeline Programs
Table purpose: To describe the level of attendance in NWD unstructured program activities by education level of trainee.
Unstructu Number
Total
red
of Hours Number of
Program
Trainees Grades
K-8

Number of Trainees
Grades

Post-high
School/

9-12

Prenursing/
College

Diploma

Associate’s

Bachelor’s

Master’s Doctoral

Pre-college
(One per
Row)

(Select
one)

Instructions: Each row represents one unstructured program. Complete each column as described below for the reporting period. The glossary
contains clarifications and/or definitions of key terms.
Program Activity: Select the unstructured program activity offered through the NWD grant. If more than one program was offered, add
additional rows to expand the table to include all programs. Refer to the table below for a description of each unstructured program activity.
The examples of activities are not exhaustive—the list is limited. Grantees should list additional activities as appropriate in the corresponding
categories

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NWD Unstructured Program
Activity

Activities

Pre-college Preparation

Tutoring, mentoring, test taking strategies, ACT/SAT preparation, computer skills, collaboration with
high school counselors, dual enrollment

College Academic Support

Individualized academic plan, intrusive counseling, tutoring/mentoring, NCLEX preparation, leadership
development, clinical externships

Social Support

Counseling, case management, learning community, service learning

Socialization

Learning communities, Future Nurses Club, summer enrichment, campus tours, case management, job
shadowing

Number of Hours: Selections: 0-39 hours; 40-79 hours; or 80-119 hours. Complete table DP-1a for programs that involve more than 120 hours.
Total Number of Trainees: Enter the total number of trainees. Count each trainee only once.
Subset of Total Number of Trainees: Count each trainee only once.
Number of Trainees, Grades K-8: Enter the total number of trainees in grades K-8.
Number of Trainees, Grades 9-12: Enter the total number of trainees in grades 9-12.
Number of Trainees, Post-high School/Pre-college: Enter the total number of trainees who graduated from high school but had not matriculated
into college.
Number of Trainees, Pre-nursing/College: Enter the total number of trainees who were pre-nursing college students or college students with an
undeclared major.
Number of Trainees, Diploma: Enter the total number of trainees who enrolled in a nursing diploma program.
Number of Trainees, Associate’s: Enter the total number of trainees enrolled in an associate’s degree nursing program.
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Number of Trainees, Bachelor’s: Enter the total number of trainees enrolled in a bachelor’s degree nursing program.
Number of Trainees, Master’s: Enter the total number of trainees enrolled in a master’s degree nursing program.
Number of Trainees, Doctoral: Enter the total number of trainees enrolled in a doctoral degree nursing program.

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Centers of Excellence
Table DP-4: Centers of Excellence - Description of Faculty in Health Professions Schools
Table purpose: To describe underrepresented minority (URM) faculty members and the number employed by the health professions school for
each discipline in the COE program.
DP-4a: Hispanic or Latino Faculty Members Information in the Health Professions School
Enter Program Discipline/Type (Select one per table)

Race

Number of Full – Time Faculty Members

Number of Part – Time Faculty Members

Total

Total

New

URM Attrition

New

URM Attrition

American Indian or
Alaska Native3
Asian
(underrepresented1)
Asian (nonunderrepresented1)
Black or AfricanAmerican
Native Hawaiian
Other Pacific
Islander2
White
Unknown
More than One Race
Total (Auto
calculate)
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DP-4b: Non- Hispanic or Non-Latino Faculty Members Information in the Health Professions School
Enter Program Discipline/Type (Select one per table)

Number of Full – Time Faculty Members

Number of Part – Time Faculty Members

Total

Total

Race
New (URM)

URM Attrition

New (URM)

URM Attrition

American Indian or
Alaska Native3
Asian
(underrepresented1)
Asian (nonunderrepresented1)
Black or AfricanAmerican
Native Hawaiian
Other Pacific
Islander2
White
Unknown
More than One Race
Total (Auto
calculate)

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Instructions for DP-4a and Dp-4b:
Complete a separate table for Hispanic or Latino ethnicity and Non-Hispanic or Non-Latino ethnicity as described below for the reporting
period. Discipline/Type selection values are populated from the Health Profession and Disciplines – Setup form. The glossary contains
clarifications and/or definitions of key terms. Include numbers for all faculty in the institution; the table is not restricted to COE faculty members.
Race: Race of the faculty member.
Discipline/Type: Indicate the discipline/type
Dentist Selections: FELLOWSHIP AND RESIDENCY PROGRAMS: Advanced Education In General Dentistry - AEGD 12 month
program (include optional 2nd year); AEGD 24 month program; Dental Public Health - DPH 12 month program; DPH 24 month
program; General Practice Residency - GPR 12 month program (include optional 2nd year); GPR 24 month program; Geriatric Dentistry;
Pediatric Dentistry (24 months);
OTHER PROGRAMS: Dental Assistant; Dental Hygiene; General Dentistry; Pediatric Dentistry; MPH year-General Dentistry
(Master's in Public Health); MPH year-Pediatric Dentistry; MPH year-Public Health Dentistry; MPH year-Dental Hygiene, Public Health
Dentistry; Other (specify)
Medicine Selections: Aerospace Medicine; Allopathic Medicine, Alternative/Complementary Medicine; Behavioral/Mental Health In
School Of Medicine And Osteopathic Medicine; Chiropractic; Family Medicine; General Internal Medicine; General Pediatrics; General
Preventive Medicine; General Preventive Medicine/ Family Medicine; General Preventive Medicine/ Internal Medicine; General
Preventive Medicine/ Public Health; Geriatric Medicine; Geriatric Psychiatry; Integrative Medicine; Internal Medicine /General
Pediatrics; Internal Medicine/Family Medicine; Neurology; Obstetrics/Gynecology; Occupational Medicine; Osteopathic General
Practice; Pediatrics/Family Medicine; Pharmacy, Podiatry; Psychiatry; Radiology; Veterinary Medicine;
Physician assistants: Disciplines are not applicable (N/A).
Nursing: Alternative/Complementary Nursing; CNS-Adult gerontology; CNS-Family; CNS-Geropsychiatric; CNS-Neonatal; CNSPediatrics; CNS-Psychiatric/Mental health; CNS-Women’s health; Clinical Nurse Specialist (CNS); Home Health Aide; Licensed
Practical/Vocational Nurse (LPN/LVN); NP - Other advanced nurse specialists; NP - Psychiatric/Mental health; NP –Adult gerontology;
NP –Family; NP –Neonatal; NP –Pediatrics; NP –Women’s health; NP- Acute care adult gerontology; NP- Acute care pediatric; NPEmergency care; NP- Geropsychiatric; Nurse Administrator; Nurse Anesthetist; Nurse Assistant/Patient Care Associate (PCA); Nurse
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Educator; Nurse Generalist; Nurse Midwife; Nurse Practitioner (NP); Nurse Researchers/Scientists; Nursing Informatics; Public Health
Nurse; Registered Nurse; Registered Nurse Student; Other (specify);
Behavioral Health/Public Health/Other Selections:
Behavioral Health Selection: Counseling Psychology; Clinical Psychology; Clinical Social Work;; Marriage and Family Therapy;
Pastoral/Spiritual Care; Other Psychology; Other Social Work, Substance Abuse/Addictions Counseling; Other (specify);
Public Health: Biostatistics; Biostatistics – Biometry; Community Health Worker Environmental Health; Environmental Health –
Environmental chemistry; Environmental Health – Environmental health planning; Environmental Health – Environmental sciences;
Environmental Health – Industrial hygiene; Environmental Health – Occupational safety and health; Environmental Health – Radiological
health; Environmental Health – Toxicology; Environmental Health – Water quality; Epidemiology; Geriatrics/Aging Populations
Global/International Health; Global/International Health – Tropical medicine; Health Education/Behavior; Health Education/Behavior –
Behavioral sciences; Health Education/Behavior – Community health sciences; Health Education/Behavior – Evaluation research; Health
Education/Behavior – Health behavior; Health Education/Behavior – Health promotion/disease prevention; Health Services Research;
Health Services/Hospital Administration; Health Services/Hospital Administration – Health management; Health Services/Hospital
Administration – Health planning; Health Services/Hospital Administration – Hospital administration; Maternal & Child Health; Maternal
& Child Health – Adolescent health; Maternal & Child Health – Infant and child health; Maternal & Child Health – Women’s health;
Nutrition; Nutrition – Dietetics; Nutrition – Public health nutrition; Occupational Health; Public Health (General Studies); Public Health
Practice; Public Health Practice – Community health practice; Public Health Practice – Program management; Urban Health; Veterinary
Science – Veterinary public health; Other (specify);
Other: Audiology; Bio-Engineering; Biomedicine; Biomedicine - Biochemistry; Biomedicine - Cancer biology; Biomedicine Immunology; Biomedicine - Microbiology; Biomedicine - Parasitology; Biomedicine - Pathobiology; Biomedicine - Biomedical and
Laboratory Sciences; Clinical Laboratory Worker; Clinical Researcher; EMT-Paramedic/First responder; Extended Care Administrator;
Forensic Science; Genetics; Health Information Systems/Data Analysis; Health Policy/Law; Lactation Consultant; Long-Term Care
Administration; Occupational Therapy; Occupational Therapy – Occupational therapy assistant; Optometry; Pharmacy; Physical Therapy;
Physical Therapy – Physical therapy assistant; Radiologic Services; Respiratory Therapy; Speech/Language Pathology; Other (specify);
Number of Full-Time Faculty Members
Total: Enter the number of full-time faculty members employed at the school for the selected discipline.
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New (URM): Enter the number of new full-time URM faculty members employed at the school for the same selected discipline.
URM Attrition: Enter the number of full-time URM faculty members who are no longer employed by the institution for the same selected
discipline.
Number of Part-Time Faculty Members
Total: Enter the number of part-time faculty members employed at the school for the selected discipline.
New (URM): Enter the number of new part-time URM faculty members employed at the school for the same selected discipline.
URM Attrition: Enter the number of part-time URM faculty members who are no longer employed by the institution for the same selected
discipline.
Total: Totals will automatically calculate.
1

For purposes of this reporting, underrepresented Asian refers to any Asian sub-population other than Chinese, Filipino, Japanese, Korean, Asian
Indian, or Thai.
2

In accordance to the Centers of Excellence legislation, enter Native Hawaiian data separately from the “Other Pacific Islander” category.

In discordance to the Centers of Excellence legislation, enter Native Hawaiian data separately from the “American Indian or Alaska Native”
category.
3

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Academic Administrative Units in Primary Care
Table AAU-1: Academic Administrative Units in Primary Care Program: Characteristics and Activities
Table purpose: To describe the training curriculum of academic administrative units as well as the integration of various disciplines among both
new and existing academic administrative units.
Is This a New AAU? (Yes/No)
Disciplines

Trainee Level

(Select all that
apply)

Integration Across Grant Activities (Percentage of Training Hours)
Didactic
Training

Clinical
Training

Faculty
Development

Research
Training

Summary
of Time

Administrative
Development

(Must
equal
100%
in each
row)

Family medicine
General internal medicine
General pediatrics
Combined internal
medicine and general
pediatrics
Combined family
medicine/internal medicine
Combined family
medicine/pediatrics
Physician assistants
Unassigned/transitional
year
Other (specify)
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Instructions: Each row represents a discipline. For each discipline complete each row as described below for the reporting period. The glossary
contains clarifications and/or definitions of key terms.
Trainee Level: Select the appropriate trainees per discipline. Selections: Medical student; Physician assistant student; Physician assistant resident;
Resident; Fellow; Physician assistant - academic; Physician assistant - community; physician- academic, physician-community.
For the purposes of this reporting, a physician or physician assistant –“community” is a provider working in a setting other than an academic
department (e.g., community preceptor). ‘Physician or physician assistant – “academic” is a provider working primarily in an academic
department or unit (e.g., medical school, physician assistant training program, residency program, department of pediatrics).
Did this BHPr funding support the development of a new academic administrative unit? Yes / No
AAUs and Grant Activities: Enter the percentage of time for each column per discipline. For the purposes of this reporting, use the following
definitions:
Didactic Training: Training is considered didactic if it involves traditional classroom or virtual education forums wherein trainees receive
instruction from designated faculty members or clinicians.
Clinical Training: Training is considered clinical if it involves patient care including clinical rotations and clerkships or residency and
fellowship training.
Faculty Development: Training is considered faculty development if it develops skills for professionals who will or do teach in graduate
or undergraduate medical education settings.
Research Training: Research training involves supervising trainees in conducting studies in clinical or academic environments, preparing
literature reviews, developing data collection protocols, implementing data collection, conducting data analysis, interpreting results, and
disseminating research findings.
Administrative Development: Administrative development activities include core administrative activities, such as curriculum
development, learner evaluation, leadership training, infrastructure building, staff management, procurement of materials, accounting,
recordkeeping, and other activities that generate indirect costs and are allowable as stipulated by the grant.
Summary of Time (per row): Enter the total percentage of time for all trainings and activities provided for each grant activity. The total time for
each row must equal 100 percent.
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Physician Faculty Development in Primary Care
Table PFD-1: Physician Faculty Development in Primary Care Program: Purpose and Completer Outcomes
Table purpose: To describe the purpose and characteristics of the physician faculty development program as well as the characteristics and
outcomes of trainees.
PFD-1: Training Program Purpose
Program
Purpose

Unit of Time
Focused on
Purpose

Amount of Time
Focused on Purpose

(Select all that
apply)

Continuing
Medical
Education
Offered?

Attrition

Number of Trainees by Trainee Level

Fellow

Physician
Faculty
Member

Physician Community

(Y/N)

Research
Development of
Education Skills
Development of
Clinical Skills
Management and
Leadership
Other (specify)
Total: Autocalculate
2012 BHPr Performance reporting

Total: Auto- Total: Autocalculate
calculate

Total: Autocalculate

Total: Autocalculate
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Instructions: Each row represents one program purpose. Complete each column as described below for the reporting period. The glossary
contains clarifications and/or definitions of key terms.
Program Purpose: Select up to two primary purposes for the grant. Selections: Research; Development of education skills; Development of
clinical skills; Management and leadership; Other (specify).
Unit of Time Focused on Purpose: Selections: Hours; Days; Months.
Amount of Time Focused on Purpose: Enter the amount of time focused on the program purpose per unit of time. The amount total will
calculate automatically.
Continuing Medical Education Offered: Indicate if continuing medical education is offered (‘Yes’ or ‘No’).
Attrition: Enter the number of trainees who permanently left the program before program completion.
Number of trainees by Trainee Level : Enter the number of trainees for each trainee level(Fellow, Physician Faculty Member, PhysicianCommunity).Total is automatically calculates based on trainee level response.
Total Number of Trainees: The total number of trainees will calculate automatically based on trainee level response.

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Table NEPQR-1: Nurse Education Practice, Quality, and Retention Program: Purpose of Grant

NEPQR Grant Purposes
(Select one)

Additional NEPQR Tables

E1: Expanding the enrollment in baccalaureate nursing programs

N-1; PY-1; IND-GEN

E2: Providing education in the new technologies, including distance learning methodologies

N-1; EXP-1a; CE-1; CE-TTY; CLSET-1;
CE-2; IND-GEN; INDGEN-EXP; PY-1

P1: Establishing or expanding nursing practice arrangements in non-institutional settings (Nurse Managed
Centers) to demonstrate methods to improve access to primary health care in medically underserved
communities

EXP-1a; CLSET-1; IND-GEN; INDGENEXP

P2: Providing care for underserved populations and other high-risk groups such as the elderly, individuals
with HIV/AIDS, substance abusers, the homeless, and victims of domestic violence

EXP-1a; CE-1; CE-TTY; CLSET-1; CE-2;
PY-1; IND-GEN; INDGEN-EXP

P3: Providing quality coordinated care, and other skills needed to practice in existing and emerging
organized health care systems

CE-1; CE-TTY; CE-2

P4: Developing cultural competencies among nurses

N/A

R1: Career Ladder Program to promote career advancement for individuals, including licensed practical
nurses, licensed vocational nurses, certified nurse assistants, home health aides, diploma degree or associate
degree nurses, to become baccalaureate prepared registered nurses or advanced education nurses in order to
meet the needs of the registered nurse workforce

N-1; PY-1; IND-GEN

R2: Developing and implementing internships and residency programs in collaboration with an accredited
school of nursing to encourage mentoring and the development of specialties

NEPQR-3

R3: Career Ladder Program to assist individuals in obtaining education and training required to enter the
nursing profession and advance within such profession

N-1; CE-1; CE-TTY; CE-2; PY-1; INDGEN

R4: Enhancing patient care delivery systems through improving the retention of nurses and enhancing
patient care that is directly related to nursing activities

NEPQR-2a; NEPQR-2b; CE-1; CE-TTY;
CE-2

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Table NEPQR-2a: Nurse Education Practice, Quality, and Retention (purpose R4 only) -Nursing Retention and Vacancy Data
Table purpose: To describe nursing program rates of retention and vacancy.
Year

Nurse Retention Rate
Projected

Nurse Vacancy Rate

Actual

Baseline (Prior to start of project)

Projected

Actual

%

%

Year One

%

%

%

%

Year Two

%

%

%

%

Year Three

%

%

%

%

Instructions: Each row represents a core retention measure. Complete each column as described below. The glossary contains clarifications
and/or definitions of key terms.
Core Retention Measures:
Nurse Retention Rate—Baseline: Enter the baseline retention rate (percentage) reported in the original grant proposal.
Nurse Vacancy Rate—Baseline: Enter the vacancy rate (percentage) reported in the original grant proposal.
Year One:
Nurse Retention Rate- Projected: Enter the projected value for nurse retention reported in your original grant proposal in percentage.
Nurse Retention Rate-Actual: Enter the actual percentage using the following calculation: the actual number of nurses retained divided by
the total number of nurses in the organization.
Nurse Vacancy Rate-Projected: Enter the projected percentage for nurse vacancy reported in the original grant proposal
Nurse Vacancy Rate-Actual: Enter the actual percentage using the following calculation: the actual number of vacant nursing positions
divided by the total number of nursing positions available.
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Year Two: See calculations in Year One above.
Year Three: See calculations in Year One from above.
Note: The number of years displayed will be based on the number of years within the project period.

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Table NEPQR-2b: Nurse Education Practice, Quality, and Retention (purpose R4 only) - Patient Care Core Indicators
Table purpose: To describe nursing program activities that relate directly to enhancing patient care.
Patient Care Core Indicators

Baseline

Year One

(Prior to start
of project)

Projected

Year Two

Actual

Projected

Year Three

Actual

Projected

Actual

1.

%

%

%

%

%

%

%

2.

%

%

%

%

%

%

%

3.

%

%

%

%

%

%

%

4.

%

%

%

%

%

%

%

Instructions: Each row represents one patient care core indicator. Complete each column in the row as described below. The glossary
contains clarifications and/or definitions of key terms.
Patient Care Core Indicators: Enter all of the patient care core indicators that were reported in the original grant proposal.
Baseline: Enter the baseline rate for each of the four patient care core indicators that were reported in the original grant proposal.
Year One:
Projected: Enter the projected value in percentages for each patient care core indicator reported in the original proposal.
Actual: Enter the actual percentage by calculating your organization’s standard metric for the core indicator identified.
Year Two: See calculations in Year One above.
Year Three: See calculations in Year One above.
Note: The number of years displayed will be based on the number of years within the project period.

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Table NEPQR-3: NEPQR (Purpose R2): Internships and Residencies
Nursing Program Support and Mentoring (NEPQR-R2)

Table Purpose: To track program progress in developing and implementing internships and residency (I & R) programs in collaboration
with an accredited school of nursing to encourage mentoring and the development of specialties.
Length of
Internship
&
Residency
Program

Specialty

Career
Role/Level

# Enrollees
Supported
Projected

Actual

(Select One)

# Program
Completers
Projected

Actual

# RN’s
Employed
and
Retained
for Year 1

# RN’s
Retained for
Year 2

# RN’s Retained
for Year 3

Indicator Descriptions and Data Entry Instructions: Please provide this information for each program offered during the reporting period. If
multiple programs are offered, enter a separate row. The glossary contains clarifications and/or definitions of key terms.
Length of the Internship and Residency Program (Weeks): For length, indicate in number of weeks (i.e., a six-month I & R equals 24 weeks).
Specialty: Enter the applicable training program specialty offered.
Nurse Selections: nurse generalist, women’s health, pediatrics, mental health, emergency care, chronic care, clinical nurse specialist,
acute care NP, nurse anesthetist, nurse administrator, public health nurse, nurse educator, nursing informatics, other (specify).
Nurse Practitioners Selections: nurse practitioners, clinical nurse specialists, nurse administrators, nurse anesthetists, nurse-midwives,
nurse educators, nurse researchers/scientists, public health nurses, and other advanced nurse specialists.
Nurse Midwife Selections: N/A should be entered.

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Career Role/Level:
Selections for the registered nurse role include: BSN; CNL; Diploma; ADN; Trainees completing an AS;
Selections for the APRN roles include: Clinical nurse specialist; Nurse administrator; Nurse anesthetist; Nurse educator; Nurse
informaticist; Nurse midwife; Nurse practitioner; Public health nurse.
Select ‘N/A’ if role is not applicable
Number of Enrollee Supported:
Projected - For each nursing program enter the projected number of internships & residency participants that were identified in the
original project application.
Actual – For each nursing program offered during the reporting period enter the actual number of internships & residency participants
supported during the project reporting period.
Number of Program Completers:
Projected - For each nursing program, enter the projected number of participants who are anticipated to successfully complete internships
& residency as identified in the original project application.
Actual - For each nursing program, enter the number of participants who successfully completed the internships & residency program.
Number of RN’s Employed and Retained for Year 1 : For each nursing program offered, enter the number of RN’s who successfully completed
the internships & residency program that have been employed and retained at the same institution for one year.
Number of RN’s Retained for Year 2 : For each nursing program offered, enter the number of RNs who successfully completed the internships
& residency program and have been employed and retained at the same institution for two-years.
Number of RN’s Retained for Year 3 : For each nursing program offered during the reporting period, enter the number of RNs who successfully
completed the internships & residency program and have been employed and retained at the same institution for three-years or more.
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Table N-2: Personal and Home Care Aides and Nursing Assistant and Home Health Aide Programs Supply Indicators
Table purpose: To describe the number and types of trainees in each program.
Progra
m
Name
(One
progra
m per
row)

Job
Title
(One
offering
per
row)

Educatio
n Levels

(Select all
that
apply)

Enrollees

Tot
al

URM
Only

# Trainees by Employment
Status

Full

Part

time

Time

Not
employed

Total

Current
Employ
ment in
Field of
Study

# of Trainees by
Exam
Results

Pass

Fail

Exam(s)
Assessed all
Competenci
es

Continuin
g
Educatio
n

Attritio
n
(Y/N)

Total

Instructions: Complete the table for each program offered during the reporting period. If multiple programs are offered, complete a separate row
for each offering. The glossary contains clarifications and/or definitions of key terms.
For the purposes of PHCAST and NAHHA reporting, a program offering is defined as a health occupations training program whose successful
completion results in skill set enabling employment in the health occupation.
Program Name: Enter the program offered during the reporting period. If more than one program was offered, add additional rows to expand the
table to include all programs.
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Job Titles: Select all that apply to the offering. Select the job titles for trainees per offering. Count trainees only once per offering.
PHCAST: Selections: Community living professional; Direct care professional; Direct care workers; Direct support professional; Home
care aide; Home health aide; Mental health support professional; Nurse aide; Personal care aide/assistant; Personal care homemaker;
Personal support professional.
NAHHA: Certified nursing assistant; Home health aide; other
Education Level: Enter the formal education level held by trainees.
Selections: Grades K-6; Grades 7-8; Grades 9-12; Post-high school/pre-college; Certificate; Two-year college/community college;
Associates; Diploma (Nursing); Four-year college; Bachelors; Twelve-month post-baccalaureate; Pre-matriculation/pre-graduate school;
Masters (MHA, MS, MSN, MSW, MPH, MSPH); Post-Masters Certificate; Doctorate (PhD, DNP, DNSc; DC, DPT); Post-Doctorate;
Resident; Fellow; Faculty member; Post-graduate; Medicine Doctor (M.D.); Doctor of Osteopathy (D.O.); Doctor of Dental Surgery
(D.D.S., D.M.D.); Doctor of Pharmacy (Pharm.D.); Doctor of Veterinary Medicine (D.V.M.); Doctor of Psychology (Psy.D.); Doctor of
Public Health (Dr.P.H.), ScD (Doctor of Science), Doctor of Veterinary Medicine (D.V.M. or V.M.D.), Adult learner; Dislocated worker;
Other.
Enrollees:
Total: Enter the total number of enrollees
URM Only: Enter the total number of underrepresented minorities per program offering. This total may be a subset of the enrollee total
Number of Trainees by Employment Status: Enter the number of trainees at the time of program entry in each of the employment status
categories listed. Selections: full-time; part-time; not employed. Total will be automatically calculated.
Current Employment in Field of Study: Enter the number of trainees that are employed in the field in which they are training.
Number of Trainees by Exam Results:
Pass: Enter the number of trainees taking an exam or test at the conclusion of the program that passed.
Fail: Enter the number of trainees taking an exam or test at the conclusion of the program that failed.
Attrition: Enter the total number of trainees who permanently left the program before program completion.
Exam(s) Assessed all Competencies: For each program offering, indicate if trainee exam(s) (written or observed performance) assessed all
competencies (“Yes” or “No”).
Continuing Education: Does the program offer continuing education to trainees after completion? (Y/N)

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State Primary Care Offices
Table PCO-1: State Primary Care Offices -Obligated Health Professional (OHP) Providing Care

Program/Activities

Discipline

# of OHP
currently
providing
care

(A)

# of
OHP
working
in
National
Health
Service
Corps’
(NHSC)
Sites
(B)

Allopathic
Physician (MD)
Osteopathic
Physician (DO)
Dentist
(DDS/DMD)
Nurse
Practitioner
(NP)
Nurse Midwife
(NM)
Physician
2012 BHPr Performance reporting

# of OHP
Participatin
g in State
Loan
Repayment
Program
(SLRP)

(C)

# of OHP
Participati
ng in NonSLRP
State Loan
Repaymen
t Program

(D)

Settings

# of
OHP
practicin
g on a J1 Waiver

# of OHP
receiving
other
incentive
s or
benefits

(E)

(F)

# of OHP
working in
Communit
y Health
Centers

(G)

# of OHP
working in
Medically
Underserve
d Areas
(MUAs)

(H)

# of OHP
working in
Health
Professiona
l Shortage
Areas
(HPSAs)

# of
OHP
Workin
g in
other
settings

(I)
(J)

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Assistant (PA)
Dental
Hygienist (DH)
Psychiatrist
(MD&DO)
Clinical
Psychologist
(CP)
Licensed
Clinical Social
Worker
(LCSW)
Psychiatric
Nurse Specialist
(PNS)
Mental Health
Clinician
Licensed
Professional
Counselor
(LPC)
Marriage and
Family
Therapist (MFT)
Other (specify):
Total

Calculate
d

Calculat
ed

2012 BHPr Performance reporting

Calculated

Calculated

Calculat
ed

Calculate
d

Calculated

Calculated

Calculated

Calcula
ted

Page 203 of 287

Instructions:
Provide data for the reporting period 7/1/2011 to 6/30/2012.
Enter the total number of Obligated Health Professionals (OHP) currently providing care by discipline in column A for the current
reporting period. Enter value greater than zero. At least one discipline is required.
Out of the total Obligated Health Professionals (column A) providing care, provide the numbers for the following (columns B - F)
o Working in a National Health Service Corps Site
o Participating in the State Loan Repayment Program (SLRP)
o Participating in Non-SLRP State Loan Repayment Program
o Practicing on a J-1 waiver
o Receiving other incentives or benefits
Count each Obligated Health Professional (column A) only once in columns B - F. The sum of columns B – F should equal the value in
column A.
Out of the total Obligated Health Professionals (column A) providing care, provide the numbers of those working in (columns G - J)
o Community Health Clinics (CHCs)
o Medically Underserved Areas (MUAs)
o Health Professional Shortage Areas (HPSAs).
o Other settings.
Obligated Health Professional (column A) can be counted more than once in columns G - J. The sum of columns G – J should equal or
greater than the value in column A.
Columns D, E, G, H and I each require a value to be entered.
Use Other if the discipline is not listed (specify).
Definition: Obligated Health Professional - A provider who is obligated to provide care, because of his/her participation in a federally or state
funded program.

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2012 BHPr Performance reporting

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Table PCO-2: State Primary Care Offices :Number of NHSC R&R Assistance Application State Recommendation Forms Submitted

Number of Forms Submitted
Total number of National Health Service Corps' (NHSC) Recruitment
& Retention (R&R) assistance application state recommendation forms
submitted by the State Primary Care Office to the NHSC

Total number of National Health Service Corps' (NHSC) Recruitment
& Retention (R&R) assistance application state recommendation forms
submitted by the state Primary Care Office to the NHSC within 14 days
(10 business days)

Instruction: Provide the data for the reporting period

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Table PCO-3a: State Primary Care Offices: New Safety Net Sites Developed or Expanded

Type of New Safety Net Site

Total # New Safety Net Sites

330 Sites
RHC
FQHC Look-A-Like
Free Clinics
School Based Health Centers
Faith Based Clinics
Other (specify)
Total

Calculated

Instruction:
Provide the data for the tables above for the reporting period.
Specify total number of new safety net sites for each type of new safety net site.

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Table PCO-3b: State Primary Care Offices: Number of Clients Who Received Technical Assistance

Type of Clients
Who Received
Technical
NHSC
Assistance

Other Technical Assistance Type
Expansion

Data Sharing

Designation

Needs
Assessment

Clients

Specify

Community
Provider
J1-Waiver
Community
Health Center
Health
Department

State Agency
Office of
Regional
Operations
Medicaid
Primary Care
Association
State Loan
Repayment
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Program
Rural Health
Clinic
NHSC
Other (specify)
Total

Calculated

Calculated

Calculated

Calculated

Calculated

Calculated

Instruction:
Provide the data for the tables above for the reporting period.
For each type of client, specify number of clients who received technical assistance by type of technical assistance. For
‘Other Technical Assistance Type’, please also provide the type of technical assistance.

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Appendix A. HRSA Strategic Goals
Vision
Healthy Communities, Healthy People
Mission
To improve health and achieve health equity through access to quality services, a skilled health workforce, and innovative programs.
Goal I: Improve Access to Quality Health
Sub-goals
a. Assure a medical home for populations served.
b. Expand oral health and behavioral health services and integrate into primary care settings.
c. Integrate primary care and public health.
d. Strengthen health systems to support the delivery of quality health services.
e. Increase outreach and enrollment into quality care.
f.

Strengthen the financial soundness and viability of HRSA-funded health organizations.

g. Promote innovative and cost-efficient approaches to improve health.
Goal II: Strengthen the Health Workforce
Sub-goals
a. Assure the health workforce is trained to provide high quality, culturally and linguistically appropriate care.
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b. Increase the number of practicing health care providers to address shortages, and develop ongoing strategies to monitor, forecast, and meet
long-term health workforce needs.
c. Align the composition and distribution of health care providers to best meet the needs of individuals, families, and communities.
d. Assure a diverse health workforce.
e. Support the development of interdisciplinary health teams to improve the efficiency and effectiveness of care.
Goal III: Build Healthy Communities
Sub-goals
a. Lead and collaborate with others to help communities strengthen resources that improve health for the population.
b. Link people to services and supports from other sectors that contribute to good health and well-being.
c. Strengthen the focus on illness prevention and health promotion across populations and communities.
Goal IV: Improve Health Equity
Sub-goals
a. Reduce disparities in quality of care across populations and communities.
b. Monitor, identify, and advance evidence-based and promising practices to achieve health equity.
c. Leverage our programs and policies to further integrate services and address the social determinants of health.
d. Partner with diverse communities to create, develop, and disseminate innovative community-based health equity solutions, with a
particular focus on populations with the greatest health disparities.

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Appendix B. BHPr Workforce Cross-cutting Performance Measures
Table Purpose: This table presents the revised program performance measures that align with new HRSA/BHPr priorities. These measures are
intended to assess the effectiveness of groups of programs in achieving these new priorities. Cross-cutting measures focus on a common purpose
and assess the shared outcomes of a specific group of programs. This allows the Bureau to monitor and assess the cumulative outcomes of
programs given the mission of BHPr is to increase the workforce supply of quality, trained health professions. Of the 31 cross-cutting performance
measures, ten are current and 21 are new. These annual performance measures in conjunction with other program assessments allow BHPr to
monitor the investments made in programs to meet the established goals.
Reading the table: The first column states the BHPr goals. The second column of the table presents the evaluation questions in relation to the
BHPr goals, and the third column describes the measures and indicators that will be used to measure each program’s performance to answer the
evaluation question. The fourth column identifies the specific programs reporting on the measures. As part of the table heading, the cluster focus
(e.g., supply, quality) related to the goal is noted.
Legend:
* New Measures

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BHPr
Performance
Goals

BHPr Evaluation
Questions

BHPr Measures/Indicators

Data Sources
By BHPr Program

Supply Indicators
Develop diverse
well trained
healthcare
practitioners.

S1: Are BHPr programs
increasing the number of
trainees in pre-professional
and health professions
programs?

2012 BHPr Performance reporting

S1-a: *Number of enrollees in
Advanced Degree Health
Professions program funded by
BHPr

Academic Administrative Units in Primary Care
(AAU)
Advanced Education Nurse Traineeship (AENT)
Advanced Nursing Education (ANE)
Advanced Nursing Education Expansion (ANEE)
Area Health Education Centers (AHEC)(Infrastructure and Point of Service)
Centers of Excellence (COE)
Comprehensive Geriatric Education Programs
(CGEP)
Dental Faculty Loan Repayment
Expansion of the Physician Assistant Training
(EPAT) Programs
Faculty Development in General, Pediatric, and
Public Health Dentistry and Dental Hygiene
(FDD)
Faculty Development: Integrated Technology
into Nursing Education and Practice
Geriatric Academic Career Award (GACA)
Geriatric Education Centers (GEC)
Geriatric Training Program for Physicians,
Dentists, and Behavioral and Mental Health
Professions (GTPD)
Graduate Psychology Education (GPE)
Health Careers Opportunity Program (HCOP)
Page 213 of 287

BHPr
Performance
Goals

BHPr Evaluation
Questions

BHPr Measures/Indicators

Data Sources
By BHPr Program

Interdisciplinary and Interprofessional Joint
Graduate Degree Program (Joint Degree)
Nurse Anesthetist Traineeship (NAT)
Nurse Faculty Loan Program (NFLP)
Nurse Managed Health Clinics (NMHC)
Nursing Education, Practice, Quality, and
Retention (NEPQR)
Nursing Workforce Diversity (NWD)
Physician Assistant Training in Primary Care
(PAT)
Physician Faculty Development in Primary Care
(PFD)
Post-doctoral Training in General, Pediatric, and
Public Health Dentistry (PDD)
Pre-doctoral Training in General, Pediatric, and
Public Health Dentistry and Dental Hygiene (PD)
Pre-doctoral Training in Primary Care
Preventive Medicine Residencies (PMR)
Primary Care Residency Expansion (PCRE)
Public Health Traineeships (PHT)
Public Health Training Centers (PHTC)
Residency Training in Primary Care
Teaching Health Centers (THC)

Develop diverse
S1: Are BHPr programs
well trained
increasing the number of
2012 BHPr Performance reporting

S1-b: *Number of enrollees in
pre-professional programs

Area Health Education Centers (AHEC)(Infrastructure and Point of Service)
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BHPr
Performance
Goals

BHPr Evaluation
Questions

BHPr Measures/Indicators

Data Sources
By BHPr Program

healthcare
practitioners.

trainees in pre-professional
and health professions
programs?

funded by BHPr

Centers of Excellence (COE)
Comprehensive Geriatric Education Programs
(CGEP)
Geriatric Education Centers (GEC)
Health Careers Opportunity Program (HCOP)
Nurse Managed Health Clinics (NMHC)
Nursing Assistant and Home Health Aide
Program (NAHHA)
Nursing Education, Practice, Quality, and
Retention (NEPQR)
Nursing Workforce Diversity (NWD)
Personal and Home Health Aide State Training
(PHCAST)

Develop diverse

S2: Are BHPr programs

S2-a

Advanced Education Nursing Traineeship

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BHPr
Performance
Goals
well trained health
care practitioners.

BHPr Evaluation
Questions

increasing the number of
trainees completing training
who indicate their intent to
practice?

BHPr Measures/Indicators

Numerator :
*Number of BHPr program
completers and graduates that
indicate their intent to practice
in primary care

Denominator:
Number of completers and
graduates from BHPr-funded
programs that answer intent to
practice question

Develop diverse
well trained health
care practitioners.

S2: Are BHPr programs
increasing the number of
trainees completing training
who indicate their intent to
practice?
2012 BHPr Performance reporting

S2-b
Numerator:
*Number of BHPr program
completers and graduates that

Data Sources
By BHPr Program

(AENT)
Advanced Nursing Education Expansion (ANEE)
Area Health Education Centers (AHEC)(Infrastructure and Point of Service)
Centers of Excellence (COE)
Comprehensive Geriatric Education Program
(CGEP)
Expansion of the Physician Assistant Training
(EPAT)
Graduate Psychology Education (GPE)
Health Careers Opportunity Program (HCOP)
Interdisciplinary and Interprofessional Joint
Graduate Degree Program (Joint Degree)
Nursing Anesthesia Traineeship (NAT)
Nurse Faculty Loan Program (NFLP)
Nursing Workforce Diversity (NWD)
Physician Assistant Training in Primary Care
(PAT)
Pre-doctoral Training in General, Pediatric, and
Public Health Dentistry and Dental Hygiene (PD)
Public Health Traineeships (PHT)
Public Health Training Centers (PHTC)

Advanced Education Nursing Traineeship
(AENT)
Advanced Nursing Education Expansion (ANEE)
Area Health Education Centers (AHEC)(Infrastructure and Point of Service)
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BHPr
Performance
Goals

BHPr Evaluation
Questions

BHPr Measures/Indicators

Data Sources
By BHPr Program

indicate their intent to practice
in Medically Underserved
Communities (MUC)

Centers of Excellence (COE)
Comprehensive Geriatric Education Program
(CGEP)
Expansion of the Physician Assistant Training
(EPAT) Programs
Graduate Psychology Education (GPE)
Health Careers Opportunity Program (HCOP)
Interdisciplinary and Interprofessional Joint
Graduate Degree Program (Joint Degree)
Nursing Anesthesia Traineeship (NAT)
Nurse Faculty Loan Program (NFLP)
Nursing Workforce Diversity (NWD)
Physician Assistant Training in Primary Care
(PAT)
Public Health Traineeships (PHT)
Public Health Training Centers (PHTC)

Denominator:
Number of completers and
graduates from BHPr-funded
programs that answer intent to
practice question

Develop diverse
well trained health
care practitioners.

S2: Are BHPr programs
increasing the number of
trainees completing training
who indicate their intent to
practice?

2012 BHPr Performance reporting

S2-c
Numerator:
Number of
completers/graduates who
indicate their intent to practice

Advanced Education Nursing Traineeship
(AENT)
Advanced Nursing Education Expansion (ANEE)
Area Health Education Centers (AHEC)(Infrastructure and Point of Service)
Centers of Excellence (COE)
Page 217 of 287

BHPr
Performance
Goals

BHPr Evaluation
Questions

BHPr Measures/Indicators

Data Sources
By BHPr Program

in the most needed settings (e.g.
Medically Underserved
Communities (MUC) or rural
areas or PC)

Comprehensive Geriatric Education Program
(CGEP)
Expansion of the Physician Assistant Training
(EPAT)
Graduate Psychology Education (GPE)
Health Careers Opportunity Program (HCOP)
Interdisciplinary and Interprofessional Joint
Graduate Degree Program (Joint Degree)
Nursing Anesthesia Traineeship (NAT)
Nurse Faculty Loan Program (NFLP)
Nursing Workforce Diversity (NWD)
Physician Assistant Training in Primary Care
(PAT)
Public Health Traineeships (PHT)
Public Health Training Centers (PHTC)

Denominator:
Number of completers and
graduates from BHPr-funded
programs that answer intent to
practice question

Develop diverse
well trained health
care practitioners.

S2: Are BHPr programs
increasing the number of
trainees completing training
who indicate their intent to

2012 BHPr Performance reporting

S2-d
Numerator:
*Number of BHPr program

Advanced Education Nursing Traineeship
(AENT)
Advanced Nursing Education Expansion (ANEE)
Area Health Education Centers (AHEC)Page 218 of 287

BHPr
Performance
Goals

BHPr Evaluation
Questions

practice?

BHPr Measures/Indicators

completers and graduates that
indicate their intent to practice
in a rural area
Denominator:
Number of completers and
graduates from BHPr-funded
programs that answer intent to
practice question

Develop diverse
well trained
healthcare
practitioners.

S3: Are BHPr programs
increasing the number of
completers/graduates in
primary care disciplines?

2012 BHPr Performance reporting

S3: *Number of BHPr program
completers and graduates in a
primary care discipline

Data Sources
By BHPr Program

(Infrastructure and Point of Service)
Centers of Excellence (COE)
Comprehensive Geriatric Education Program
(CGEP)
Expansion of the Physician Assistant Training
(EPAT)
Graduate Psychology Education (GPE)
Health Careers Opportunity Program (HCOP)
Interdisciplinary and Interprofessional Joint
Graduate Degree Program (Joint Degree)
Nursing Anesthesia Traineeship (NAT)
Nurse Faculty Loan Program (NFLP)
Nursing Workforce Diversity (NWD)
Physician Assistant Training in Primary Care
(PAT)
Public Health Traineeships (PHT)
Public Health Training Centers (PHTC)

Advanced Education Nursing Traineeship (AENT)
Advanced Nursing Education (ANE)
Advanced Nursing Education Expansion (ANEE)
Area Health Education Centers (AHEC)(Infrastructure and Point of Service)
Centers of Excellence (COE)
Comprehensive Geriatric Education Programs
(CGEP)
Page 219 of 287

BHPr
Performance
Goals

BHPr Evaluation
Questions

BHPr Measures/Indicators

Data Sources
By BHPr Program

Expansion of the Physician Assistant Training
(EPAT) Programs
Health Careers Opportunity Program (HCOP)
Interdisciplinary and Interprofessional Joint
Graduate Degree Program (Joint Degree)
Nurse Anesthesia Traineeship (NAT)
Nursing Education, Practice, Quality, and
Retention (NEPQR)
Nursing Workforce Diversity (NWD)
Physician Assistant Training in Primary Care
(PAT)
Physician Faculty Development in Primary Care
(PFD)
Post-doctoral Training in General, Pediatric, and
Public Health Dentistry (PDD)
Pre-doctoral Training in General, Pediatric, and
Public Health Dentistry and Dental Hygiene (PD)
Pre-doctoral Training in Primary Care
Primary Care Residency Expansion (PCRE)
Residency Training in Primary Care
Teaching Health Centers (THC)
Develop diverse
well trained
healthcare
practitioners.

S4: Are BHPr programs
increasing the number of
program
completers/graduates?

2012 BHPr Performance reporting

S4: Number of BHPr program
completers and graduates

All BHPr programs

Page 220 of 287

BHPr
Performance
Goals

BHPr Evaluation
Questions

Develop diverse
well trained
healthcare
practitioners.

S5: Are BHPr programs
improving retention?

2012 BHPr Performance reporting

BHPr Measures/Indicators

S5-a: Attrition in BHPr activity

Data Sources
By BHPr Program

Academic Administrative Units in Primary Care
(AAU)
Advanced Education Nurse Traineeship (AENT)
Advanced Nursing Education Expansion
Program (ANEE)
Area Health Education Centers (AHEC)(Infrastructure and Point of Service)
Centers of Excellence (COE)
Comprehensive Geriatric Education Programs
(CGEP)
Dental Faculty Loan Repayment
Expansion of the Physician Assistant Training
(EPAT) Programs
Faculty Development in General, Pediatric, and
Public Health Dentistry and Dental Hygiene
(FDD)
Faculty Development: Integrated Technology
into Nursing Education and Practice (ITNEP)
Geriatric Academic Career Award (GACA)
Geriatric Education Centers (GEC)
Geriatric Training Program for Physicians,
Dentists, and Behavioral and Mental Health
Professions (GTPD)
Graduate Psychology Education (GPE)
Health Careers Opportunity Program (HCOP)
Interdisciplinary and Interprofessional Joint
Graduate Degree Program (Joint Degree)
Nurse Anesthetist Traineeship (NAT)
Page 221 of 287

BHPr
Performance
Goals

BHPr Evaluation
Questions

BHPr Measures/Indicators

Data Sources
By BHPr Program

Nurse Education, Practice, Quality, and
Retention (NEPQR)
Nurse Faculty Loan Program (NFLP)
Nurse Managed Health Clinics (NMHC)
Nursing Assistant and Home Health Aide
Program (NAHHA)
Nursing Workforce Diversity (NWD)
Personal and Home Care Aide State Training
Program (PHCAST)
Physician Assistant Training in Primary Care
(PAT)
Physician Faculty Development in Primary Care
(PFD)
Post-doctoral Training in General, Pediatric, and
Public Health Dentistry (PDD)
Pre-doctoral Training in General, Pediatric, and
Public Health Dentistry and Dental Hygiene (PD)
Pre-doctoral Training in Primary Care
Preventive Medicine Residencies (PMR)
Primary Care Residency Expansion (PCRE)
Public Health Traineeships (PHT)
Public Health Training Centers (PHTC)
Residency Training in Primary Care
State to Support Oral Health Workforce
Programs (SOHWP)
Teaching Health Centers (THC)

2012 BHPr Performance reporting

Page 222 of 287

BHPr
Performance
Goals
Develop diverse
well trained
healthcare
practitioners.

BHPr Evaluation
Questions

S5: Are BHPr programs
improving retention?

2012 BHPr Performance reporting

BHPr Measures/Indicators

S5-b: Attrition in BHPrfunded health professions
programs

Data Sources
By BHPr Program

Academic Administrative Units in Primary Care
(AAU)
Advanced Education Nurse Traineeship (AENT)
Advanced Nursing Education (ANE)
Advanced Nursing Education Expansion
Program (ANEE)
Dental Faculty Loan Repayment
Expansion of the Physician Assistant Training
(EPAT) Programs
Faculty Development in General, Pediatric, and
Public Health Dentistry and Dental Hygiene
(FDD)
Faculty Development: Integrated Technology
into Nursing Education and Practice (ITNEP)
Geriatric Academic Career Award (GACA)
Geriatric Education Centers (GEC)
Geriatric Training Program for Physicians,
Dentists, and Behavioral and Mental Health
Professions (GTPD)
Graduate Psychology Education (GPE)
Nurse Anesthetist Traineeship (NAT)
Nurse Faculty Loan Program (NFLP)
Nursing Assistant and Home Health Aide
Program (NAHHA)
Personal and Home Care Aide State Training
Program (PHCAST)
Physician Assistant Training in Primary Care
(PAT)
Physician Faculty Development in Primary Care
Page 223 of 287

BHPr
Performance
Goals

BHPr Evaluation
Questions

BHPr Measures/Indicators

Data Sources
By BHPr Program

(PFD)
Post-doctoral Training in General, Pediatric, and
Public Health Dentistry (PDD)
Preventive Medicine Residencies (PMR)
Primary Care Residency Expansion (PCRE)
Public Health Traineeships (PHT)
Public Health Training Centers (PHTC)
Residency Training in Primary Care
Teaching Health Centers (THC)
Develop diverse
well trained
healthcare
practitioners.

S6: Number of trainees
receiving financial support
from BHPr

S6: *Number of trainees
receiving financial support
from BHPr

Academic Administrative Units in Primary Care
(AAU)
Advanced Education Nursing Traineeship
(AENT)
Advanced Nursing Education Expansion (ANEE)
Centers of Excellence (COE)
Comprehensive Geriatric Education Programs
(CGEP)
Expansion of the Physician Assistant Training
(EPAT) Programs
Faculty Development in General, Pediatric, and
Public Health Dentistry and Dental Hygiene
(FDD)
Geriatric Academic Career Award (GACA)
Graduate Psychology Education (GPE)
Geriatric Training Program for Physicians,
Dentist, and Behavioral and Mental Health

2012 BHPr Performance reporting

Page 224 of 287

BHPr
Performance
Goals

BHPr Evaluation
Questions

BHPr Measures/Indicators

Data Sources
By BHPr Program

Professions (GTPD)
Health Careers Opportunity Program (HCOP)
Interdisciplinary and Interprofessional Joint
Graduate Degree Program (Joint Degree)
Nurse Anesthesia Traineeship (NAT)
Nurse Faculty Loan Program (NFLP)
Nursing Assistant and Home Health Aide
Program (NAHHA)
Nursing Workforce Diversity (NWD)
Personal and Home Care Aide State Training
Program (PHCAST)
Physician Assistant Training in Primary Care
(PAT)
Physician Faculty Development (PFD)
Post-doctoral Training in General, Pediatric, and
Public Health Dentistry (PDD)
Pre-doctoral Training in General, Pediatric, and
Public Health Dentistry and Dental Hygiene (PD)
Predoctoral Training in Primary Care
Preventive Medicine Residencies (PMR)
Primary Care Residency Expansion Program
(PCRE)
Public Health Traineeships (PHT)
Public Health Training Centers (PHTC)
Residency Training in Primary Care
Teaching Health Centers (THC)

Quality Indicators
2012 BHPr Performance reporting

Page 225 of 287

BHPr
Performance
Goals

Enhance the quality
of training.

BHPr Evaluation
Questions

Q1: Are BHPR programs
increasing the number of
programs offering training in
selected content areas?

BHPr Measures/Indicators

Q1: Number of BHPr programs
offering innovative curriculum
in selected competency areas:
· cultural competencies
· Interprofessional integrated
models of care
· quality improvement and
patient safety
· health promotion and disease
prevention
· Informatics

2012 BHPr Performance reporting

Data Sources
By BHPr Program

Academic Administrative Units in Primary Care
(AAU)
Area Health Education Centers (AHEC)
Centers of Excellence (COE)
Expansion of the Physician Assistant Training
(EPAT) Programs
Faculty Development in General, Pediatric, and
Public Health Dentistry and Dental Hygiene
(FDD)
Geriatric Education Centers (GEC)
Graduate Psychology Education (GPE)
Health Careers Opportunity Program (HCOP)
Interdisciplinary and Interprofessional Joint
Graduate Degree Program (Joint Degree)
Nursing Workforce Diversity (NWD)
Physician Assistant Training in Primary Care
(PAT)
Physician Faculty Development in Primary Care
(PFD)
Post-doctoral Training in General, Pediatric, and
Public Health Dentistry (PDD)
Pre-doctoral Training in General, Pediatric, and
Public Health Dentistry and Dental Hygiene (PD)
Pre-doctoral Training in Primary Care
Primary Care Residency Expansion (PCRE)
Preventative Medicine Residency Program
(PMR)
Public Health Training Centers (PHTC)
Page 226 of 287

BHPr
Performance
Goals

BHPr Evaluation
Questions

BHPr Measures/Indicators

Data Sources
By BHPr Program

Residency Training in Primary Care
State Oral Health Workforce Program (SOHWP)
Teaching Health Centers (THC)
Diversity Indicators
Diversify the health
professions pipeline.

D1: Are BHPr programs
increasing the proportion of
program completers and
graduates who are
underrepresented minorities
and/or from disadvantaged
backgrounds? (Budget)

D1:

All BHPr programs

Numerator:
Number of BHPr program
completers and graduates who
are underrepresented minorities
and/or from disadvantaged
backgrounds
Denominator: Total number of
BHPr completers and graduate

Diversify the health
professions pipeline.

D2: Are BHPr Programs
increasing the proportion of
faculty who are
underrepresented minorities?

D2:
Numerator: Number of
underrepresented minority
faculty in BHPr -funded faculty
training programs
Denominator: Total number of
faculty in BHPr-funded faculty

2012 BHPr Performance reporting

Academic Administrative Units in Primary Care
(AAU)
Centers of Excellence (COE)
Comprehensive Geriatric Education Programs
(CGEP)
Dental Faculty Loan Repayment
Expansion of the Physician Assistant Training
(EPAT) Programs
Faculty Development in General, Pediatric, and
Page 227 of 287

BHPr
Performance
Goals

Diversify the health
professions pipeline.

BHPr Evaluation
Questions

D3: Are BHPr programs
increasing the proportion of
underrepresented minorities
accepted into health
professional training

2012 BHPr Performance reporting

BHPr Measures/Indicators

Data Sources
By BHPr Program

training programs

Public Health Dentistry and Dental Hygiene
(FDD)
Faculty Development: Integrated Technology into
Nursing Education and Practice (ITNEP)
Geriatric Academic Career Award (GACA)
Geriatric Education Centers (GEC)
Geriatric Training Program for Physicians,
Dentists, and Behavioral and Mental Health
Professionals (GTPD)
Interdisciplinary and Interprofessional Joint
Graduate Degree Program (Joint Degree)
Nurse Faculty Loan Program (NFLP)
Physician Assistant Training in Primary Care
(PAT)
Physician Faculty Development in Primary Care
(PFD)
Pre-doctoral Training in Primary Care
Primary Care Residency Expansion (PCRE)
Residency Training in Primary Care
State Oral Health Workforce Program (SOHWP)
Teaching Health Centers (THC)

D3:

Area Health Education Centers (AHEC)
Centers of Excellence (COE)
Health Careers Opportunity Program (HCOP)
Nursing Workforce Diversity (NWD)

Numerator:
*Number of underrepresented
minority completers and

Page 228 of 287

BHPr
Performance
Goals

BHPr Evaluation
Questions

programs?

BHPr Measures/Indicators

Data Sources
By BHPr Program

graduates from BHPr-funded
pipeline programs accepted into
health professional training
programs
Denominator:
Total number completers and
graduates in BHPr-funded
pipeline programs
Distribution Indicators

Influence practice
location of health
practitioners

Dist1: Are BHPr programs
increasing the proportion of
trainees receiving clinical
training in Medically
Underserved Communities
(MUC) or rural areas?

Dist1-a:
Numerator:
Number of BHPr trainees
receiving clinical training in
Medically Underserved
Communities (MUC)
Denominator:
Total number of BHPr trainees
receiving clinical training

2012 BHPr Performance reporting

Academic Administrative Units in Primary Care
(AAU)
Advanced Education Nurse Traineeship (AENT)
Advanced Nursing Education (ANE)
Advanced Nursing Education Expansion Program
(ANEE)
Area Health Education Centers (AHEC)(Infrastructure and Point of Service)
Centers of Excellence (COE)
Expansion of the Physician Assistant Training
(EPAT)
Geriatric Academic Career Award (GACA)
Geriatric Education Centers (GEC)
Geriatric Training Program for Physicians,
Dentists, and Behavioral and Mental Health
Professions (GTPD)
Interdisciplinary and Interprofessional Joint
Page 229 of 287

BHPr
Performance
Goals

BHPr Evaluation
Questions

BHPr Measures/Indicators

Data Sources
By BHPr Program

Graduate Degree Program (Joint Degree)
Nurse Anesthetist Traineeship (NAT)
Nurse Education, Practice, Quality, and Retention
(NEPQR)
Nurse Faculty Loan Program (NFLP)
Nurse Managed Health Clinics (NMHC)
Nursing Workforce Diversity (NWD)
Physician Assistant Training in Primary Care
(PAT)
Physician Faculty Development in Primary Care
(PFD)
Post-doctoral Training in General, Pediatric, and
Public Health Dentistry (PDD)
Pre-doctoral Training in Primary Care
Preventive Medicine Residencies (PMR)
Primary Care Residency Expansion (PCRE)
Public Health Training Centers (PHTC)
Residency Training in Primary Care
State to Support Oral Health Workforce Programs
(SOWHP)
Teaching Health Centers (THC)

Influence practice
location of health
practitioners

Dist1: Are BHPr programs
increasing the proportion of
trainees receiving clinical
training in Medically
Underserved Communities
2012 BHPr Performance reporting

Dist1-b:
Numerator:
*Number of BHPr trainees
receiving clinical training in a

Academic Administrative Units in Primary Care
(AAU)
Advanced Education Nurse Traineeship (AENT)
Advanced Nursing Education (ANE)
Page 230 of 287

BHPr
Performance
Goals

BHPr Evaluation
Questions

(MUC) or rural areas?

BHPr Measures/Indicators

rural settings
Denominator:
Total number of BHPr trainees
receiving clinical training

2012 BHPr Performance reporting

Data Sources
By BHPr Program

Advanced Nursing Education Expansion
Program (ANEE)
Area Health Education Centers (AHEC)(Infrastructure and Point of Service)
Centers of Excellence (COE)
Expansion of the Physician Assistant Training
(EPAT)
Geriatric Academic Career Award (GACA)
Geriatric Education Centers (GEC)
Geriatric Training Program for Physicians,
Dentists, and Behavioral and Mental Health
Professions (GTPD)
Interdisciplinary and Interprofessional Joint
Graduate Degree Program (Joint Degree)
Nurse Anesthetist Traineeship (NAT)
Nurse Education, Practice, Quality, and
Retention (NEPQR)
Nurse Faculty Loan Program (NFLP)
Nurse Managed Health Clinics (NMHC)
Nursing Workforce Diversity (NWD)
Physician Assistant Training in Primary Care
(PAT)
Physician Faculty Development in Primary Care
(PFD)
Post-doctoral Training in General, Pediatric, and
Public Health Dentistry (PDD)
Pre-doctoral Training in Primary Care
Preventive Medicine Residencies (PMR)
Page 231 of 287

BHPr
Performance
Goals

BHPr Evaluation
Questions

BHPr Measures/Indicators

Data Sources
By BHPr Program

Primary Care Residency Expansion (PCRE)
Public Health Training Centers (PHTC)
Residency Training in Primary Care
State to Support Oral Health Workforce
Programs (SOWHP)
Teaching Health Centers (THC)

Influence practice
location of health
practitioners

Dist2: Are BHPr programs
increasing the proportion of
health professionals who enter
practice in the most needed
settings (e.g. Medically
Underserved Communities
(MUC) or rural areas?

Dist2-a:
Numerator:
Number of BHPr program
completers and graduates who
enter practice in Medically
Underserved Communities
(MUC) or Dental HPSAs
Denominator:
Total number of BHPr program
completers and graduates
eligible to enter practice

2012 BHPr Performance reporting

Advanced Education Nurse Traineeship (AENT)
Advanced Nursing Education (ANE)
Area Health Education Centers (AHEC)(Infrastructure and Point of Service)
Centers of Excellence (COE)
Expansion of the Physician Assistant Training
(EPAT) Programs
Geriatric Training Program for Physicians,
Dentists, and Behavioral and Mental Health
Professions (GTPD)
Health Careers Opportunity Program (HCOP)
Interdisciplinary and Interprofessional Joint
Graduate Degree Program (Joint Degree)
Nurse Anesthetist Traineeship (NAT)
Nurse Education, Practice, Quality, and
Retention (NEPQR)
Nurse Faculty Loan Program (NFLP)
Nursing Workforce Diversity (NWD)
Physician Assistant Training in Primary Care
(PAT)
Page 232 of 287

BHPr
Performance
Goals

BHPr Evaluation
Questions

BHPr Measures/Indicators

Data Sources
By BHPr Program

Physician Faculty Development in Primary Care
(PFD)
Pre-doctoral Training in Primary Care
Preventive Medicine Residencies (PMR)
Primary Care Residency Expansion (PCRE)
Public Health Traineeships (PHT)
Residency Training in Primary Care
Teaching Health Centers (THC)

Influence practice
location of health
practitioners.

Dist2: Are BHPr programs
increasing the proportion of
health professionals who enter
practice in the most needed
settings (e.g. Medically
Underserved Communities
(MUC) or rural areas?

Dist2-b:
Numerator:
Number of BHPr program
completers and graduates who
enter practice in rural areas
Denominator:
Total number of BHPr program
completers and graduates
eligible to enter practice

2012 BHPr Performance reporting

Advanced Education Nurse Traineeship (AENT)
Advanced Nursing Education (ANE)
Area Health Education Centers (AHEC)(Infrastructure and Point of Service)
Centers of Excellence (COE)
Expansion of the Physician Assistant Training
(EPAT) Programs
Geriatric Training Program for Physicians,
Dentists, and Behavioral and Mental Health
Professions (GTPD)
Health Careers Opportunity Program (HCOP)
Interdisciplinary and Interprofessional Joint
Graduate Degree Program (Joint Degree)
Nurse Anesthetist Traineeship (NAT)
Nurse Education, Practice, Quality, and
Retention (NEPQR)
Nurse Faculty Loan Program (NFLP)
Nursing Workforce Diversity (NWD)
Page 233 of 287

BHPr
Performance
Goals

BHPr Evaluation
Questions

BHPr Measures/Indicators

Data Sources
By BHPr Program

Physician Assistant Training in Primary Care
(PAT)
Physician Faculty Development in Primary Care
(PFD)
Pre-doctoral Training in Primary Care
Preventive Medicine Residencies (PMR)
Primary Care Residency Expansion (PCRE)
Public Health Traineeships (PHT)
Residency Training in Primary Care
Teaching Health Centers (THC)

Influence practice
location of health
practitioners.

Dist2: Are BHPr programs
increasing the proportion of
health professionals who enter
practice in the most needed
settings (e.g. Medically
Underserved Communities
(MUC) or rural areas?

Dist2-c:
Numerator:
Number of BHPr program
completers and graduates who
enter practice in primary care
setting
Denominator:
Total number of BHPr program
completers and graduates
eligible to enter practice

2012 BHPr Performance reporting

Advanced Education Nurse Traineeship (AENT)
Advanced Nursing Education (ANE)
Area Health Education Centers (AHEC)(Infrastructure and Point of Service)
Centers of Excellence (COE)
Expansion of the Physician Assistant Training
(EPAT) Programs
Geriatric Training Program for Physicians,
Dentists, and Behavioral and Mental Health
Professions (GTPD)
Health Careers Opportunity Program (HCOP)
Interdisciplinary and Interprofessional Joint
Graduate Degree Program (Joint Degree)
Nurse Anesthetist Traineeship (NAT)
Nurse Education, Practice, Quality, and
Retention (NEPQR)
Page 234 of 287

BHPr
Performance
Goals

BHPr Evaluation
Questions

BHPr Measures/Indicators

Data Sources
By BHPr Program

Nurse Faculty Loan Program (NFLP)
Nursing Workforce Diversity (NWD)
Physician Assistant Training in Primary Care
(PAT)
Physician Faculty Development in Primary Care
(PFD)
Pre-doctoral Training in Primary Care
Preventive Medicine Residencies (PMR)
Primary Care Residency Expansion (PCRE)
Public Health Traineeships (PHT)
Residency Training in Primary Care
Teaching Health Centers (THC)

Influence practice
location of health
practitioners.

Dist2: Are BHPr programs
increasing the proportion of
health professionals who enter
practice in the most needed
settings (e.g. Medically
Underserved Communities
(MUC) or rural areas?

Dist2-d:
Numerator:
Number of BHPr program
completers and graduates
employed as faculty
Denominator:
Total number of BHPr program
completers and graduates
eligible to enter practice

2012 BHPr Performance reporting

Centers of Excellence (COE)
Expansion of the Physician Assistant Training
(EPAT) Programs
Geriatric Training Program for Physicians,
Dentists, and Behavioral and Mental Health
Professions (GTPD)
Interdisciplinary and Interprofessional Joint
Graduate Degree Program (Joint Degree)
Nurse Faculty Loan Program (NFLP)
Physician Assistant Training in Primary Care
(PAT)
Physician Faculty Development in Primary Care
(PFD)
Pre-doctoral Training in Primary Care
Page 235 of 287

BHPr
Performance
Goals

BHPr Evaluation
Questions

BHPr Measures/Indicators

Data Sources
By BHPr Program

Primary Care Residency Expansion (PCRE)
Residency Training in Primary Care
Teaching Health Centers (THC)

Influence practice
location of health
practitioners.

Dist2: Are BHPr programs
increasing the proportion of
health professionals who enter
practice in the most needed
settings (e.g. Medically
Underserved Communities
(MUC) or rural areas?

Dist2-e:
Numerator:
*Number of BHPr program
completers and graduates who
are employed in field of study
Denominator:
Total number of BHPr program
completers and graduates
eligible to enter practice

2012 BHPr Performance reporting

Advanced Education Nurse Traineeship (AENT)
Advanced Nursing Education (ANE)
Area Health Education Centers (AHEC)(Infrastructure and Point of Service)
Centers of Excellence (COE)
Expansion of the Physician Assistant Training
(EPAT) Programs
Geriatric Training Program for Physicians,
Dentists, and Behavioral and Mental Health
Professions (GTPD)
Health Careers Opportunity Program (HCOP)
Interdisciplinary and Interprofessional Joint
Graduate Degree Program (Joint Degree)
Nurse Anesthetist Traineeship (NAT)
Nurse Education, Practice, Quality, and
Retention (NEPQR)
Nurse Faculty Loan Program (NFLP)
Nursing Workforce Diversity (NWD)
Physician Assistant Training in Primary Care
(PAT)
Physician Faculty Development in Primary Care
(PFD)
Pre-doctoral Training in Primary Care
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BHPr
Performance
Goals

BHPr Evaluation
Questions

BHPr Measures/Indicators

Data Sources
By BHPr Program

Preventive Medicine Residencies (PMR)
Primary Care Residency Expansion (PCRE)
Public Health Traineeships (PHT)
Residency Training in Primary Care
Teaching Health Centers (THC)
Infrastructure Indicators
Build capacity with
training
infrastructure
support.

I1: Are BHPr programs
increasing the number of new
primary care academic
administrative units?

I1: *Number of new academic
administrative units funded by
BHPr

Academic Administrative Units in Primary Care
(AAU)

Build capacity with
training
infrastructure
support.

I2: Are BHPr programs
increasing the number of new
and expanded dental facilities?

I2: *Number of new and
expanded dental facilities in a
dental health professional
shortage area (HPSA) funded
by BHPr

State Oral Health Workforce Program (SOHWP)

Build capacity with
training
infrastructure
support.

I3: Are BHPr programs
increasing the number of
clinicians training to become
faculty or faculty receiving
development training?

I3-a: *Number of trainees
receiving faculty development
training who intend to teach

Academic Administrative Units in Primary Care
(AAU)
Centers of Excellence (COE)
Comprehensive Geriatric Education Programs
(CGEP)
Dental Faculty Loan Repayment
Expansion of the Physician Assistant Training
(EPAT) Programs

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BHPr
Performance
Goals

BHPr Evaluation
Questions

BHPr Measures/Indicators

Data Sources
By BHPr Program

Faculty Development in General, Pediatric, and
Public Health Dentistry and Dental Hygiene
(FDD)
Faculty Development: Integrated Technology
into Nursing Education and Practice (ITNEP)
Geriatric Academic Career Award (GACA)
Geriatric Education Centers (GEC)
Geriatric Training Program for Physicians,
Dentists, and Behavioral and Mental Health
Professions (GTPD)
Interdisciplinary and Interprofessional Joint
Graduate Degree Program (Joint Degree)
Nurse Faculty Loan Program (NFLP)
Physician Assistant Training in Primary Care
(PAT)
Physician Faculty Development in Primary Care
(PFD)
Pre-Doctoral Training in Primary Care
Primary Care Residency Expansion (PCRE)
Residency Training in Primary Care
State Oral Health Workforce Program (SOHWP)
Teaching Health Centers (THC)

Build capacity with
training
infrastructure
support.

I3: Are BHPr programs
increasing the number of
clinicians training to become
faculty or faculty receiving
development training?

2012 BHPr Performance reporting

I3-b: *Number of faculty
development training
completers from BHPr program

Academic Administrative Units in Primary Care
(AAU)
Centers of Excellence (COE)
Comprehensive Geriatric Education Programs
(CGEP)
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BHPr
Performance
Goals

BHPr Evaluation
Questions

BHPr Measures/Indicators

Data Sources
By BHPr Program

Dental Faculty Loan Repayment
Expansion of the Physician Assistant Training
(EPAT) Programs
Faculty Development in General, Pediatric, and
Public Health Dentistry and Dental Hygiene
(FDD)
Faculty Development: Integrated Technology
into Nursing Education and Practice (ITNEP)
Geriatric Academic Career Award (GACA)
Geriatric Education Centers (GEC)
Geriatric Training Program for Physicians,
Dentists, and Behavioral and Mental Health
Professions (GTPD)
Interdisciplinary and Interprofessional Joint
Graduate Degree Program (Joint Degree)
Nurse Faculty Loan Program (NFLP)
Physician Assistant Training in Primary Care
(PAT)
Physician Faculty Development in Primary Care
(PFD)
Pre-Doctoral Training in Primary Care
Primary Care Residency Expansion (PCRE)
Residency Training in Primary Care
State Oral Health Workforce Program (SOHWP)
Teaching Health Centers (THC)

Build capacity with
I4: Are BHPr programs
2012 BHPr Performance reporting

I4-a: Measure 'Number of

Post-doctoral Training in General, Pediatric, and
Page 239 of 287

BHPr
Performance
Goals

BHPr Evaluation
Questions

BHPr Measures/Indicators

Data Sources
By BHPr Program

training
infrastructure
support.

increasing the number of new
primary care academic
administrative units?

newly accredited residency
programs funded by BHPr'

Public Health Dentistry (PDD)
Preventive Medicine Residencies (PMR)
Primary Care Residency Expansion (PCRE)
Residency Training in Primary Care
State Oral Health Workforce Program (SOHWP)
Teaching Health Centers (THC)

Build capacity with
training
infrastructure
support.

I4: Are BHPr programs
increasing the number of new
primary care academic
administrative units?

I4-b: Number of newly filled
residency positions funded by
BHPr

Post-doctoral Training in General, Pediatric, and
Public Health Dentistry (PDD)
Preventive Medicine Residencies (PMR)
Primary Care Residency Expansion (PCRE)
Residency Training in Primary Care
State Oral Health Workforce Program (SOHWP)
Teaching Health Centers (THC)

Build capacity with
training
infrastructure
support.

I4: Are BHPr programs
increasing the number of new
primary care academic
administrative units?

I4-c: Measure Number of newly
filled dentist/dental provider
positions funded by BHPr

State Oral Health Workforce Program (SOHWP)

2012 BHPr Performance reporting

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BHPr
Performance
Goals

BHPr Evaluation
Questions

BHPr Measures/Indicators

Data Sources
By BHPr Program

Build capacity with
training
infrastructure
support.

I4: Are BHPr programs
increasing the number of new
primary care academic
administrative units?

I4-d: Number of newly filled
physician assistant training
positions funded by BHPr

Interdisciplinary and Interprofessional Joint
Graduate Degree Program (Joint Degree)
Expansion of the Physician Assistant Training
(EPAT) Programs
Physician Assistant Training in Primary Care
(PAT)

Build capacity with
training
infrastructure
support.

I4: Are BHPr programs
increasing the number of new
primary care academic
administrative units?

I4-e: Number of newly filled
advanced nursing training
positions funded by BHPr

Advanced Nursing Education Expansion (ANEE)

2012 BHPr Performance reporting

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Appendix C.

Glossary

This glossary provides general definitions for terms that are used in the performance tables. Some
programs may have program specific definitions that are different from what is presented in this glossary.
If there are questions about the definition of any terms presented in this glossary, please refer to the
authorizing statute, the Funding Opportunity Announcement for your program and the Project Officer for
clarification.
Adult learner/Adult students are typically identified with a larger group characterized as "nontraditional
students”. The National Center for Education Statistics (NCES), U.S. Department of Education, has
identified seven characteristics that typically define nontraditional students. According to the NCES, adult
students often:








Have delayed enrollment into postsecondary education
Attend part-time
Are financially independent of parents
Work full-time while enrolled
Have dependents other than a spouse
Are a single parent
Lack a standard high school diploma.1

Allied Health Professional is defined in section 799b of the Public Health Service Act (42 U.S.C.
295p(5). Further, Allied Health (or Health Related Professions) is used to identify a cluster of health
professions, encompassing approximately 80 different professions. The allied health professions fall into
two broad categories: technicians (assistants) and therapists/technologists. Technicians are trained to
perform procedures, and their education lasts less than two years. They are required to work under the
supervision of technologists or therapists. Therapists/technologists include physical therapy assistants,
medical laboratory technicians, radiological technicians, occupational therapy assistants, recreation
therapy assistants, and respiratory therapy technicians.2
Allied Health Disciplines An example of categories/groups (not exclusive):
Assistants refer to: Home Health Aides and Medical Assistants.
Clinical Laboratory Sciences refers to: Cytotechnologists, Histologic
Technicians/Technologists, Medical Laboratory Technicians, Medical
Technologists and Phlebotomists.
Dental refers to: Dental Hygienists, Dental Assistants and Dental Laboratory
Technicians.

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1

Horn, L. (1996). Nontraditional Undergraduates, Trends in Enrollment From 1986 to 1992 and Persistence and
Attainment Among 1989–90 Beginning Postsecondary Students (NCES 97–578). U.S. Department of Education, NCES.
Washington, DC: U.S. Government Printing Office. http://nces.ed.gov/programs/coe/analysis/2002a-sa09.asp
2
Definition retrieved from http://explorehealthcareers.org/en/Field/1/Allied_Health_Professions

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Food and Nutrition Services refers to: Dietetic Technicians, Dietitians, and
Nutritionists.
Health Information refers to: Health Information Administrators and Health
Information Technicians.
Rehabilitation refers to: Occupational Therapists, Occupational Therapy
Assistants, Orthotists or Prosthetists, Physical Therapists, Physical Therapy
Assistants, Recreation Therapists and Speech Pathologist/Audiologists.
Technicians and Technologists refers to: Clinical Perfusionists, Cardiopulmonary
Technologists, Diagnostic Medical Sonographers, Electrocardiograph
Technicians (EKG), Electroencephalograph Technicians (EEG), Medical
Imaging Technologists, Nuclear Medicine Technologists, Ophthalmic Medical
Technicians/ Technologists, Radiation Therapy Technologists, Radiology
Technologists, Respiratory Therapists, Respiratory Therapy Technicians,
Surgical Technologists, and Emergency Medical Technicians or EMT
Paramedics.
Unspecified refers to any Allied Health discipline not included in the
categories/groups as defined.

Attrition is defined as the reduction in a school's student population as a result of transfers or dropouts.3
Attrition refers to the number of trainees who permanently left the program before completing the training
year. Attrition can also refer to the number of faculty who permanently left the program.
Behavioral Health refers services aimed at prevention, screening, intervention, assessment, diagnosis,
treatment, and follow-up of common mental health disorders, such as depression, anxiety, and Attention
Deficit Disorder with Hyperactivity (ADHD). Behavioral health services also include the treatment and
follow-up of patients with severe mental illnesses (e.g., schizophrenia, bi-polar disorder, psychotic
depression) who have been stabilized and are treatment compliant on psychiatric/psychotropic
medications. Clinical and support services may include individual and group counseling/psychotherapy,
cognitive-behavioral therapy or problem solving therapy, psychiatric/psychotropic medications, selfmanagement groups, psycho-educational groups, and case management.
Clinical training is the patient-care component of health professions education, including but not limited
to clinical rotations, preceptorships, and clerkships. For purposes of BHPr reporting, include hands-on
field training with patient encounters (not didactic or observations).
Community-Based Setting/Health Facilities are entities that provide delivery of health services in a
community and may include a community hospital, community or public health center, outpatient medical
facility, rehabilitation facility, facility for long-term care, community mental health center, migrant health

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3

Page ccxliii of 287

Definition retrieved from http://www.education.com/definition/student-attrition/

2012 BHPr Performance reporting

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center, and a facility operated by a city or county health department that serves and supports clinical
training. These facilities usually serve a catchment area that is not reasonably accessible to an adequately
served area or a population with special health needs.
Community health center provides primary care in a community-based and patient-directed way.
Required to serve populations with limited access to health care and can serve a variety of underserved
populations or areas,
Community behavioral health center is a community-based mental health agency accredited by The Joint
Commission
Completer refers to a trainee who has successfully met the didactic and/or clinical requirements of a
course of study or training program designed to improve their knowledge or skills. This term differs from
graduates since an official degree or diploma is not conferred. Contact your project officer to clarify if
your trainees should be considered completers or graduates. (See definition of ‘graduate’ in the glossary).
Contact hours refers to a unit of measure that represents an hour of scheduled instruction given to
students. This definition does not include patient contact time for clinical settings.
Continuing education program is a formal, post-licensure educational program designed to increase
knowledge or skills of health professions. Continuing education programs may include workshops,
institutes, clinical conferences, staff development courses, and individual studies. It does not include
study for an academic degree, post-master’s degree certificate, or other evidence of completing such a
program.
Cultural competence refers to a set of academic and interpersonal skills that allow an individual to
increase his or her understanding and appreciation of cultural differences and similarities within, as well
as among and between, groups. This requires willingness and ability to draw on values, traditions, and
customs of the populations served and the ability to develop culturally sensitive interventions.
Curriculum is a set of courses constituting an area of specialization.
Didactic training involves traditional classroom or virtual education forums wherein trainees receive
instruction from designated faculty members and/or clinicians.
Disadvantaged means an individual who (1) educationally comes from an environment that has inhibited
the individual from obtaining knowledge, skills, and abilities required to enroll in and graduate from a
health professions school or (2) economically comes 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,
adjusted annually for changes in the Consumer Price Index and adjusted by the Secretary for use in all
health professions programs.
Examples of criteria for educationally disadvantaged are below:
(1) The individual graduated from (or last attended) a high school with low SAT score based on
most recent data available:
(2) The individual graduated from (or last attended) a high school from which, based on most
recent data available:
(a) low percentage of seniors receive a high school diploma; or
(b) low percentage of graduates go to college during the first year after graduation.
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(3) The individual graduated from (or last attended) a high school with low per capita funding.
(4) The individual graduated from (or last attended) a high school at which based on most recent
data available, many of the enrolled students are eligible for free or reduced price lunches.
(5) The individual comes from a family that receives public assistance (e.g., Aid to Families with
Dependent Children, food stamps, Medicaid, public housing).
(6) The individual comes from a family that lives in an area that is designated under section 332
of the Act as a health professional shortage area.
(7) The individual would be the first generation in a family to attend college
Discipline means a field of study.
Dislocated worker refers to an individual who (A) (i) has been terminated or laid off, or who has received
a notice of termination or layoff, from employment; (ii) (I) is eligible for or has exhausted entitlement to
unemployment compensation; or (II) has been employed for a duration sufficient to demonstrate, to the
appropriate entity at a one-stop center referred to in section 134(c), attachment to the workforce, but is not
eligible for unemployment compensation due to insufficient earnings or having performed services for an
employer that were not covered under a State unemployment compensation law; and (iii) is unlikely to
return to a previous industry or occupation; (B)(i) has been terminated or laid off, or has received a notice
of termination or layoff, from employment as a result of any permanent closure of, or any substantial
layoff at, a plant, facility, or enterprise; (ii) is employed at a facility at which the employer has made a
general announcement that such facility will close within 180 days; or (iii) for purposes of eligibility to
receive services other than training services described in section 134(d)(4), intensive services described in
section 134(d)(3), or supportive services, is employed at a facility at which the employer has made a
general announcement that such facility will close; (C) was self-employed (including employment as a
farmer, a rancher, or a fisherman) but is unemployed as a result of general economic conditions in the
community in which the individual resides or because of natural disasters; or (D)is a displaced
homemaker.4
Disparity refers to a pattern of differences in health outcomes that occurs by age, gender, race, ethnicity,
education or income, disability, geographic location, or sexual orientation.
Diversity as defined by BHPr: Diversity is most often viewed as the proportion and number of individuals
from groups underrepresented among students, faculty, administrators, and staff (i.e., structural diversity).
Diversity, however, can also be conceptualized as the diversity of interactions that take place on campus
(e.g., the quality and quantity of interactions across diverse groups and the exchange of diverse ideas), as

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4

Page ccxlv of 287

Workforce Investment Act, Title I, Subsection A, Section 101.

2012 BHPr Performance reporting

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well as campus diversity-related initiatives and pedagogy (e.g., the range and quality of curricula and
programming pertaining to diversity, such as cultural activities and cultural awareness workshops).”
Enrollee is a trainee who is receiving training in a program, but has not finished the program during a
given grant year. Enrollees do not include graduates or program completers.
Entering practice means health professions students who intend to begin providing direct patient care or
public health upon graduation from a funded formative or advanced education and training program.
Ethnicity refers to two categories: “Hispanic or Latino” and “Non-Hispanic and Non-Latino.” “Hispanic
or Latino” refers to an individual of Cuban, Mexican, Puerto Rican, South or Central American, or other
Spanish culture or origin, regardless of race.
Experiential training (i.e., learning by doing) is learning through concrete experience followed by
observation and reflection, the formation of abstract concepts about the experience followed by testing
what was learned in new situations.5
Faculty refers to the group of individuals who have received a formal assignment to teach resident/fellow
physicians or other trainees in a health professions training program. At some sites appointment to the
medical staff of the hospital constitutes appointment to the faculty.6 The faculty provides instruction to
develop students’ skills inherent in practice to a level of professional competency which, in graduate
education, may include the development of research capability. A faculty includes all faculty members,
even those who participate on an as-needed basis. Faculty members will be counted by a full-time
equivalent (FTE) measure unless otherwise noted.
Federally Qualified Health Center (FQHC) an entity, per Section 1905(l)(2)(B) of the Social Security Act
(42 USC 1396d), which (i) is receiving a grant under section 254b of this title, or
(ii) (I) is receiving funding from such a grant under a contract with the recipient of such a grant, and
(II) meets the requirements to receive a grant under section 254b of this title;
(iii) based on the recommendation of the Health Resources and Services Administration within the Public
Health Service, is determined by the Secretary to meet the requirements for receiving such a grant,
including requirements of the Secretary that an entity may not be owned, controlled, or operated by
another entity, or
(iv) was treated by the Secretary, for purposes of part B of subchapter XVIII of this chapter, as a
comprehensive Federally funded health center as of January 1, 1990; and includes an outpatient health
program or facility operated by a tribe or tribal organization under the Indian Self-Determination Act
(Public Law 93-638) [25 U.S.C. 450f et seq.] or by an urban Indian organization receiving funds under
title V of the Indian Health Care Improvement Act [25 U.S.C. 1651 et seq.] for the provision of primary

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5

Definition derived from Kolb. D. A. and Fry, R. (1975) 'Toward an applied theory of experiential learning; in C. Cooper (ed.)
Theories of Group Process, London: John Wiley.
6
Definition was adapted from the ACGME glossary at http://www.acgme.org/acWebsite/about/ab_ACGMEglossary.pdf.

2012 BHPr Performance reporting

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health services. In applying clause (ii), (4) the Secretary may waive any requirement referred to in such
clause for up to 2 years for good cause shown.
Fellowship means a one or two year organized training effort designed to meet a specific training
purpose.
Financial Award Types
Scholarship is tuition-only funding to aid a person attending an educational institution. Generally
not considered taxable income.
Stipend is a set amount of funding to be used for tuition, living expenses or whatever the recipient
determines necessary. Is usually considered taxable income.
Traineeship is the provision of graduate or specialized training in field of study
Loan means the amount of money advanced to a student by a school from a health professions
student loan fund under a properly executed promissory note.

Frontier is an area where remote clinic sites are located and where weather and distance can prevent
patients who experience severe injury or illness from obtaining immediate transport to an acute care
hospital.7
Geriatrics focuses on health promotion and the prevention and treatment of disease and disability in later
life.
Graduate refers to a trainee who has successfully completed all educational requirements for a specified
academic program of study culminating in a degree or diploma, as in a university, college, or health
professions school during this reporting period.
Health careers enrichment/training activities are AHEC health career activities ranging from 0 - ≥120
hours. Health career activity greater than 120 hours must have a minimum of 10 students per educational
level.
Health professional refers to an individual who has received a certificate, an associate’s degree, a
bachelor’s degree, a master’s degree, a doctorate degree, or post-baccalaureate training in a field related
to health care and who shares in the responsibility for the delivery of health care or related services.
Health professional shortage area (HPSA) refers to an area designated as having a shortage of primary
medical care, dental, or mental health providers. The area may be geographic (a county or service area),
demographic (low income population), or institutional (comprehensive health center, federally qualified

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7

Definition provided in the Office of Rural Health Policy 2009 Annual Report, retrieved from
http://www.hrsa.gov/ruralhealth/pdf/annualreport2009.pdf

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health center, or other public facility). More information about HPSAs is available on the BHPr Web
sites: http://bhpr.hrsa.gov/shortage and http://muafind.hrsa.gov/.
Health professions student refers to an individual who is pursuing a certificate, an associate’s degree, a
bachelor’s degree, a master’s degree, a doctoral degree, or post-baccalaureate training in a field relating to
health care and who shares in the responsibility for the delivery of health care or related services.
Hours of Instruction refers to the total amount of time (in hours) it takes to impart instruction for a
particular course.
Interdisciplinary means two or more persons from the same profession but different specialties (e.g.
Medical/Surgical Nurse and Labor and Delivery Nurse)
Internship means a type of training that gives entry-level job seekers substantive work experience.
Internships may be paid or unpaid and may or may not carry the offer of full-time, permanent
employment upon completion.
Interprofessional education occurs when two or more professions learn about, from and with each other to
enable effective collaboration and improve quality of care and health outcomes.8
Interprofessional practice occurs when two or more professions collaborate in the provision of health care
services, and through it each profession’s contribution to care is enhanced and quality is improved. 8
Medically Underserved Areas/Populations (MUA/P) are areas or populations designated by HRSA as
having: too few primary care providers, high infant mortality, high poverty and/or high elderly
population. Health Professional Shortage Areas (HPSAs) are designated by HRSA as having shortages of
primary medical care, dental or mental health providers and may be geographic (a county or service area),
demographic (low income population) or institutional (comprehensive health center, federally qualified
health center or other public facility). Medically Underserved Areas (MUAs) may be a whole county or a
group of contiguous counties, a group of county or civil divisions or a group of urban census tracts in
which residents have a shortage of personal health services. Medically Underserved Populations (MUPs)
may include groups of persons who face economic, cultural or linguistic barriers to health care.9
Medically Underserved Community (MUC) is any geographic area or population served by any of the
following practice sites:
Ambulatory practice sites designated by State Governors as serving medically underserved
communities.
Community health centers (section 330)
Federally qualified health centers (section 1905(1)(2)(B) of the Social Security Act)
Health Care for the Homeless grantees (section 330)

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8

Definition derived from World Health Organization. (2010). Framework for Action on Interprofessional Education and
Collaborative Practice. Geneva: WHO.
9
http://muafind.hrsa.gov

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Indian Health Services sites (Pub. L. 93-638 for tribal operated sites and Pub. L. 94-437 for IHS
operated sites)
Migrant health centers (section 330)
Primary medical care, mental health, and dental health professional shortage areas (federally
designated under section 332)
Public housing primary care grantees (section 330)
Rural health clinics, federally designated (section 1861(aa)(2) of the Social Security Act)
State or local health departments (regardless of sponsor; for example, local health departments
that are funded by the State would qualify)
Note: Information on CHCs, MHCs, Health Care for the Homeless grantees, Public Housing Primary
Care grantees, National Health Service Corps’ sites, and HPSAs is available on the BHPr or the
Bureau of Primary Health Care Web sites: http://bhpr.hrsa.gov or http://bhpc.hrsa.gov (select “Key
Program Areas” and “Resources”).
Medically underserved populations (MUP) may include groups of persons who face economic, cultural,
or linguistic barriers to health care. More information about MUPs can be found on the BHPr Web site:
http://bhpr.hrsa.gov/shortage/.
Partners/Leveraging consists of partnerships, cooperative agreements, or any similar
collaborative arrangement that is entered into by the grantee and another organization, such as a hospital,
educational institution, trade or consumer group, or state or local government agency. Partnerships or
leveraging can be formal or informal but is always cooperative and beneficial to all parties involved.10
Patient-Centered Care recognizes the patient or designee as the source of control and full partner in
providing compassionate and coordinated care based on respect for patient's preferences, values, and
needs.11 “Patient-centered” means considering patients’ cultural traditions, personal preferences and
values, family situations, social circumstances and lifestyles.12
Patient encounter is defined as documented, face-to-face contact between a patient and a provider who
exercises independent professional judgment in the provision of services to the patient. For more
information, see Bureau of Primary Health Care Web sites: http://bhpr.hrsa.gov or http://bhpc.hrsa.gov
Population Health has been defined as “the health outcomes of a group of individuals, including the
distribution of such outcomes within the group.” It is an approach to health that aims to improve the
health of an entire population. One major step in achieving this aim is to reduce health inequities among
population groups. Population health seeks to step beyond the individual-level focus of mainstream

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10

Definition adaption from FDA, HHS definition of Leveraging and Partnerships. See FDA Leveraging Handbook:
http://www.fda.gov/downloads/AboutFDA/CentersOffices/CDER/WhatWeDo/UCM121662.pdf
11
12

Definition retrieved from Quality and Safety Education for Nurses (QSEN) http://www.qsen.org/definition.php?id=1
Definition adapted from the Institute of Medicine (IOM) and Institute for Healthcare Improvement (IHI).

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medicine and public health by addressing a broad range of factors that impact health on a populationlevel, such as environment, social structure, resource distribution.13
Practicum training refers practical experiences (not didactic or clinical) that are hands-on field training
without clinical patient encounters, such as shadowing and observations
Publications refer to articles, reports, or other documents based on HRSA-supported data and published
information.
Public health is the science and art of protecting and improving the health of communities through
education, promotion of healthy lifestyles, and research for disease and injury prevention.
Pre-Professional pertains to the period preceding specific study for a profession. Pre-professional
students are those trained in K-12 or undergraduate programs that help students develop interest or intent
to enroll in a health professions program of study.14
Primary Care is the provision of integrated, accessible health care services by clinicians who are
accountable for addressing a large majority of personal health care needs, developing a sustained
partnership with patients, and practicing in the context of family and community. The term clinician
refers to an individual who uses a recognized scientific knowledge base and has the authority to direct the
delivery of personal health services to patients. A clinician has direct contact with patients and may be a
physician, nurse practitioner, or physician assistant.15
Primary care setting refers to a setting that provides integrated comprehensive and continuous, accessible
health care services by clinicians, including nurse practitioners and nurse-midwives, who are accountable
for addressing a large majority of personal health care needs within their scopes of practice, developing a
sustained partnership with clients, and practicing in the context of family and communities. Critical
elements also include accountability of clinicians and systems for quality of care, consumer satisfaction,
efficient use of resources, and ethical behavior. Clients have direct access to an appropriate source of
care, which continues over time for a variety of problems and includes needs for preventive services.
Program Completers are trainees who successfully completed a non-degree course of study or training
program.
Quality of Care is the degree to which health services for individuals and populations increase the
likelihood of desired health outcomes and are consistent with current professional knowledge.16

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13

Definition adapted from Kindig D, Stoddart G. What is population health? American Journal of Public Health 2003
Mar;93(3):380-3.
14

Definition adapted from http://www.merriam-webster.com/dictionary/preprofessional

15

Definition adapted from Donaldson, M.S. [et al.], editors (1996), Primary care: America's health in a
new era, Committee on the Future of Primary Care Services, Division of Health Care Services, Institute
of Medicine.
16

Retrieved from Institute of Medicine, Measuring the Quality of Health Care http://www.nap.edu/catalog/6418.html

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Race according to standards for the classification of federal data on race and ethnicity from OMB, five
minimum categories on race exist: American Indian or Alaska Native, Asian, Black or African-American,
Native Hawaiian or Other Pacific Islander, and White.17 The minimum categories for data on race and
ethnicity for Federal statistics, program administrative reporting, and civil rights compliance reporting are
defined as follows:
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 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.
Terms such as “Haitian” or “Negro” can be used in addition to “Black or African-American.”
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, the Middle East, or
North Africa.
Note: See “Ethnicity” for definitions of Hispanic or Latino ethnicity.
Racial and Ethnic Minority Group means American Indians (including Alaska Natives, Eskimos, and
Aleuts); Asian Americans; Native Hawaiians and other Pacific Islanders; Blacks; and Hispanics.18
Minority/Minorities refer to individual(s) from a racial and ethnic minority group.
Underrepresented Minority/Minorities, with respect to a health profession, means racial and
ethnic populations that are underrepresented in the health profession relative to the number of
individuals who are members of the population involved. This includes Blacks or AfricanAmericans, American Indians or Alaska Natives, Native Hawaiians or Other Pacific Islanders,
Hispanics or Latinos, and certain Asian subpopulations (other than Chinese, Filipino, Japanese,
Asian Indian, or Thai).19
Research training involves the supervision of trainees in conducting research in clinical or academic
environments. Such training may involve literature reviews, development of data collection protocols,
data collection, data analysis, results interpretation, or the dissemination of research findings.
FY2012 – BHPr Performance Report

Page ccli of 287

17

OMB guidance on aggregation and allocation of data on race can be retrieved from:
http://www.whitehouse.gov/omb/bulletins_b00-02
18
Public Health Service Act, Section 1707.
19
Public Health Service Act, Section 799b

2012 BHPr Performance reporting

Page 251 of 287

Residency is a program accredited to provide a structured educational experience designed to conform to
the program requirements of a particular specialty.20
Rural describes all counties that are not part of a Metropolitan Statistical Area (MSA). The White
House’s Office of Management and Budget (OMB) designates counties as Metropolitan, Micropolitan, or
Neither. Micropolitan counties are considered non-Metropolitan or rural along with all counties that are
not classified as either Metro or Micro.
For more information on Metro areas, see:
http://www.census.gov/population/www/estimates/metroarea.html
There is an additional method of determining rurality that HRSA uses called the Rural-Urban commuting
area (RUCA) codes. Like the MSAs, these are based on Census data which is used to assign a code to
each Census Tract. Tracts inside Metropolitan counties with the codes 4-10 are considered rural. While
use of the RUCA codes has allowed identification of rural census tracts in Metropolitan counties, among
the more than 60,000 tracts in the U.S. there are some that are extremely large and where use of RUCA
codes alone fails to account for distance to services and sparse population. In response to these concerns,
HRSA’s Office of Rural Health Policy has designated 132 large area census tracts with RUCA codes 2 or
3 as rural. These tracts are at least 400 square miles in area with a population density of no more than 35
people.
For more information on RUCAs, see:
http://www.ers.usda.gov/briefing/Rurality/RuralUrbanCommutingAreas/
The HRSA website has page where you can search for eligible counties, or eligible census tracts inside
Metro counties, at http://datawarehouse.hrsa.gov/RuralAdvisor/. You can also download a complete list
of eligible areas from that page.21 Stipend is a cost-of-living allowances for trainees and fellows if
permitted by a program’s statute authorizing or implementing regulations. The specific amounts may be
established by policy. Generally, these payments are made according to a pre-established schedule based
on the individual’s experience and level of training. A stipend is not a fee-for-service payment and is not
subject to the cost accounting requirements of the cost principles. Stipends are not allowable under
research grants even when they appear to benefit the research project.22
Summer program (≥120 hours) is a designed curriculum or set of activities of a minimum of 25 students
per educational level that provides 6 hours of structured learning activities per day for a minimum of 6
weeks.

FY2012 – BHPr Performance Report

20

21

Page cclii of 287

Definition was adapted from the ACGME glossary at http://www.acgme.org/acWebsite/about/ab_ACGMEglossary.pdf.

Retrieved from the HRSA, Office of Rural Health Policy: http://www.hrsa.gov/ruralhealth/policy/definition_of_rural.html

22

Definition adapted from Department of Health and Human Services Grants Policy Statement, 2007. Available at:
www.aoa.gov/aoaroot/grants/terms/docs/hhs_gps.doc

2012 BHPr Performance reporting

Page 252 of 287

Suburban refers to a separate residential community within commuting distance from a city. This
definition excludes areas defined as urban, rural or frontier.
Trainee is a person receiving training or education in a vocation, occupation or profession. Enrollees,
Program Completers and Graduates are subsets of trainees.
Underserved area/population includes:
The elderly, individuals with HIV/AIDS, substance users, and survivors of domestic violence
Homeless populations
Health professional shortage areas/populations
Medically underserved areas/populations
Migrant and seasonal farm workers
Nurse shortage areas
Residents of public housing
Rural communities
Rural health clinic (RHC) is a federally qualified health clinic certified to receive special Medicare and
Medicaid reimbursement. RHCs are required to be staffed by a team that includes one mid-level provider,
such as a nurse practitioner (NP), physician assistant (PA), or certified nurse midwife (CNM), that must
be on-site to see patients at least 50 percent of the time the clinic is open and a physician (MD or DO) to
supervise the mid-level practitioner in a manner consistent with state and federal law. RHCs must be
located within non-urban rural areas that have health care shortage designations.23
Urban is classified by the U.S. Census Bureau as all territory, population, and housing units located
within urbanized areas (UA) and urban clusters (UC), both defined using the same criteria. The U.S.
Census Bureau delineates UA and UC boundaries that represent densely developed territory,
encompassing residential, commercial, and other nonresidential urban land uses. In general, this territory
consists of areas of high population density and urban land use resulting in a representation of the “urban
footprint.”
According to the U.S. Census Bureau, an UA is:
“An area consisting of a central place(s) and adjacent territory with a general population density
of at least 1,000 people per square mile of land area that together have a minimum residential

FY2012 – BHPr Performance Report

Page ccliii of 287

23

Office of Rural Health Policy Web Site:
http://www.hrsa.gov/healthit/toolbox/RuralHealthITtoolbox/Introduction/ruralclinics.html

2012 BHPr Performance reporting

Page 253 of 287

population of at least 50,000 people. The U.S. Census Bureau uses published criteria to determine
the qualification and boundaries of UAs” (U.S. Census Bureau Web site).24
The agency goes on to further clarify this definition with the following additional information:
“…a densely settled area that has a census population of at least 50,000. A UA generally consists
of a geographic core of block groups or blocks that have a population density of at least 1,000
people per square mile, and adjacent block groups and blocks with at least 500 people per square
mile. A UA may consist of all or part of one or more incorporated places or census designated
places, and may include area adjacent to the place(s).”
Vulnerable populations include adolescents, children, chronically ill, college students, homeless
individuals, individuals with HIV/AIDS, individuals with mental health or substance abuse disorders,
migrant workers, military and/or military families, older adults, people with disabilities, pregnant women
and infants, unemployed, returning war veterans (Iraq or Afghanistan), veterans, and victims of abuse or
trauma.

FY2012 – BHPr Performance Report

24

Page ccliv of 287

Office of Rural Health Policy Web site: http://www.hrsa.gov/ruralhealth/pdf/rhcmanual1.pdf

2012 BHPr Performance reporting

Page 254 of 287

Appendix D. Matrix of Cross-cutting Data Tables Required by Program
The following section includes each of these tables with the specific purpose and instructions for completing each table. BHPr requires its grantees to
provide the data only for the appropriate and relevant cross-cutting measures as detailed in table below.
Key:
Table
LR-1, LR-2
DV-1, DV-2
DV-3
N-1
N-2
PC-1
PC-R
R-1
EXP-1
EXP-2
CLSET-1
CE-1
CE-TTY
CE-2
DP-1
OH-1
PY-1
IND-GEN
IND-INTPRAC
IND-FAC
INDGEN-EXP
2012 BHPr Performance reporting

Description
Trainee Information
Diversity Measures
Trainee Residential Background
Supply Indicators for Nursing Programs
Supply Indicators for Personal and Home Care Aides and Nursing Assistant and Home Health
Aide Programs
Program Level Supply Indicators for Primary Care
Primary Care Curriculum Content
Program Level Supply Indicators for Residency Programs
Experiential and/or Clinical Training
Nursing Experiential Training
Clinical Settings Per Training Year
Educational Offering Description
Continuing Education Trainee Type
Educational Offering Employment
Diversity/Pipeline Program Content
Oral Health Key Training Content Areas
Prior Year Completers and Graduates
Individual Trainee General Characteristics
Individual Intent to Practice Characteristics
Individual Faculty Characteristics
Individual Trainee-to-Experiential/Clinical Training Site Association
Page 255 of 287

U76,
U77

√

√

√

√

√

√

√

√

√

√

√

√

√

2012 BHPr Performance reporting

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

INDGEN
-EXP

√

√

INDGEN
INDINTPRA
C
IND-FAC

√

PY-1

√

OH-1

√

DP-1

√

CE-2

√

CE-TTY

√

√

CE-1

√

CLSET-1

√

EXP-2

√

EXP-1

√

R-1

√

PC-R

√

PC-1

√

N-2

√

N-1

DV-3

T57

DV-2

D09

DV-1

A10

Academic
Administrat
ive Units in
Primary
Care
(AAU)
Advanced
Education
Nurse
Traineeship
(AENT)
Advanced
Nursing
Education
(ANE)
Advanced
Nursing
Education
Expansion
Program
(ANEE)
Area Health
Education
Centers
(AHEC)(Infrastruct
ure
Developme

LR-2

D54,
D12,
D5A

Program
Name

LR-1

Act.
Code

√

√

√

√

√

Page 256 of 287

√

√

√

√

√

INDGEN
-EXP

√

INDGEN
INDINTPRA
C
IND-FAC

√

PY-1

√

OH-1

√

DP-1

√

CE-2

√

CE-TTY

√

CE-1

√

CLSET-1

√

EXP-2

√

EXP-1

√

R-1

√

PC-R

DV-3

√

PC-1

DV-2

√

N-2

DV-1

√

N-1

LR-2

Program
Name

LR-1

Act.
Code

√

√

√

nt and Point
of Service
Maintenanc
e and
Enhanceme
nt)
D34,
D3E
D87,
D82

D62

T88

Centers of
Excellence
(COE)
Dental
Faculty
Loan
Repayment
Comprehen
sive
Geriatric
Education
Programs
(CGEP)
Expansion
of the
Physician
Assistant
Training
(EPAT)
Programs

2012 BHPr Performance reporting

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

Page 257 of 287

√

√

√

√

√

√

√

√

√

2012 BHPr Performance reporting

√

√

INDGEN
-EXP

√

INDGEN
INDINTPRA
C
IND-FAC

√

√

PY-1

√

OH-1

√

DP-1

√

CE-2

√

CE-TTY

√

CE-1

√

CLSET-1

√

R-1

√

EXP-2

EXP-1

PC-R

√

PC-1

√

N-2

√

N-1

DV-3

UB4

DV-2

K01

DV-1

U1K

Faculty
Developme
nt in
General,
Pediatric,
and Public
Health
Dentistry
and Dental
Hygiene
(FDD)
Faculty
Developme
nt:
Integrated
Technology
into
Nursing
Education
and Practice
Geriatric
Academic
Career
Award
(GACA)
Geriatric
Education
Centers
(GEC)

LR-2

D86

Program
Name

LR-1

Act.
Code

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

Page 258 of 287

√

√

√

√

√

√

√

√

√

2012 BHPr Performance reporting

√

√

√

√

√

√

√

√

INDGEN
-EXP

√

INDGEN
INDINTPRA
C
IND-FAC

√

PY-1

√

√

OH-1

√

DP-1

√

CE-2

√

CE-TTY

√

CE-1

√

CLSET-1

√

R-1

√

EXP-2

EXP-1

PC-R

√

PC-1

√

N-2

√

N-1

DV-3

T85,
T86
(ARR
A)

DV-2

D18,
D1H
(ARR
A)

DV-1

D40

Geriatric
Training
Program for
Physicians,
Dentists,
and
Behavioral
and Mental
Health
Professions
(GTPD)
Graduate
Psychology
Education
(GPE)
Health
Careers
Opportunity
Program
(HCOP)
Interdiscipli
nary and
Interprofess
ional Joint
Graduate
Degree
Program
(Joint
Degree)

LR-2

D01

Program
Name

LR-1

Act.
Code

√

√

√

√

√

√

√

√

√

√

√

√

Page 259 of 287

E2,
P1,
P2

E2,
P1,
P2

√

√

D11

Nurse
Education,
Practice,
Quality,
and
Retention
(NEPQR)

√

√

√

√

√

E
1,
E
2,
R
1,
R
3

UD7

Nursing
Education,
Practice,
Quality,
and
Retention
(NEPQR) –
IPCP
(NEPQRIPCP)

√

√

√

√

√

√

2012 BHPr Performance reporting

√

E2,
P2,
P3,
R3,
R4

E2,
P2,
P3,
R3,
R4

E
2,
P
2,
P
3,
R
3,
R
4

INDGEN
-EXP

√

INDGEN
INDINTPRA
C
IND-FAC

√

PY-1

√

OH-1

√

√

DP-1

√

CE-2

√

CE-TTY

√

R-1

√

CE-1

CLSET-1

EXP-2

EXP-1

PC-R

√

PC-1

DV-3

√

N-2

DV-2

√

N-1

DV-1

A22

Mental and
Behavioral
Health
Education
and
Training
Nurse
Anesthetist
Traineeship
(NAT)

LR-2

M01

Program
Name

LR-1

Act.
Code

√

√

√

√

√

√

√

E
1,
E
2,
R
1,
R
3

E1,
E2,
P1,
P2,
R1,
R3

E2,
P1,
P2

Page 260 of 287

√

√

D19,
D1N
(ARR
A)

Nursing
Workforce
Diversity
(NWD)

√

√

√

√

√

T82

Personal
and Home
Care Aide
State
Training
Program
(PHCAST)

√

√

√

√

√

2012 BHPr Performance reporting

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

INDGEN
-EXP

√

INDGEN
INDINTPRA
C
IND-FAC

√

√

PY-1

√

√

OH-1

√

DP-1

√

CE-2

√

CE-TTY

√

CE-1

√

CLSET-1

√

EXP-2

√

EXP-1

√

R-1

√

PC-R

N-1

√

PC-1

DV-3

√

N-2

DV-2

T51

DV-1

T56
(ACA
)

Nurse
Faculty
Loan
Program
(NFLP)
Nurse
Managed
Health
Clinics
(NMHC)
Nursing
Assistant
and Home
Health Aide
Program
(NAHHA)

LR-2

E01,
E0A
(ARR
A)

Program
Name

LR-1

Act.
Code

√

√

√

√

√

Page 261 of 287

PY-1

INDGEN
INDINTPRA
C
IND-FAC

INDGEN
-EXP

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

2012 BHPr Performance reporting

EXP-2

R-1
√

OH-1

√

DP-1

√

CE-2

√

CE-TTY

√

CE-1

√

CLSET-1

PC-R

√

EXP-1

PC-1

√

N-2

√

N-1

DV-3

D85,
D83
(ARR
A)

DV-2

D88,
D84,
D5G,
D13

DV-1

D55,
D5C

Physician
Assistant
Training in
Primary
Care (PAT)
Physician
Faculty
Developme
nt in
Primary
Care (PFD)
Postdoctoral
Training in
General,
Pediatric,
and Public
Health
Dentistry
(PDD)
Predoctoral
Training in
General,
Pediatric,
and Public
Health
Dentistry
and Dental
Hygiene

LR-2

D57,
D5B
(ARR
A)

Program
Name

LR-1

Act.
Code

Page 262 of 287

√

√

√

√

√

INDGEN
-EXP

√

INDGEN
INDINTPRA
C
IND-FAC

√

PY-1

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

√

OH-1

√

√

DP-1

√

√

CE-2

√

√

CE-TTY

√

√

CE-1

√

√

CLSET-1

√

√

EXP-2

√

√

EXP-1

√

R-1

√

PC-R

DV-3

√

PC-1

DV-2

√

N-2

DV-1

√

N-1

LR-2

Program
Name

LR-1

Act.
Code

(PD)

D56,
D5D
(ARR
A)
D33,
D5H

UD6

R51,
T89
(ACA
)

Predoctoral
Training in
Primary
Care
Preventive
Medicine
Residencies
(PMR)
Integrative
Medicine
Program
and
National
Coordinatin
g
Primary
Care
Residency
Expansion
(PCRE)

2012 BHPr Performance reporting

√

√

√

√

√

Page 263 of 287

√

√

√

√

√

D58,
D5F

T12

T91
(ACA
)

Residency
Training in
Primary
Care
State to
Support
Oral Health
Workforce
Programs
Teaching
Health
Centers
(THC)

√

√

√

2012 BHPr Performance reporting

√

√

√

√

√

√

√

√

√

√

activ
ity 6

activ
ity 6

√

√

√

√

√

√

√

√

√

√

√

activ
ity 7

activ
ity 7

√

INDGEN
-EXP

√

INDGEN
INDINTPRA
C
IND-FAC

√

PY-1

√

OH-1

√

DP-1

√

CE-2

Public
Health
Training
Centers
(PHTC)

CE-TTY

D20,
UC9,
UB6
(ACA
)

CE-1

√

CLSET-1

√

EXP-2

DV-3

√

EXP-1

DV-2

√

R-1

DV-1

√

PC-R

LR-2

Public
Health
Traineeship
s (PHT)

PC-1

LR-1

A03,
A0A
(ARR
A)

N-2

Program
Name

N-1

Act.
Code

√

√

√

√

activ
ity 6

activ
ity 6

activ
ity 6

√

√

√

Page 264 of 287

Appendix E. Matrix of Program-Specific Data Tables
The following table lists the program-specific data tables that grantees of each program are required to
complete. For programs which do not require program-specific data collection by grantees, “not
applicable” (N/A) has been entered in this table.

Activity Code

Program Name
*Requires individual trainee-level data collection.

D54, D12, D5A
(ARRA)
A10

Academic Administrative Units in Primary Care (AAU)

Program-Specific
Tables to be
Completed
AAU-1

Advanced Education Nurse Traineeship (AENT)

N/A

D09

Advanced Nursing Education (ANE)

N/A

T57

Advanced Nursing Education Expansion (ANEE)

N/A

U76, U77

D34, D3E (ARRA)

Area Health Education Centers (AHEC)-(Infrastructure and
Point of Service)
Centers of Excellence (COE)

DP-1a.1, 1a.2

DP-1a.1, 1a.2; DP4a,4b

R18

Chiropractic Demonstration Projects (CDP)

D62

Comprehensive Geriatric Education Programs (CGEP)

D87

Dental Faculty Loan Repayment

N/A

T88

Expansion of the Physician Assistant Training (EPAT)
Programs

N/A

D86

Faculty Development in General, Pediatric, and Public
Health Dentistry and Dental Hygiene (FDD)

FDD-1a.1, 1a.2; FDD1b.1,1b.2; FDD-2

U1K

Faculty Development: Integrated Technology into Nursing
Education and Practice

K01

Geriatric Academic Career Award (GACA)

GACA-1

UB4

Geriatric Education Centers (GEC)

GEC-1, 2

2012 BHPr Performance reporting

N/A
CGEP-1a, b

N/A

Page 265 of 287

Activity Code

Program Name
*Requires individual trainee-level data collection.

D01

Geriatric Training Program for Physicians, Dentists, and
Behavioral and Mental Health Professions (GTPD)

D40

Graduate Psychology Education (GPE)

Program-Specific
Tables to be
Completed
GTPD-1a,1b

N/A

D18, D1H (ARRA)

Health Careers Opportunity Program (HCOP)

DP-1a.1, 1a.2; DP-2

T85, T86 (ARRA)

Interdisciplinary and Interprofessional Joint Graduate
Degree Program

N/A

A22

Nurse Anesthetist Traineeship (NAT)

N/A

D11

Nurse Education, Practice, Quality, and Retention (NEPQR)

NEPQR-3 for R2;
NEPQR-2a,2b for R4

E01, E0A (ARRA)

Nurse Faculty Loan Program (NFLP)

N/A

Nurse Managed Health Clinics (NMHC)

N/A

Nursing Assistant and Home Health Aide Program
(NAHHA)

N/A

Nursing Workforce Diversity (NWD)

N/A

Personal and Home Care Aide State Training Program
(PHCAST)

N/A

D57, D5B (ARRA)

Physician Assistant Training in Primary Care (PAT)

N/A

D55, D5C (ARRA)

Physician Faculty Development in Primary Care (PFD)

PFD-1; RH-1

D13, D5G, D88,
D84 (ARRA)

Post-doctoral Training in General, Pediatric, and Public
Health Dentistry (PDD)

PYPDD-1*

D85, D83 (ARRA)

Pre-doctoral Training in General, Pediatric, and Public
Health Dentistry and Dental Hygiene (PD)

PD-1

D56, D5D (ARRA)

Pre-doctoral Training in Primary Care

N/A

T56 (ACA)
T51

D19, D1N (ARRA)
T82

D33, D5H

Preventive Medicine Residencies (PMR)

2012 BHPr Performance reporting

PMR-1
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Activity Code

Program Name
*Requires individual trainee-level data collection.

Program-Specific
Tables to be
Completed

(ARRA)
U68, U6A (ARRA)

R51, T89 (ACA)
A03, A0A (ARRA)
D20, UC9, UB6
(ACA)
D58, D5F (ARRA)
T12

T91 (ACA)

Primary Care Office (PCO)

PCO-1; PCO-2; PCO3

Primary Care Residency Expansion (PCRE)

N/A

Public Health Traineeships (PHT)

N/A

Public Health Training Centers (PHTC)

Residency Training in Primary Care
State Oral Health Workforce Program (SOHWP)

Teaching Health Centers (THC)

2012 BHPr Performance reporting

PHTC-1a, 1b

N/A
SOHWP-0, 1, 2, 3, 4,
5, 8, 9, 10, 11, 12, 13
N/A

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Appendix F. Progress Reporting Requirements for BHPr Programs
All BHPr grant programs are required to submit annual progress reports on grant-supported activities.
Each BHPr grant program will submit data on the following key elements in the progress report:
Number and types of evaluation activities planned and conducted
Number and types of partnerships and leveraging activities, including the influence on training
activities such as curriculum development and implementation, enrollment, trainee/student
placements.
Number and types of educational innovations (e.g., innovative curricula)
Number and types of best practices implemented
Description of knowledge and strategy dissemination strategies and activities

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Program-Specific Progress Reporting
In addition to the progress reporting requirements for all BHPr grant programs, select programs are
required to submit additional program-specific data. The selected programs and the program-specific
elements are outlined below.
Program

Progress Report
Attachment

Geriatric Academic Career Award (GACA)

GACA-5

Graduate Psychology Education (GPE)

GPE-3

Chiropractic Demonstration Project (CDP)

CDP-1

Academic Administrative Units (AAU)

RH-1

Physician Faculty Development in Primary Care (PFD)

RH-1

Area Health Education Centers (AHEC)

AHEC-1, 2

Data Tables

Table GACA-5: Other Activities- Geriatric Academic Career Award
Table purpose: This table describes activities that may have occurred during the reporting period other
than those addressed in previous tables.
General instructions: This table should capture all other activities that is supported by the GACA
program and not included in the GACA core or program-specific tables.
Type of Activity

Description of Activity

Administrative Activities
Research Activities (title/description)
Publications/ Presentations
Other Professional Activities

Instructions:
Administrative Duties - Indicate your committee and administrative assignments at the medical school.
2012 BHPr Performance reporting
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Research Activities - Describe any research activities in which you have been involved and your role in
the research. Indicate sponsors, titles and grant numbers of any research grants from which you have
received support.
Publications and Presentations - List any publications and formal presentations for the year.
Other Professional Activities - List any professional association leadership roles, community activities,
memberships, etc.

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Table GPE-3: Trainee Research Projects- Graduate Psychology Education

Table purpose: To describe the research projects and outcomes funded during the reporting period.

Number Research Projects

Number of Research Outcomes

Number of Research Projects: Enter the number of research projects funded through your grant during
the reporting period.
Number of Research Outcomes: Enter the number of research outcomes during the reporting period.
Products include: peer-reviewed publications, books, book chapters, reports/monographs, etc.

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Table CDP-1: Description of Treatments- Chiropractic Demonstration Project
Table purpose: To describe the treatments researched during the reporting period. A separate table
should be completed for each type of treatment.

Project
Topic
Number of
Process
Title (keyword) Deliverables from Measures
Effective
Developed
Treatments

(Check all
that apply)

Describe
Research
Outcomes

(During the
reporting
period)

List
Number of
Interventions Collaborations
Evaluated to
with Other
Treat Spinal
Providers
and Lower
Back
Conditions
(List their
disciplines)

Instructions and Indicator Descriptions
Project Title – Specify the title of the treatment that was researched during the reporting period.
Topic – Enter the condition that the treatment involves. Treatments may include spinal injury or lower
back pain.
Number of Deliverables from Effective Treatments – Enter the number and types of products that
resulted from the treatment research. Products may include method papers, concept papers, accepted
publications, conference presentations, patents, and invention reports. If the appropriate product is not
provided, select “Other” and specify the appropriate product type.
Process Measures Developed – Describe the treatments, combinations of treatments etc. that are an
intermediary stage of producing outcomes
Describe Research Outcomes – Enter the outcomes from the treatment research that was conducted
during the reporting period.
List Interventions Evaluated to Treat Spinal and Lower Back Conditions – Enter the interventions
evaluated to treat spinal and lower back conditions.
Number of Collaborations with Other Providers (List their disciplines) – Specify the number of
collaborations established with physicians and other health care providers to conduct the research during
the reporting period.
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Table RH-1— Research
Table purpose: Research training generally involves the supervision of residents in conducting studies in
clinical and/or academic environments. Research training may also involve literature reviews,
development of data collection protocols, data collection, data analysis, results interpretation, and/or the
dissemination of research findings. The purpose of this table is to describe the trainees’ research
experiences so that this information can be linked to the trainees’ outcomes.
General instructions: Complete a separate table for each trainee discipline involved in research. Expand
the table as needed by adding rows to capture each discipline. Use one row per trainee discipline.

Discipline

Number of Physician
Faculty with More
than 50% Time
Devoted to Research

Number of NonPhysician Faculty or
Staff with More than
50% Time Devoted to
Research

Number of
Trainees
Participating in
a Research
Project

Number of PeerReviewed
Publications in the
Current Academic
Year

Instructions:
Discipline - For each discipline involved in research during the reporting period, the discipline of the
researcher should be entered. Discipline may include: General Internal Medicine, Family Medicine,
Pediatrics, Combined Internal Medicine-General Pediatrics; Allopathic/ Osteopathic; MD/MPH; DDS/
DO/ MPH/ MSPH; Geriatrics. If the research involves individuals with another discipline, then the
grantee should indicate “Other” followed by identification of the specific discipline.
Number of Physician Faculty with More than 50% Time Devoted to Research - For each discipline
involved in research during the reporting period, provide the number of faculty with more than 50% of
their time devoted to research. Faculty may include Physicians, Epidemiologists, and Faculty with
expertise in medical informatics. If the appropriate type of faculty is not provided, select “Other” and
specify the appropriate type of Faculty.
Numbers of Non-Physician Faculty or Staff with More than 50% Time Devoted to Research - For
each discipline involved in research during the reporting period, provide the number of non-physician
faculty or staff with more than 50% of their time devoted to research.
Numbers of Trainees Participating in a Research Project - For each discipline involved in research
during the reporting period, provide the number of trainees participating in a research project.
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Numbers of Peer-Reviewed Publications in the Current Academic Year - For each discipline
involved in research during the reporting period, provide the number of peer-reviewed publications in the
current academic year.

2012 BHPr Performance reporting

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Table AHEC-1: Program Characteristics

Name of AHEC Program: ________________________________________________________
Date of Program Establishment: ___________________________________________________
Service Area of AHEC Program (Please check one):
□ Statewide

□ Regional area within a state

□ Multi-state

Total Program Budget: (Includes program office and affiliated AHEC centers)
Federal:

$________________

Non-Federal:

$________________

Additional
Non-Federal Funds:

$________________

In-Kind Support:

$ ________________

(funds used towards 1:1 match)

Provide the total number of federally supported full time and part time staff employed by your AHEC
Program, as well as the number of volunteer staff. Please include staff employed by each AHEC center in
your service area (as reported on the AHEC Center Characteristics form), as part of the total number
provided below.
Total AHEC Program Office and Center Staff:
a. Number of Federally Supported Full Time Staff: ________
b. Number of Federally Supported Part Time Staff: ________
(Equivalent to ______ FTEs)
c. Number of volunteer Staff: ________
(Equivalent to ______ FTEs)

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In the AHEC Program Activity table below, please estimate the percentage of staff time and effort
focused on each AHEC program activity. Please include staff time and effort from each AHEC center, as
reported on the AHEC Center Program Activity Table, in addition to the effort of AHEC Program Office
staff. This table provides a snapshot of staff time and effort for the entire AHEC Program, including
affiliated AHEC centers within your service area. If one or more program areas are not applicable, please
indicate a 0% time allocation.
AHEC Program Activity

Percent of Staff Time/Effort Focused
on Programmatic Category

a. Health Careers Recruitment
b. Community-based education, field placements or
preceptorships, emphasis on primary care
c. Continuing Education
d. Evaluation
e. Interdisciplinary Training
f.

Public Health Careers

g. Dissemination of evidenced-based information,
research results, best practices
h. Innovative curricula
i.

Community Based Participatory Research

j.

Other activity related to health workforce development

TOTAL

2012 BHPr Performance reporting

100%

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Table AHEC-2: Center Characteristics
Complete the following information for each AHEC center that receives federal funds:
Name of AHEC Center: _________________________________________________________
(Do not abbreviate the name of the center)
Date of Center Establishment: ____________________________________________________
Total Number of Years Center has Received Federal Funds: _____________________________
Describe/Explain Funding Gaps, if Applicable: _________________________________
_______________________________________________________________________
Geographic Location of Center (Please check one):
□ Urban

□ Rural

□ Frontier

Geographic Service Area of Center (Check all that apply):
□ Urban

□ Rural

□ Frontier

Total Center Budget:
Federal:

$________________

Non-Federal:

$________________

Additional
Non-Federal Funds:

$________________

In-Kind Support:

$ ________________

(funds used towards 1:1 match)

Provide the total number of federally supported full time and part time staff employed by your AHEC
center. Data provided for “federally supported part time staff” must include both the number of
employees and the full time equivalent (FTE) of part-time staff members.
Total Center Staff:
a. Number of Federally Supported Full Time Staff: ________
b. Number of Federally Supported Part Time Staff: ________
(Equivalent to ______ FTEs)
d. Number of volunteer Staff: ________
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(Equivalent to ______ FTEs
In the AHEC Center Program Activity table below, please estimate the percentage of staff time and effort
focused on each AHEC Center program activity. If one or more program areas are not applicable, please
indicate a 0% time allocation.
AHEC Center Program Activity

Percent of Staff Time/Effort Focused
on Programmatic Category

a. Health Careers Recruitment
b. Community-based education, field placements or
preceptorships, emphasis on primary care
c. Continuing Education
d. Evaluation
e. Interdisciplinary Training
f.

Public Health Careers

g. Dissemination of evidenced-based information,
research results, best practices
h. Innovative curricula
i.

Community-based Participatory Research

j.

Other activity related to health workforce development

TOTAL

2012 BHPr Performance reporting

100%

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This is the final page of the
2012 BHPr Performance Reporting Manual

2012 BHPr Performance reporting

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