Form 4 Data Collection Worksheet Form

The Nursing Scholarship Program

Data Collection Worksheet Summary

Data Collection Worksheet Form

OMB: 0915-0301

Document [pdf]
Download: pdf | pdf
DCW Summary Report
School Name: Oregon Health & Science University - School of Nursing
Discipline: Registered Nurse
Degree: Bachelor's (Accelerated)
School Year: 2019 - 2020
POC Name: Jane Doe
POC Email Address: [email protected]
Tuition
Residential Status

Year 1 Amount Year 2 Amount Year 3 Amount

Non-Resident

$43,620.00

$19,251.00

$0.00

Resident

$32,700.00

$14,418.00

$0.00

School Incurred Fees
Fee

Year 1 Amount Year 2 Amount Year 3 Amount

Academic Support Services

$0.00

$0.00

$0.00

Administrative Fee

$0.00

$0.00

$0.00

Background Check

$0.00

$0.00

$0.00

Building Use / Campus Use Fee /
Facility Fee

$0.00

$0.00

$0.00

Capstone Course (if required) mandatory preparatory course

$0.00

$0.00

$0.00

Career Resource Fee

$0.00

$0.00

$0.00

Computer Use Fee

$0.00

$0.00

$0.00

Counseling Fees

$0.00

$0.00

$0.00

Curriculum Fee

$0.00

$0.00

$0.00

Disability Insurance (if required of all
students)

$0.00

$0.00

$0.00

Drug Testing

$0.00

$0.00

$0.00

Education Fee

$0.00

$0.00

$0.00

Graduation Fee - for students in last
year of program

$0.00

$60.00

$0.00

$5,639.00

$1,486.00

$0.00

Health Services Fee and
Immunizations

$0.00

$0.00

$0.00

Laboratory Fee

$0.00

$0.00

$0.00

Health Insurance - for students only (if
required)

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DCW Summary Report

Year 4 Amount
$0.00
$0.00

Year 4 Amount
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00

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DCW Summary Report
Library Fee

$0.00

$0.00

$0.00

Malpractice Insurance (if required)

$0.00

$0.00

$0.00

Material Fees / Nursing Material Fee
(if required and does Not include
books)

$0.00

$0.00

$0.00

Matriculation Fee

$0.00

$0.00

$0.00

NCLEX Review (if required) mandatory preparatory course

$0.00

$0.00

$0.00

Online Tuition - for a course; not an
entire program

$0.00

$0.00

$0.00

Processing Fee

$0.00

$0.00

$0.00

Recreation Fee

$0.00

$0.00

$0.00

Registration Fee

$0.00

$0.00

$0.00

Student Activities Fee

$0.00

$0.00

$0.00

Student Association and Union - for
campus services; not educational
associations

$0.00

$0.00

$0.00

Student Government

$0.00

$0.00

$0.00

Student Initiated Fees (if required) - to
fund campus programs and services

$0.00

$0.00

$0.00

Student Services Fee

$64.00

$32.00

$0.00

Technology Fee

$0.00

$0.00

$0.00

Testing (if required) - for course
advancement

$0.00

$0.00

$0.00

Transcript Fee

$0.00

$0.00

$0.00

Transportation (if required) - for
campus-wide system only

$0.00

$0.00

$0.00

$2,288.00

$1,144.00

$0.00

$0.00

$0.00

$0.00

University Fee
Other Fees *

Other Reasonable Costs
Other Items

Year 1 Amount Year 2 Amount Year 3 Amount

Books

$2,252.00

$1,126.00

$0.00

Clinical Supplies/Instruments

$0.00

$0.00

$0.00

Uniforms

$0.00

$0.00

$0.00

Existing Comments
Friday, Jun 21, 2019
[email protected]
1/23/2020 1:17:39 PM

at 02:26 PM

Created the DCW.

DCW Summary Report
$0.00
$0.00
$0.00

$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00

$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00

Year 4 Amount
$0.00
$0.00
$0.00

CW.
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DCW Summary Report

Public Burden Statement: The purpose of the Nurse Corps Scholarship Program (Nurse Corps SP) is
to provide scholarships to nursing students in exchange for a minimum two-year full-time service
commitment (or part-time equivalent), at an eligible health care facility with a critical shortage of
nurses. The information that applicants supply is used to evaluate their eligibility, qualifications and
to assess their continued compliance with the applicable standards for participation in the Nurse
Corps SP. The OMB control number for this information collection is 0915-0301 and it is valid until
05/30/2021 This information collection is voluntary. Public reporting burden for this collection of
information is estimated to average .8 hours per response, including the time for reviewing
instructions, searching existing data sources, and completing and reviewing the collection of
information. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer,
5600 Fishers Lane, Room 14N136B, Rockville, Maryland, 20857 or [email protected].

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File Typeapplication/pdf
File TitleDCW Summary
File Modified2020-02-14
File Created2020-01-23

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