Scholarships for Disadvantaged Students (SDS) Program

HEALTH RESOURCES AND SERVICES ADMINISTRATION
BUREAU OF HEALTH PROFESSIONS

INSTRUCTIONS FOR SCHOLARSHIPS FOR DISADVANTAGED STUDENTS (SDS) PROGRAM APPLICATION

Academic Year 2010-2011

PUBLIC REPORTING 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 0915-0149. Public reporting burden for the applicant for this collection of information is estimated to average __ hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, 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 11A-33, Rockville, Maryland, 20857.

GENERAL INFORMATION

Regardless of which option the application is submitted under, you are required to complete a program specific form for each discipline for which you are seeking support.

To be eligible to participate in the SDS program, the application must be submitted through Grants.gov by XXXXX, 2010 and supplemental information must be submitted in HRSA’s EHBs by XXXX, 2010. If your school receives SDS funding, you will be required annually to provide to HRSA program and fiscal data using the Financial Status Report and SDS Performance Report.

Your submission of the SDS Application represents an agreement between the applicant school and the Secretary of the Department of Health and Human Services (HHS) for the management and administration of the SDS Program, and is binding on all parties participating in the program.

ELIGIBILITY CRITERIA: A school must meet all of the criteria listed below to be eligible to be considered for SDS funds for FY 2010. All requirements refer to full-time students (using the school’s requirements for full-time):

• Full-time students from disadvantaged backgrounds must be:

1) At least 10 percent of the total enrollment (full-time enrolled) of your program during Academic Year (AY) 2008-2009 (7/1/08-6/30/09), and

2) At least 10 percent of the total graduates (who were full-time students) of your program during AY 2008-2009.

3) A school must have had at least one full-time economically disadvantaged students enrolled and graduated during AY 2008-2009.

In addition to the above, if your school is a newly established school, as long as you have students enrolled for the reporting year (7/1/08 – 6/30/09) you may apply. Since newly established schools have not yet graduated students, and do not have graduate data, schools may complete the "graduates" data on the application using the data on the class year of expected first graduating class in place of the graduate data. For example, if your program is a 4-year program and you have students enrolled only in the first 2 years, you must use the second year data in providing the "graduates" information. In other words, the data for the second year and the data for the "graduates" will be the same.

Program Application Instructions

A. FULL-TIME STUDENTS IN YOUR PROGRAM FOR ACADEMIC YEAR 2008-2009 (7/1/08-6/30/09) AND THEIR RACIAL/ETHNIC BACKGROUNDS

You must include all full-time students (using your school's definition of full-time) enrolled in your program. Complete this table showing the enrollment and racial/ethnic background of full-time students enrolled in the program for which your school is applying for SDS funds (i.e. health professions, baccalaureate nursing, public health, clinical psychology, etc.) during Academic Year 2008-09.

If you do not provide the complete data requested, your school will not be considered for the funding priority based on the "underrepresented minority enrollment".

Select the category of racial/ethnic background using the following definitions. If the racial/ethnic background is unknown or undisclosed, you must categorize the student to the best of your knowledge under the following:

Race:
American Indian or Alaska Native: A person having origins in any of the original peoples of North America, and who maintains cultural identification through tribal affiliation or community recognition.

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

Asian Underrepresented: Any Asian (see above definition) other than Chinese, Filipino, Japanese, Korean, Asian Indian or Thai.

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

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

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

More than One Race: A person having origins from more than one race.

Click the “here” button to navigate to the “More than One Race Combination for Hispanic or Latino Students” page. Select race combinations and enter counts for full-time enrollment for the current discipline.

If you are unable to provide the counts or there are no students by race combinations, provide reason in the comment field at the bottom of the page. Once the comment is provided and upon “Save and continue”, the fields corresponding to Item 2.F In the SDS Information Page will be editable. Please enter the counts in these fields accordingly.

*Note: If there are no students by race combinations, please enter “0” in Item 2.F on SDS Information Page after providing, comments in “More than One Race Combination for Hispanic or Latino Students” page.

Ethnicity:

Hispanic or Latino: A person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.

Non-Hispanic/Non-Latino: A person not having origins of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.

B. TOTAL FULL-TIME ENROLLMENT AND FULL-TIME DISADVANTAGED ENROLLMENT BY CLASS YEAR FOR STUDENTS IN YOUR PROGRAM FOR ACADEMIC YEAR 2008-2009 (7/1/08-6/30/09)

CLASS YEAR - Enter full-time enrollment by class year (using the school’s definition for full time). Space on the application is available for programs up to six years in length. Enter only Class Year data that is appropriate for the length of your program. For example, if your program is four years in length, the Fifth and Sixth years on the application would be left blank.

For graduate degree programs with more than one type of degree (e.g. masters and doctorate, or pharmacy baccalaureate and graduate), all students who are in the last year of their program should be included in the same year. For example, if a school has a one year program and a two year program, the students in the one year program would be included in the same year as the students in the second year of the two year program.

DISADVANTAGED ENROLLMENT - Complete the table, showing full-time student enrollment from disadvantaged backgrounds (using your school’s requirements for full time) by class year.

Enter Class Year data that is applicable for the length of your program.

An individual from a disadvantaged background is defined as someone who:

[Part I - educational/environmental] comes from an environment that has inhibited the individual from obtaining the knowledge, skill, and abilities required to enroll in and graduate from a school;

The Department expects that eligible students who meet these criteria will

(1) Have the abilities needed to succeed in a health career, but come from backgrounds and educational environments that have made it difficult for them to reach and fully demonstrate their academic potential; and
(2) Are more likely than other students to provide care to underserved areas and populations following completion of their degree.

EXAMPLES - schools are not limited to these examples only:

(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.
(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.

OR

[Part II - economic] 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 of Health and Human Services for adaptation to this program.

For income levels that determine what constitutes a low income family for determining economically disadvantaged students enrolled/graduated during AY 2008-09 for the Academic Year 2008-2009 SDS see page XX. Beginning with FY 2010 application, the parents’ income will be used to determine eligibility for economically disadvantaged in all cases except in those cases where the student is at least 24 years old and has not been listed as a dependent on his or her parents’ income tax for 3 or more years.

Of the Total Full-Time Disadvantaged, enter the number of students who qualify as disadvantaged under the economic (Part II) definition.

Please NOTE: When identifying students from disadvantaged backgrounds, minority status in itself is NOT a factor for determining disadvantaged status.

C. TOTAL NUMBER OF FULL-TIME STUDENTS GRADUATED, TOTAL NUMBER OF FULL_TIME STUDENTS GRADUATED THAT RECEIVED SDS FUNDS, AND NUMBER OF FULL-TIME DISADVANTAGED STUDENTS GRADUATED FROM YOUR PROGRAM FOR ACADEMIC YEAR 2008-2009 (7/1/08-6/30/09).

Enter the Total Full-time Students (using your school’s requirements for full time) Graduated, Total number of Full-time students graduated that received SDS funds, and Total Full-time Disadvantaged Students Graduated for the academic year 2008-2009 (7/1/08-6/30/09).

For newly established schools or programs that had full-time students enrolled in AY 2008-2009, but had not been in existence long enough to have had a graduating class in AY 2008-2009, provide the data from the table in Section B. that represents the first graduating class, in place of graduate data. For example, if a four year program had students enrolled in the first, second and third years during AY 2008-2009, the school would provide data on the third year full-time students in place of the graduate data requested.

Of the Total Full-Time Disadvantaged, enter the number of students who qualify as disadvantaged under the economic (Part II) definition.

D. GRADUATES FROM YOUR PROGRAM SERVING IN PRIMARY CARE AND/OR MEDICALLY UNDERSERVED COMMUNITIES

1. Primary Care

Primary Care fields are limited to Allopathic Medicine, Osteopathic Medicine, Dentistry, Graduate Nursing, and Physician Assistants. Disciplines other than listed above are not eligible for providing Primary Care data.

For schools of Medicine and Osteopathic Medicine, enter the total number of full-time students graduated in academic year 2004-2005 (7/1/04-6/30/05). Enter the total number of full-time students graduated in academic year 2004-2005 who were serving in Primary Care (residency included) during 2008-2009. If your school currently participates in the Primary Care Loan Program (PCL), data can be found on your Annual Operating Report (AOR) 2009, Page 1.

Of the total number of full-time graduates serving in primary care, enter the number that received SDS.

For schools of Dentistry, Nursing (graduate degree), and Physician Assistants, enter the total number of full-time students graduated in academic year 2007-2008 (7/1/07-6/30/08. Enter the total number of full-time students graduated in academic year 2007-08 who were serving in Primary Care (residency included) during 2008-2009.

Following are the definitions of Primary Care:

Allopathic Medicine/Osteopathic Medicine

Family Medicine

General Internal Medicine

General Pediatrics

Preventive Medicine

Osteopathic General Practice

Please note that OBGYN is an unacceptable primary care residency/practice for this program.

Dentistry:

General Dentistry

Dental Public Health

Pediatric Dentistry

Graduate Nursing

Midwifery

Nurse Practitioner

Physician Assistants:

Non-Specialized Practice

If the graduated student is in Primary Care as well as working in Medically Underserved Communities, include this graduate in both categories.

2. Medically Underserved Communities (MUC)

For schools of Medicine and Osteopathic medicine, enter the total number of full-time students graduated in academic year 2004-2005 (7/1/04-6/30/05). Enter the total number of full-time students graduated in academic year 2004-2005 who were serving (residency included) during 2008-2009 in Medically Underserved Communities.

For disciplines other than Medicine and Osteopathic medicine, enter the total number of full-time students graduated in academic year 2007-2008 (7/1/07-6/30/08). Enter the total number of full-time students graduated in academic year 2007-2008 who were serving in Medical Underserved Communities (residency included) during 2008-2009.

Of the total number of full-time graduates serving in MUCs, enter the number that received SDS.

“The term “Medically Underserved Community” means an urban or rural area or population that:

(A) is eligible for designation under Section 332 of the PHS Act as a health professional shortage area (HPSA);

(B) is eligible to be served by a migrant health center under Section 329 [now 330(g)] of the PHS Act, a community health center under Section 330 of the PHS Act, a grantee under Section 330(h) of the PHS Act, (relating to homeless individuals), or a grantee under Section 340A [now 330(i)] of the PHS Act (relating to residents of public housing);

(C) has a shortage of personal health services, as determined under criteria issued by the Secretary under Section 1861(aa)(2) of the Social Security Act (relating to rural health clinics); or

(D) is designated by a State Governor (in consultation with the medical community) as a shortage area or medically underserved community.

In keeping with the Congressional intent that eligible entities should not be limited to formally designated Health Professional Shortage Areas (HPSAs) and populations serviced by CHCs, MHCs, or homeless health centers, the list of types of practice sites that can be claimed under this provision includes the following:

• Community Health Centers (CHC) (section 330 of the PHS Act)

• Migrant Health Centers (MHC) (section 330(g) of the PHS Act)

• Health Care for the Homeless Grantees (section 330(h) of the PHS Act)

• Public Housing Primary Care Grantees (section 330(i) of the PHS Act)

• Rural Health Clinics, federally designated (section 1861(aa)(2) of the Social Security Act)

• National Health Service Corps (NHSC) Sites (section 333 of the PHS Act)

• An outpatient health program or facility operated by a tribe or tribal organization under the Indian Self-Determination Act or by an urban Indian organization receiving funds under Title V of the Indian Health Care Improvement Act (25 U.S.C. § 450 et seq. and 25 U.S.C. § 1601 et seq.)

• Federally Qualified Health Centers (section 1861(aa)(2) of the Social Security Act)

• Primary Medical Care Health Professional Shortage Areas (HPSAs) (section 332 of the PHS Act)

• Mental Health HPSA

• Dental HPSAs (section 332 of the PHS Act)

• Nurse Shortage Areas (section 846 of the PHS Act)

• State or Local Health Departments (regardless of sponsor - for example, local health departments who are funded by the state would qualify)

• Practice sites designated by State Governors as serving medically underserved communities

Program Administrator: The person responsible for the day-to-day administration of this Program. Entering the Name, Phone Number and E-mail address of the program administrator certifies that the applicant institution is in compliance with the requirements outlined in the SFAG.

Certification and Acceptance: By supplying the name, phone number and e-mail address of the authorizing official, the applicant institution accepts, as to any Federal funds allocated and paid as a result of this application, the obligation to comply with the applicable provisions of the Public Health Service Act as amended, regulations, and with the Public Health Service policies in effect at the time of such allocation and payment.

Authorizing Official: The person legally responsible and accountable for the use and disposition of any funds awarded on the basis of this application. Please enter Name, Telephone Number, and E-mail address.

Important: After submission of the application, the email is sent to the Authorizing Official, Project Direct, Creator of Application, Business Official and the Point of Contact for the application. When the face page is received and uploaded, the email goes to Authorizing Official, Project Direct, Business Official and the Point of Contact for the application.

E. Cost of Tuition for Full-time Students for this Program: Enter the average cost of tuition for one year (average of in-state and out-state) for full-time students for the program you are applying for.

F. Length of Program: Enter the length of time (in years) necessary to complete this program (e.g., Nursing Baccalaureate, enter 4).

G. ACCREDITATION

Health professions and nursing schools that are interested in participating in the SDS program must be accredited by a recognized body approved for such purpose by the Secretary of Education.

Each program/discipline must be accredited by the specialized accrediting body approved for the health discipline applying for program participation.

Enter the Name of Accrediting Body (American Osteopathic Association, Commission on Dental Accreditation, Council on Education of the American Podiatric Association, National League for Nursing, etc.) that your discipline (Osteopathic Medicine, Dentistry, Podiatric Medicine, Graduate Nursing, etc.) is accredited by and accreditation expiration date, mm/yy.

H Point of Contact: The person responsible for the application data.

PERFORMANCE PROGRESS REPORT(SF-PPR-2)

*Note: This form is used to collect the additional information for SDS in the EHBs:

PPR-2-001. What is your requested Award Amount? Enter the award amount requested this budget period. Requested amount cannot be less than $1,000.

PPR-2-002. How many students do you plan to support with the requested award amount? Enter the number of students the school plans to support with the requested award amount.

PPR-2-003. Is your school/program public or any other non profit accredited institution? Enter Yes or No. Note: For profit institutions are eligible for nursing and physician assistant programs only.

PPR-2-004. Does your school want to receive funds from the American Recovery and Reinvestment Act (ARRA)? Enter Yes or No

PPR-2-005. CERTIFICATION AND ELIGIBILITY QUESTIONS:

5 I certify that SDS scholarship funds will be given to individuals with financial need for a scholarship, disadvantaged students who are enrolled or accepted to the health professions school applying for SDS funds.

Enter Yes or No.

6. Does your program have methods and standards for setting the amounts of scholarships?

Enter Yes or No.

7. Check box(s) that reflect(s) the method the program will use to disburse the SDS scholarships to students:

□ Disburse directly to the students

□ Apply funds towards tuition expenses

□ Both

8. Check box(s) that reflect(s) how the SDS scholarships will be used:

□ Tuition

□ Fees and other reasonable educational expenses

□ Reasonable living expenses

OMB PPR-2

APPENDIX C: Historical HHS Poverty Table

HHS Poverty Table for Use in Responding to Program Specific Questions B and C requesting historical data about students in the academic year 2008-09 who were identified by your institution using the 2007 income tax data.

Note: This table is not to be used to identify students for the 2010-11 academic year. For the most current table to be used for the 2010-11 academic year, see the definition of disadvantaged student section of this application.

Historical Poverty Table for FY 2008

Size of Parents’ family *	Income Level **
1…………………………………………	$20,800
2………………………………………...	28,000
3………………………………………...	35,200
4…………………………………………	42,400
5………………………………………..	49,600
6……………………………………..…	56,800
7…………………………..,,,,,,,,,,	64,000
8……………………………………..…	71,200

* Includes only dependents listed on Federal income tax forms.

** Adjusted gross income for calendar year 2007.

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