Form 2 SDSPR

SDS PR FYXX data template part 2
SDSPR-1: Funding Information
Complete all the questions for the discipline identified below.
Allopathic Medicine
1. Funding information:
A. Total Federal Funds Authorized for this Funding Period
B. Total Amount of line 1A Disbursed
C. Unused Balance of Federal Funds (Line 1A minus line 1B)
D. Check to indicate zero disbursements
SDSPR-2: Graduate Information
Complete all the questions for the discipline identified below.
2. Graduate Information:
A. Total number of full-time Allopathic Medicine graduates at your school during the current reporting period
B. Total number of underrepresented minorities (URM) Allopathic Medicine graduates at your school during the current reporting period
C. Total number of full-time Allopathic Medicine graduates from rural background during the current reporting period
D. Total number of Allopathic Medicine students that received SDS funds who graduated during XX/XX/20XX – XX/XX/20XX (for discipline 10, and 20), or XX/XX/20XX – XX/XX/20XX ( for the others).
3. Medically Underserved Communities (MUC) details
A. Number of SDS Allopathic Medicine graduates during this reporting period that indicate an intention to serve in medically underserved community
B. Of the graduates in question 2D, enter the total number of full-time Allopathic Medicine students that received SDS funds and served in medically underserved community during XX/XX/20XX – XX/XX/20XX
4. Primary Care (PC) details
A. Number of SDS Allopathic Medicine recipients during this reporting period that indicate an intention to practice in primary care
B. Of the graduates in question 2D, enter the total number of full-time Allopathic Medicine students that received SDS funds and practiced in primary care during 7/1/2012 – 6/30/2013
5. Graduates That Entered Field of Study
Enter the number of <discipline name> SDS students who graduated during XX/XX/20XX – XX/XX/20XX (for discipline 10, and 20), or XX/XX/20XX – XX/XX/20XX ( for the others) that subsequently entered the field for which they received their degree.
6. Enrollment and Attrition
hle1: Please replace "Nursing - Baccalaureate "by dynamic discipline name in this question. A. Enter the total full-time Nursing - Baccalaureate student enrollment at your school during XX/XX/20XX-XX/XX/20XX		hle1: This code should be changed to S71 to avoid a gap in coding.
hle1: Please insert dynamic discipline name in this question. B. Of those students enrolled above, enter the number of full-time <discipline name> students that dropped out during 7/1/2012-6/30/2013.		hle1: This code should be changed to $72
C. Of those students who dropped out during XX/XX/20XX-XX/XX/20XX (in 6B above), how many received SDS funds?		hle1: This code should be changed to S73
7. SDS Recipients Receiving Pipeline Training from Other HRSA Diversity/Pipeline Programs.
Are there SDS recipients, during this reporting period, who received or are receiving pipeline training from other HRSA diversity/pipeline programs
A. Area Health Education Center (AHEC)
B. Centers of Excellence (COE)
C. Health Careers Opportunity Program
D. Nursing Workforce Diversity
E. Other, Specify
8. Community College Question
Is your school a community college?		S77
9. Scholarship usage
How were the SDS funds used?
□ Tuition		hle1: This code should be changed to S74
□ Fees and other reasonable educational expenses		hle1: This code should be changed to S75
□ Reasonable living expenses		hle1: This code should be changed to S76
10. RECRUITMENT INFORMATION
High School Recruitment
General	[ ]College Fairs
	[ ]Summer camps/programs for high school students to receive information about programs offered
	[ ]Other
	[ ]N/A
Specifically Targeting/Recruiting Disadvantaged Students	[ ]Attending college fairs in areas with high percentages of disadvantaged students locally or on a broader scale
	[ ]Training recruiters specifically to answer questions and provide information to disadvantaged students
	[ ]Providing specifically designed information packets on programs and accommodations your school offers for disadvantaged students
	[ ]Prep Courses for disadvantaged high school students interested in careers in the health professions
	[ ]Other
	[ ]N/A
College level Recruitment
General	[ ]Recruitment from community colleges in disadvantaged areas
	[ ]Community College joint admissions programs for disadvantaged students
	[ ]Other :
	[ ]N/A
Specifically Targeting/Recruiting Disadvantaged Students	[ ]Attending college fairs in areas with high percentages of disadvantaged students locally or on a broader scale
	[ ]Training recruiters specifically to answer questions and provide information to disadvantaged students
	[ ]Providing specifically designed information packets on programs and accommodations your school offers for disadvantaged students
	[ ]Prep Courses for disadvantaged high school students interested in careers in the health professions
	[ ]Other
	[ ]N/A
Application Services	[ ]Online programs that waive or assist with application fees for disadvantaged students
	[ ]Other :
	[ ]N/A
Open Houses	[ ]Booths or presentations on resources for disadvantaged students
	[ ]Targeted advertisements for open houses or other programs in areas with high percentage of disadvantaged students
	[ ]Other
	[ ]N/A
11. RETENTION INFORMATION
Individual or Group Peer Mentor Program (Big Brother/Big Sister)	[ ]Open to all
	[ ]Specifically designed for disadvantaged students
	[ ]Placing students in peer support or networks and groups
	[ ]Other
	[ ]N/A
Individual Staff/Advisor Mentor Program	[ ]Open to all
	[ ]Specifically designed for disadvantaged students
	[ ]Other
	[ ]N/A
Specialized Pre-attendance Orientation for Disadvantaged Students	[ ]Team and camaraderie building activities to help students feel included in the school
	[ ]Educate disadvantaged students on how to best use the accommodations and resources the school provides
	[ ]Introduce and build contacts between disadvantaged students and faculty/staff (ex: Heads of departments, Tutors, Financial aid and/or advisors)
	[ ]Specialized welcome packets for disadvantaged students with additional information on available resources and programs that will help them succeed
	[ ]Other
	[ ]N/A
College Skills Development and Review Programs	[ ]Summer or pre-matriculation sessions in a classroom setting teaching disadvantaged students skills that they will need to be successful (eg: study skills, note taking skills, test taking skills, and/or time management skills)
	[ ]Summer or pre-matriculation classes for disadvantaged students to review and strengthen prerequisite knowledge of the course work
	[ ]Individual assessment and profile of disadvantaged students strengths and weaknesses with advisor and plan for development of skills
	[ ]Other
	[ ]N/A
Early Identification for Students at Risk	[ ]Identify students who are falling behind early and provide assistance for them in furthering their academic career
	[ ]Develop individualized plans for struggling disadvantaged students to ensure success/coordination support
	[ ]Provide learning specialists for disadvantaged students who can identify possible learning disabilities or assess strengths and weaknesses
	[ ]Seminars and lectures specifically for disadvantaged students
	[ ]Other
	[ ]N/A
Group or Individual Tutoring Services	[ ]Provide faculty or peer tutors to disadvantaged students
	[ ]Tutors specifically trained to help students faced with difficulties and are from a disadvantaged background
	[ ]Financial mentoring/tutoring
	[ ]Other
	[ ]N/A
Child Care Support	[ ]Free
	[ ]Partially subsidized
	[ ]Other :
	[ ]N/A
Professional Opportunities	[ ]Shadowing health professional
	[ ]Interviewing health professional
	[ ]Other
	[ ]N/A
B. Provide a detailed description on your current and retention activities for students of disadvantaged backgrounds, including minority students who enter into the health professions. Also, if your school has plans to improve the performance of those recruitment and retention programs, please describe those plans.
C. Please share any success stories for SDS recipients below: