2 Nat Table 2

Table 2 - NAT: Graduate Data - Rural, Underserved, or Public Health (7/01/XX-6/30/XX)

Meeting the Statutory Funding Preference is contingent on meeting the Statutory Funding Preference High Rate – reference section V.2

Meeting the Special Consideration is contingent on meeting the Special Consideration High Rate – reference section V.2

Complete Table 2, as appropriate, providing data on the number of Nurse Anesthesia graduates (whether supported with BHW NAT funds or not) who completed degree requirements between 7/1/XX-6/30/XX and are employed at clinical practice sites substantially benefiting rural or underserved populations, or in State or local health departments. Instructions for completing Table 2 are below.

Practice Settings	Number of Graduates
Community Health Centers
Migrant Health Centers
Health Care for the Homeless Grantees
National Health Service Corps Sites
Indian Health Service Sites/Tribal Health Sites
Federally Qualified Health Centers
State or Local Health Departments
Ambulatory Practice Sites Designated by State Governors
Health Professional Shortage Areas (HPSAs)
Rural Populations / Settings
Underserved Populations / Settings
1. Total Number of Graduates employed in these Settings (from 07/01/XX – 06/30/XX)
2. Total Number of Graduates (from 07/01/XX – 06/30/XX)
3. Percentage of Graduates Employed in these Settings (Number 1 divided by Number 2)
4. Percentage of Graduates Employed in HPSAs (SPC) (Total Number of HPSAs divided by Total Number of Graduates from 07/01/XX-06/30/XX)

OMB Number (0915-0374) and Expiration date (1/31/2017) RENEWAL

Instructions for completing Table 2 - NAT:

IMPORTANT NOTES:

• All applicant institutions requesting the Statutory Funding Preference (SFP) must complete this table which will be used to determine if the applicant has met the SFP.

• All applicant institutions requesting the Special Consideration (SPC) must complete this table which will be used to determine if the applicant has met the SPC.

• Do not make any changes to this table.

• Although a graduate’s practice site may qualify under more than one category, each individual graduate should be reported only once.

• Data on this table should reflect only the number of Nurse Anesthetist graduates who completed degree requirements between 07/01/20XX and 06/30/20XX.

• Number of Graduates. Enter the total number of “Nurse Anesthetist” graduates (whether supported with BHW NAT funds or not) employed in each of the “Practice Settings” for each applicable row.

• Item 1. Enter the cumulative “Total Number of Graduates Employed in these Settings” from 07/01/20XX – 06/30/20XX.

• Item 2. Enter the “Total Number of Graduates” completing degree requirements between 07/01/20XX and 06/30/20XX.

• Item 3. Statutory Funding Preference (SFP). The “Percentage of Graduates Employed in these Settings” is calculated by dividing the Item 1 “Total Number of Graduates employed in these Settings from 07/01/XX-06/30/XX” by Item 2 “Total Number of Graduates from 07/01/XX-06/30/XX”. This percentage will be used to determine if the applicant has met the SFP and it is automatically computed by the electronic system.

• Item 4. Special Consideration (SPC). The “Percentage of Graduates employed in HPSAs” is calculated by dividing the “Number of Graduates from the Health Professional Shortage Areas” [HPSAs] row under the Practice Settings by Item 2 “Total Number of Graduates from 07/01/XX-06/30/XX”. This percentage will be used to determine if the applicant has met the SPC and it is automatically calculated by the electronic system.

OMB Number (0915-0374) and Expiration date (1/31/2017)

RENEWAL