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Division of Health Careers Diversity and Development (DHCDD)

Checklist

for

SDS Application 2005-2006

Eligibility Criteria for AY 2005-06 Application

School/program must have a program for recruiting and retaining disadvantaged students and meet the SDS eligibility criteria described below.

Students from disadvantaged backgrounds (see attached) must comprise the following:

1) At least 10% of the total enrollment (full-time students) of your program (e.g., dentistry, baccalaureate nursing) during AY 2003-2004 (7/1/03-6/30/04).

2) At least 10% of the total graduates (full-time students) of your program during AY 2003–2004 (7/1/03-6/30/04).

In addition, in order to be eligible to receive SDS funding, a school must provide the number of economically disadvantaged students enrolled and graduated during AY 2003-04.

Collect data on the following:

In completing the application, please use the data for the period of July 1, 2003 through June 30, 2004, unless otherwise noted. All data requested pertains to FULL-TIME students’ information.

1. Number of full-time students enrolled in your specific discipline program for which your school is applying for AY 2005-06 (7/1/05 - 6/30/06) SDS funds). Categorize by racial and ethnic backgrounds.

Categorize the student to the best of your knowledge under the following:

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 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.

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

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.

2 . Number of full-time students and full-time disadvantaged (environmentally and economically) students enrolled in your program during AY 2003-04 listed by class year. Collect class year data that is applicable to the length of your program. For example, if your program is a four-year program, provide number of full-time students and full-time disadvantaged students for each class year for four years.

Of the total number of full-time disadvantaged students, number who are from economically disadvantaged backgrounds enrolled in your program during AY 03-04. Use the low-income levels which reflects 200 % of the calendar year 2002 Department of Health and Human Services (HHS) poverty guidelines.

Note: In order to determine whether a student comes from a economically disadvantaged background, regardless of independent or dependent status of a student, school must use student’s parents income information under this definition. School must provide number of economically disadvantaged students enrolled and graduated (see number 3. below) in order to be eligible to receive SDS funding.

3. Number of total full-time students and full-time disadvantaged (environmentally and economically) students graduated from your program during AY 03-04.

Of the total number of full-time disadvantaged graduates, number of graduates who were from economically disadvantaged backgrounds from your program during AY 03-04. Use the low-income levels which reflects 200 % of the 2002 Department of Health and Human Services (HHS) poverty guidelines.

Note: School must provide number of economically disadvantaged students enrolled and graduated in order to be eligible to receive SDS funding

4. Number of total graduates from academic year listed below and graduates serving in primary care. This line item is limited to the following disciplines only:

Allopathic Medicine/Osteopathic Medicine (Family Medicine, General Internal Medicine, General Pediatrics, Preventive Medicine, Osteopathic General Practice)

$ For Allopathic/Osteopathic Medicine, provide graduates data from AY 99-00 (7/1/99-6/30/00), who were serving in primary care or completing a primary care residency during AY 03-04. In other words, use “Post Graduate Year (PGY) 4” data. For schools participating in the Primary Care Loan (PCL) program, your data provided on the Annual Operating Report (AOR) 2004 will be inserted on your application from the DHCDD database.

$ For Dentistry, Graduate Nursing and Physician Assistants, provide graduates data from AY 02-03 (7/1/02/30/03) serving in primary care during AY 03-04.

5. Number of total graduates for academic year listed below and graduates serving in Medically Underserved Communities (include number of graduates if serving residency in Medically Underserved Communities). This line item applies to all disciplines.

$ For Allopathic/Osteopathic Medicine, provide graduates data from AY 99-00(7/1/99-6/30/00) serving in medically underserved communities during AY 03-04 (use PGY 4 data).

$ For the remaining disciplines, provide graduates data from AY 02-03 (7/1/02-6/30/03) serving in medically underserved communities during AY 03-04.

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

7. Of the total number of full-time graduates practicing in Primary Care, enter the number that received SDS.