This is the Annual Survey of Med


*Draft Annual Report of Program Directors*

This is only a draft of the 2010 Annual Report and may be different from the final product. Do not send this in as a completed report. The actual report will be conducted through zarca.

Program Information

* (a) Program Name

______________________________________________

* (b) Institution Name

______________________________________________

* (c) Program's Web Site Address

____________________________________________________________________

2. Program Director Information

* (a) First Name

___________________________________________________________

* (b) Last Name

____________________________________________________________

* (c) Address 1

____________________________________________________________

(d) Address 2

_____________________________________________________________

* (e) City

_________________________________________________________________

* (f) State

__________________

* (g) Zip Code

______________

* (h) Telephone Number

_________________________________

(i) Extension

__________________

(j) Fax Number

_________________________________________

* (k) E-mail address

______________________________________________

What type of institution houses your program? (Select one option)

	__	4-year College/University
	__	2-year College
	__	Hospital or Medical Center
	__	Independent Laboratory
	__	Military Facility
	__	Academic Health Center/Medical School
	__	Blood Center
	__	Non-degree granting Proprietary Institution

. Institutional Information

* (a) CEO or President First Name

_________________________________________________

* (b) CEO or President Last Name

_________________________________________________

* (c) Address 1

_________________________________________________________________

(d) Address 2

_________________________________________________________________

* (e) City

_________________________________________________________________

* (f) State

________________

* (g) Zip Code

____________

* (h) Telephone Number

_______________________

(i) Extension

__________

(j) Fax Number

________________________________

* (k) E-mail address

________________________________________

Name of the person completing this survey. If the same as Program Director, please leave this blank.

__________________________________________________________________

PROGRAM DETAILS

*Program Type: (Select one option)

	__	CA (Clinical Assistant)
	__	CG (Cytogenetic Technologist)
	__	DMS (Diagnostic Molecular Scientist)
	__	HT (Histotechnician)
	__	HTL (Histotechnologist)
	__	MLT/CLT (Medical Laboratory Technician/Clinical Laboratory Technician)
	__	MT/CLS (Medical Technologist/Clinical Laboratory Scientist)
	__	PA (Path A/Pathologists' Assistant)
	__	PBT/PHLEB (Phlebotomist)

Program Status: (Select one option)

___Active ___Inactive ___Closed

If Closed, please put the date that the program closed.

Month (2 digit)

__________

Year (4 digit)

__________

Is there a possibility that your program may be discontinued in the upcoming year? (Select one option)

___Yes ___No

What is the maximum number of students (Class Capacity) that your program allows per start date or session?

____________________________________________________________________

* How many months does your full-time program last?

_______________________

If your program has a graduate degree, how many months would it take to complete if attended full time?

________________________________

What is the tuition per year for a full-time student in your program, or, for programs lasting less than one year, what is the tuition for the entire program?

(a) Undergraduate Resident

_____________________________________________________

(b) Undergraduate Non-resident

________________________________________________

(c) Graduate Resident

__________________________________________________________

(d) Graduate Non-resident

______________________________________________________

Does your program offer a stipend? (Select one option)

___Yes ___No

If Yes, how much is the stipend?

_____________________________________

* In what month(s) does your program begin? (Check all that apply)

	___	Open Enrollment
	___	January
	___	February
	___	March
	___	April
	___	May
	___	June
	___	July
	___	August
	___	September
	___	October
	___	November
	___	December

* . Approximately what percentage of the professional phase of the program can be completed via evening and/or weekend classes?

____%

* Approximately what percentage of the professional phase of the program can be completed via distance/on-line education? (Select one option)

____%

* Does your program offer education/courses in medical/health care terms in non-English languages?

___Yes ___No

* Does your program offer education in cultural competence? (Cultural competence education is defined as courses and training to increase students' ability to interact effectively with people of different cultures.)

___Yes ___No

STUDENT DATA

Enrollments, Graduates, and Attrition July 1, 2008 to June 30, 2009
These numbers are required for NAACLS Programs

.	Enrollment

Graduates

Attrition

(a)

Certificate/Diploma requiring less than one year

___________

(b)

1-year undergraduate certificate/diploma

___________

(c)

2-year undergraduate certificate/diploma

___________

(d)

Associate degree

___________

(e)

Baccalaureate degree

___________

(f)

Post-baccalaureate certificate

___________

(g)

Master's degree

___________

(h)

Doctoral degree

___________

Enrollment and Graduates by Race/Ethnic Origin and Gender

Enrollment-Male

Enrollment-Female

Graduates-Male

Graduates-Female

(a)

Black (non-Hispanic)

_____________

(b)

White (non-Hispanic)

_____________

(c)

Hispanic

_____________

(d)

Asian/Pacific Islander

_____________

(e)

Native American/Alaskan Native

_____________

(f)

Multi-Racial

_____________

(g)

Other/Unknown

_____________

Continued...

30.	Attrition-Male

31.	Attrition-Female

(a)

Black (non-Hispanic)

_____________

(b)

White (non-Hispanic)

_____________

(c)

Hispanic

_____________

(d)

Asian/Pacific Islander

_____________

(e)

Native American/Alaskan Native

_____________

(f)

Multi-Racial

_____________

(g)

Other/Unknown

_____________

Number of students enrolled from July 1, 2008 to June 30, 2009 who have disabilities (e.g. Psychological, Learning, and/or Physical):

#__________

Of the students graduated from your program from July 1, 2008 to June 30, 2009

* (a) # who found jobs within 6 months

#___________________________________

* (b) # who pursued additional education

#_________________________________

* (c) # who did Neither of the above

#_____________________________________

Of the graduates who found employment within 6 months of graduation, how many were employed in the following settings?

* (a) Medical Laboratory

#________________________

* (b) Industrial Laboratory

#______________________

* (c) Research Laboratory

#_______________________

* (d) Non-Laboratory Related

#____________________

* (e) Do Not Know

#_____________________________

How many graduates do you anticipate in your program between July 1, 2009 and June 30, 2010?

(a) # of Graduates, Male

#______________________

(b) # of Graduates, Female

#______________________

For the number of students who graduated during the time periods listed, please answer the following questions.

( Count each student only once)

.	July 1, 2008 to June 30, 2009

(a)

How many took the ASCP-BOC exam?

____________

(b)	How many passed the ASCP-BOR exam?

____________

(c)	How many passed on subsequent attempts?

____________

* The number of students from July 1 2008 to June 30, 2009 has: (Select one option)

___Increased ___Decreased ___Stayed the same

In my opinion, the quality of students from July 1 2008 to June 30, 2009 has: (Select one option)

___Increased ___Decreased ___Stayed the same

COMMENTS: Please tell us if we have left anything out of the survey. Also, please let us know about any questions, comments, inclusions, exclusions, etc about the survey.

____________________________________________________________________

____________________________________________________________________