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Application
Tracking #
00064593
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View 1 (Same as Guidance) | View 2 (Same as Guidance + SF PPR-2)
PROGRAM SPECIFIC
Fiscal Year: 2009

Application Tracking #: 00064593

Program Type: Allopathic Medicine
A. FULL-TIME STUDENTS IN YOUR PROGRAM FOR ACADEMIC
YEAR 2008-2009 (7/1/08-6/30/09) AND THEIR RACIAL/ETHNIC
BACKGROUNDS
Full-Time Students Enrolled
Race/Ethnicity

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NonHispanic/Latino Hispanic/NonLatino

a. American Indian/Alaskan
Native

0

0

b. Asian - all

0

0

b1. Asian Underrepresented

0

0

c. Black or African American

0

0

d. Native Hawaiian or Other
Pacific Islander

0

0

e. White

0

0

f. More than One Race

0

0

Sub Total

0

0

Grand Total (Sum of
Hispanic/Latino Students and
Non-Hispanic/Non-Latino
Students)

0

B. TOTAL FULL-TIME ENROLLMENT AND FULL-TIME
DISADVANRAGED ENROLLMENT BY CLASS YEAR FOR STUDENTS
IN YOUR PROGRAM FOR ACADEMIC YEAR 2008-2009 (7/1/086/30/09)

Class Year

Total Full-Time Class
Enrollment

Total Full-Time
Disadvantaged
Enrollment

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First

0

0

Second

0

0

Third

0

0

Fourth

0

0

Fifth

0

0

Sixth

0

0

Total

0

0

Of the number of full-time disadvantaged,
how many are economically
disadvantaged?

0

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)
Total Full-Time Graduates

0

Of the number of full time graduates, number of
graduates that received SDS

0

Total Full-Time Disadvantaged Graduates

0

Of the number or full-time disadvantaged, how
many are economically disadvantaged?

0

D. GRADUATES FROM YOUR PROGRAM SERVING IN PRIMARY
CARE AND/OR MEDICALLY UNDERSERVED COMMUNITIES
Primary Care
Number of Full-Time Graduates in Primary Care

0

Of the Number of Full-Time Graduates in Primary
Care (above), number of Graduates that received
SDS

0

Medically Underserved Communities
Number of Full-Time Graduates in Medically
Underserved Communities

0

Of the Number of Full-Time Graduates in Medically
0
Underserved Communities (above), number of
Graduates that received SDS
E. COST OF TUITION FOR FULL-TIME STUDENTS FOR THIS
PROGRAM
Average cost of tuition for one year (average of instate and out-state) for full-time students for the $ 0.00
program
F. LENGTH OF PROGRAM

Length of time (in years) necessary to complete

4

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this program
G. CERTIFICATION AND ELIGIBILITY QUESTIONS
Will preference be given to students for whom the
cost of attendance would constitute a severe
[X] Yes [_] No
financial hardship?
Does your program have methods and standards
for setting the amounts of scholarships?

[X] Yes [_] No

Describe the method the program will use to
disburse the SDS scholarships to students.

Disburse
Directly to
Students

How the SDS scholarships will be used?

Tuition

H. POINT OF CONTACT
Name

Martha Harris

Title
Phone Number

703-944-2132

Email Address

mathh@reisys.com

OMB Approval No.: 0915-0149 Expiration Date: 9/30/2010
2. Federal Grant
1. Federal Agency
or Other
3a.
4. Reporting
and Organization
Identifying
DUNS 800771152 Period End
Element to Which
Number Assigned #
Date
Report is Submitted
by Federal Agency
Health Resources
and Services
Administration
(HRSA)

Application #:
00062785

3b.
EIN

746000952 6/30/2010

I. REQUESTED AWARD AMOUNT
Award amount requested this budget period

$ 0.00

J. STUDENTS SUPPORTED
How many students do you plan to support with
the requested award amount

0

K. PUBLIC OR ANY OTHER NON PROFIT ACCREDITED
INSTITUTION
Is your school/program public or any other
nonprofit accredited institution?

[X] Yes [_] No

L. AMERICAN RECOVERY AND REINVENTIMENT ACT (ARRA)
Does your school want to receive funds from the

[X] Yes [_] No

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American Recovery and Reinvestment Act (ARRA)?
M. ACCREDITATION

Name of Accrediting Body

Liasion
Committee on
Medical
Education

Expiration Date

9/30/2010

(mm/dd/yyyy)

SF PPR-2 OMB Approval No.:

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