HRSA_SDS_3_0-V3.0-Instructions.pdf

OMB Number: 0906-0073 Exp Date: 11/30/2025

U. S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

HEALTH RESOURCES AND SERVICES ADMINISTRATION

BUREAU OF HEALTH PROFESSIONS

INSTRUCTIONS FOR SCHOLARSHIPS FOR DISADVANTAGED STUDENTS

APPLICATION PROGRAM SPECIFIC FORM

Academic Years 2025-2030

PUBLIC REPORTING BURDEN STATEMENT

The purpose of this information collection is to obtain disparity and demographic related data for health workforce programs to assess the experience and performance of applicants in strengthening the health workforce and the populations in which they serve. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this information collection is 0906-0073 and it is valid until 11/30/2025. Public reporting burden for this collection of information is estimated to average 16.29 hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N136B, Rockville, Maryland, 20857 or paperwork@hrsa.gov.

GENERAL INFORMATION

You are required to complete a program specific form for each discipline for which you are seeking support. All data reported must be on the health professions degree program for which you are requesting funding.

To be eligible to participate in the SDS program, all data must be submitted online as part of the application process. (If your school receives SDS funding, you will be required to provide HRSA program and fiscal data and submit reports electronically via the Electronic Handbooks (EHBs). The three required reports are the annual Federal Financial Report (FFR), the SDS Annual Performance Report (APR) and the annual Non-Competing Continuation Progress Report

(NCC).

Your submission of the SDS Application represents an agreement between the applicant school and the Secretary of the Department of Health and Human Services (HHS) for the management and administration of the SDS Program, and is binding on all parties participating in the program.

mailto:paperwork@hrsa.gov

ELIGIBILITY CRITERIA: A school must meet all of the criteria listed below to be eligible to be considered for SDS funds for fiscal year (FY) 2025. All requirements refer to full-time, U.S. citizen students (using the school’s requirements for full-time):

Full-time students from disadvantaged backgrounds must be:

1) At least 20 percent of the total enrollment (full-time enrolled) of the health profession degree program during Academic Years (AY) 2021-2024 (7/1/2021- 6/30/2024) and

2) At least 20 percent of the total graduates (who were full-time students) of your health profession degree program during AY 2021-2024 (7/1/2021- 6/30/2024), If your school is a newly established school, as long as you have students enrolled for the SDS program reporting years (7/1/2022 – 6/30/2024) you may apply. Since newly established schools do not have three years of data for program enrollment and graduates, such schools must provide at least two (2) years of student enrollment and at least one (1) year of graduation data that demonstrates at least 20 percent of the health profession degree program’s total enrollment and graduates are from disadvantaged backgrounds.

PROGRAM SPECIFIC FORM

INSTRUCTIONS

Current Fiscal Year – select the current fiscal year date that is provided in the current SDS Notice of Funding Opportunity Announcement Cover page

Add Discipline – select your discipline. The subsequent questions will populate based on the discipline chosen.

A. PUBLIC OR NON-PROFIT INSTITUTION

Enter Yes or No.

B. POINT OF CONTACT

The person responsible for the application data.

C. FULL-TIME STUDENTS IN YOUR PROGRAM FOR ACADEMIC YEARS 2021-

2024 (7/1/2021-6/30/2024) AND THEIR RACIAL/ETHNIC BACKGROUNDS

You must include all full-time students (using your school's definition of full-time) enrolled in your eligible degree program. Complete this table showing the enrollment and racial/ethnic background of full-time students enrolled in the eligible degree program for which your school is applying for SDS funds (e.g., bachelor’s in nursing, graduate public health, graduate clinical psychology, etc.) during Academic Years 2021-2024.

Select the category of racial/ethnic background using the following definitions.

Race:

American Indian or Alaska Native – a person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment

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

Black or African American – a person having origins in any of the Black racial groups of Africa

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, the Middle East, or North Africa

More than One Race: A person having origins from more than one race.

Race Not Reported: Race unknown

Ethnicity:

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

Non-Hispanic/Non-Latino: A person not having origins of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.

D. TOTAL FULL-TIME CLASS ENROLLMENT AND FULL-TIME

DISADVANTAGED BACKGROUND ENROLLMENT BY CLASS YEAR FOR

STUDENTS IN YOUR HEALTH PROFESSION DEGREE PROGRAM FOR

ACADEMIC YEARS 2021-2024 (7/1/2021-6/30/2024)

TOTAL FULL-TIME CLASS ENROLLMENT - Enter full-time enrollment by class year from the previous three years (using the school’s definition for full time). Space on the application is available for programs up to six years in length. Enter only Class Year data that is appropriate for the length of your program. For example, if your program is four years in length, the Fifth and Sixth years on the application would be left blank.

For the graduate degree programs with more than one type of degree (e.g. masters and doctorate,), all the students who are in the last year of their program should be included in the same year. For example, if a school has a one-year program and a two-year program, the students in the one-year program would be included in the same year as the students in the second year of the two-year program.

TOTAL FULL-TIME DISADVANTAGED BACKGROUND ENROLLMENT - Complete the table, providing three years of full-time enrollment data on students from disadvantaged backgrounds (using your school’s requirements for full-time) by class year. The data should reflect the same class year and degree program as the full-time enrollment.

Enter Class Year data that is applicable for the length of your program.

An individual from a disadvantaged background is defined as someone who is any/all of these:

Environmentally Disadvantaged

A person’s environment inhibited them from obtaining the knowledge, skills, and abilities required to enroll in and graduate from a health professions school.

Educationally Disadvantaged

A person who comes from a social, cultural, or educational environment that has demonstrably and directly inhibited the person from obtaining the knowledge, skills, and abilities necessary to develop and participate in a health professions education or training program.

Steps to determine if a student is educationally/environmentally disadvantaged:

• Clarify your classification criteria according to the definition.

• Apply the criteria consistently for all students.

• Define "low" rates based on your health profession schools’ current student population.

Use the most recent data from your state's Department of Education site, under high school report cards. See examples:

o The individual graduated from or last attended a high school that has a low overall student average SAT score.

o The individual graduated from or last attended a high school with either a:

▪ Low percentage of seniors receiving a high school diploma.

▪ Low percentage of graduates who go to college during the first year after graduation.

o The student graduated from or last attended a high school with low per capita funding.

o The student graduated from or last attended a high school where many of the enrolled students are eligible for free or reduced-price lunches.

o The student is the first generation in his or her family to attend college. Please follow the instructions to determine the student’s first-generation status using

FASFA’s Parents Education Status questions.

Economically Disadvantaged

A person from a family with an annual income below a level based on low-income thresholds, according to family size established by the U.S. Census Bureau, adjusted annually for changes https://studentaid.gov/2425/help/parents-education-status in the Consumer Price Index, and adjusted by the Secretary of the U.S. Department of Health and Human Services, for use in all health professions programs. A family is a group of two or more people.

The Secretary updates these income levels in the Federal Register annually.

Steps to determine if a student is economically disadvantaged:

• Use parental income for students deemed “dependent” by the U.S. Department of

Education guidelines.

• Use student income for students deemed “independent” by the U.S. Department of

Education guidelines.

• Use the U.S. Department of Health and Human Services Poverty Guideline table for one 1 year preceding the data submitted on the FAFSA.

This person must also be a citizen, national, or a lawful permanent resident of one of these:

• United States

• Commonwealths of Puerto Rico

• Marianas Islands

• U.S. Virgin Islands

• Guam

• American Samoa

• Trust Territory of the Pacific Islands

• Republic of Palau

• Republic of the Marshall Islands

• Federated State of Micronesia

Of the Total Full-Time Students from Disadvantaged Backgrounds, enter the number of students who qualify as coming from a disadvantaged background under the economically disadvantaged definition.

Please NOTE: When identifying students from disadvantaged backgrounds, minority status in itself is NOT A FACTOR for determining disadvantaged status.

E. TOTAL FULL-TIME GRADUATES AND FULL-TIME DISADVANTAGED

BACKGROUND GRADUATES FOR ACADEMIC YEARS 2021-2024 (7/1/2021 -

6/30/2024)

* Total Full-Time Graduates:

Enter the total full-time students (using your school’s requirements for full time) graduates for the academic years 2021-2024.

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*Full-Time Disadvantaged Background Graduates:

Enter total full-time students from disadvantaged backgrounds graduates for the academic years 2021-2024

* Of the Total Full Time Graduates for Academic Years 2021-2024, enter the number of graduates that received SDS or similar scholarships for students from disadvantaged backgrounds:

Of the number full-time graduates above, enter the total number of full-time students graduates that received SDS or similar scholarships regardless of when they received the funds.

* Of the Total Full-Time Graduates for Academic Years 2021-2024, enter the number of students who qualify as coming from a disadvantaged background under the economic disadvantaged definition

Of the total number of full-time graduates from disadvantaged backgrounds above, enter the number of students who qualify as coming from a disadvantaged background under the economic definition for the academic years 2021-2024.

F. GRADUATES FROM YOUR PROGRAM SERVING IN PRIMARY CARE

AND/OR MEDICALLY UNDERSERVED COMMUNITIES:

If the graduated student is working in primary care and practicing in medically underserved communities, please include this graduate in both categories.

PRIMARY CARE

Definition: The provision of integrated, accessible health services by clinicians who are accountable for

• addressing a large majority of personal health care needs,

• developing a sustained partnership with patients, and

• practicing in the context of family and community.

For the SDS program, primary care fields are limited to Allopathic Medicine, Osteopathic Medicine, Dentistry, Dental Hygiene, Behavioral and Mental Health, Graduate Nursing, Certified nursing and non-nursing graduate degrees in midwifery, Physician Assistants.

Disciplines other than those listed above are not eligible for providing Primary Care data.

Number of Full-Time Graduates

For schools of allopathic and osteopathic medicine: total number of full-time graduates in academic years 7/1/2017-6/30/2020

For schools of dentistry, dental hygiene, behavioral and mental health, nursing (graduate degree), Certified nursing and non-nursing graduate degrees in midwifery and physician assistants: total number of full-time graduates in academic year ‘s 7/1/2020- 6/30/2023.

Of the Full-Time Graduates, enter the number of graduates serving in Primary Care.

For schools of allopathic and osteopathic medicine: enter the total number of full-time graduates serving in Primary Care in Academic Years 7/1/2021-6/30/2024.

For schools of dentistry, dental hygiene, behavioral and mental health, nursing physician assistants: enter the total number of full-time graduates serving in Primary Care in Academic Years 7/1/2021-6/30/2024.

Of the Full-Time Graduates serving in Primary Care (above), enter the number of graduates that received SDS funds or similar scholarships from disadvantaged backgrounds:

For schools of allopathic and osteopathic medicine: Of the number of full-time graduates in primary care enter the total number of students who received SDS funds or similar scholarships from disadvantaged backgrounds, regardless of when they received them.

For schools of dentistry, dental hygiene, mental and behavioral health, nursing physician assistants: Of the number of full-time graduates in primary care, enter the total number of students who received SDS funds or similar scholarships from disadvantaged backgrounds, regardless of when they received them.

MEDICALLY UNDERSERVED COMMUNITIES (MUC)

Definition of Medically Underserved Community:

A geographic location or population of people eligible for designation by the federal government as a

• Health Professional Shortage Area,

• Medically Underserved Area,

• Medically Underserved Population, or

• Governor’s Certified Shortage Area for Rural Health Clinic.

As an umbrella term, MUC also includes populations such as people experiencing homelessness, migrant or seasonal workers, and residents of public housing.

Number of Full-Time Graduates

For schools of allopathic and osteopathic medicine: total number of full-time graduates in academic years 7/1/2017-6/30/2020

For all other disciplines: total number of full-time graduates in academic year ‘s 7/1/2020-6/30/2023.

* Of the Full-Time Graduates, enter the number practicing in Medically Underserved

Communities.

For schools of allopathic and osteopathic medicine: enter the total number of full-time graduates serving in medically underserved communities (residency included) in Academic Years 7/1/2021-6/30/2024.

For all other disciplines: enter the total number of full-time graduates serving in medically underserved communities (residency included) in Academic Years 7/1/2021- 6/30/2024.

Of the Full-Time Graduates practicing in Medically Underserved Communities, enter the number of graduates that received SDS funds or similar scholarships from disadvantaged backgrounds.

For schools of allopathic and osteopathic medicine: Of the number of full-time graduates practicing in medically underserved communities (above), enter the total number of graduates who received SDS funds or similar scholarships from disadvantaged backgrounds, regardless of when they received them.

For all other disciplines: Of the number of full-time graduates practicing in medically underserved communities (above), enter the total number of graduates who received SDS funds or similar scholarships from disadvantaged backgrounds, regardless of when they received them.

G. COST OF ANNUAL TUITION FOR FULL-TIME HEALTH PROFESSSION

DEGREE PROGRAM STUDENT: Enter the cost of tuition for one year for full-time students for the program you are applying. Public/State institutions should enter in-state tuition.