PROFILE VERIFICATION

Please carefully review the information in Section I. If any information is missing or incorrect please make the corrections. These changes are not official notification to ABHES. If you have not yet submitted the proper notification or change of

SECTION I

Name
ABHES ID#
Address
Phone
Fax
Website
Fiscal Year End
CONTACT TYPE / NAME / TITLE / EMAIL
Primary

ABHES Approved Separate Classrooms (if any)

Programs offered betweenJuly 1, 2012and June 30, 2013(includes discontinued programs if they had enrollment during the reporting period.) The information will be prepopulated in table format and you will need to verify all of the information is correct for the following categories:

Program Name

CIP Code

Method of Delivery

Credential Awarded

Program Status

Maximum Percent Distance Education

Semester Credit Hours

Quarter Credit Hours

Approval Date

Discontinuation Date

Inside Clock Hours

Recognized Outside Clock Hours

Total Clock Hours

Length in Weeks – Day

Length in Weeks – Evening

Length in Weeks – Weekend

Length in Weeks – Full Time

Length in Weeks – Part Time

I affirm that all the programs offered by my institution between July 1, 2012and June 30, 2013are listed on this Profile Verification.

Verify and Access the Annual Report / Cancel and Go to Home Page

GENERAL INFORMATION

EMERGENCY CONTACT INFORMATION

Please provide personalalternate/emergency information for the institution:

Personal Alternate/Emergency Contact Information for the Institution:
Name:
Address:
Telephone:
Email:

LEGAL STATUS, OWNERSHIP OR FORM OF CONTROL

The institution is a:

Non-Profit Organization

Privately Held Business Corporation

Publicly Held Business Corporation

Sole Proprietorship Business

 Other

If you select Non-Profit Organization:

List all the members and officers of the board of directors/trustees.

Name / Title / Voting Member (Yes or No)

Has this organization been officially recognized by the Internal Revenue Service as an exempt organization under Section 501 (c) (3)?

Yes

No

If you select Privately Held Business Corporation:

List the exact ownership structure, including all levels of subsidiaries under the parent corporation and any subsidiary corporations operating as non-main campuses:

  • Provide the ownership percentage breakdown of each entity in the chain of ownership, up to an including the individual(s) who control the ultimate ownership entity in the chain of ownership.
  • Provide descriptions for each level that include all individuals, partnerships, LLCs, corporations, trusts, or other forms of ownership (for publicly traded corporations, this includes shareholders that directly own 10% of the stock.)

List all corporate officers:

Name / Title

If you select Publicly Held Business Corporation:

List the exact ownership structure, including all levels of subsidiaries under the parent corporation and any subsidiary corporations operating as non-main campuses:

  • Provide the ownership percentage breakdown of each entity in the chain of ownership, up to an including the individual(s) who control the ultimate ownership entity in the chain of ownership.
  • Provide descriptions for each level that include all individuals, partnerships, LLCs, corporations, trusts, or other forms of ownership (for publicly traded corporations, this includes shareholders that directly own 10% of the stock.)

List all corporate officers:

Name / Title / Voting Member (Yes/No)

If publicly held business corporation, the stock is traded on the:

NASDAQ

NYSE

ASE

OTC

Regional Exchange

If you select Sole Proprietorship Business:

If sole proprietorship business, provide legal name and address.

Legal Name / Address

List name, title and address of individual(s) responsible for operations of the sole proprietorship business that owns the institution.

Name / Title / Address

If you select Other:

Please explain below:

Since July 1, 2012 have there been any changes in legal status, ownership or form of control?

 Yes No

If yes, please complete the chart documenting the changes.

Previous Owner(s) / New Owner(s) / Date of Change

Were these changes considered a change in legal status, ownership or form of control by ABHES?

Yes No

Did the U.S. Department of Education consider these changes a change of legal status, ownership or form of control?

 Yes No

Does the institution or sponsoring institution for the program(s) have pending litigation?

Yes/No

If yes, please explain.

OTHER ACCREDITATION

Does your institution hold institutional or programmatic accreditation in addition to ABHES accreditation?

YesNo

Please provide the additional information for each accreditation held. (Question will only appear if you answer YES to the above question)

Accrediting Agency / Accreditation Type (Institutional or Programmatic) / If Programmatic,
List Program. If Institutional Select No Data. / Expiration of Current Grant of Accreditation / Explanation of Any Current Disciplinary Actions (Probation, Reporting, etc.)

PROGRAMS

ENROLLMENT

Please provide the total student enrollment per program.

Program Name / Credential Awarded / Total # of students enrolled during previous reporting period / Total # of students enrolled during current reporting period / % of Increase/Decrease from previous to the current reporting period
TOTAL

Please provide the most recent enrollment and graduation date for each of the programs offered by the institution.

Program Name / Credential Awarded / Enrollment Date / Graduation Date

Are degree program(s) offered?

 Yes No

PROGRAM OUTCOMES

RETENTION STATISTICS

Please provide retention statistics for the period of July 1, 2012 to June 30, 2013.

Program Name / Credential Awarded / CIP Code / Beginning Enrollment
(BE) / Re-entries (RE) / New Starts (NS) / Ending Enrollment
(EE) / Grads (G) / Retention Rate (R%)

PLACEMENT STATISTICS

Please provide placement statistics for the period of July 1, 2012 to June 30, 2013.

Program Name / Credential Awarded / CIP Code / Number of Grads(G) / Number Placed in Field (F) / Number Placed in Related Field (R) / Number Not Placed or Placed Out of Field / Un-available (U) / Placement Rate (P%)

CREDENTIALING/LICENSURE STATISTICS

Is a credential or license required for graduates to work in the field?

 Yes NoOther

If other, please explain:

If yes, what is the state pass rate?

Please provide credentialing and/or licensure statistics for the period of July 1, 2012 to June 30, 2013.

Program Name / Credential Awarded / CIP Code / Credentialing or Licensure Examination Name / Grads / How many graduates took exam (G) / How many graduates passed exam (first attempt) / How many graduates failed exam (first attempt) / How many graduates retook exam and passed (all attempts) (F) / Percentage of graduates passing (all attempts) (L%)

SECTION – DISTANCE EDUCATION

When was the distance delivery method originallyapproved by ABHES?

Date

Please provide the student enrollment for programs with any portion offered via Distance Education. Please separate the students into full distance education delivery (DE), blended delivery and residential, as applicable (Full DE = entire program minusremote externships or labs, if applicable. Blended = combination of on-campus and distance courses. See Accreditation Manual Glossary for detailed definitions.)

Program Name / Credential Awarded / Delivery Method
Drop down to include: full distance education, blended and residential / Total # of Students Enrolled During Previous Reporting Period / Total # of Students Enrolled During Current Reporting Period / % of Increase/Decrease from the Previous to Current Reporting Period

Please provide retention statistics for the period July 1, 2012 to June 30, 2013 for programs with any portion offered via distance education. Please separate the students into full distance education delivery (DE), blended delivery and residential, as applicable.

Program Name / Credential Awarded / Delivery Method
Drop down to include: full distance education, blended, residential / Beginning Enrollment (BE) / Re-entries (RE) / New Starts (NS) / Ending Enrollment (EE) / Grads (G) / Retention Rate (R%)

Please provide placement statistics for the period of July 1, 2012to June 30, 2013 for programs with any portion offered via distance education. Please separate the students into full distance education delivery (DE), blended delivery and residential, as applicable.

Program Name / Credential Awarded / Delivery Method Drop down to include: full distance education, blended, residential / Number of Graduates (G) / Number Placed in Field (F) / Number Placed in Related Field (R) / Number Not Placed or Placed Out of Field / Un-available (U) / Placement Rate (P%)

Is a credential or license required for graduates to work in the field? Please answer this question as it pertains to your distance education offerings only.

Other

If other, please explain:

Please provide credentialing and/or licensure statistics for the periodof July 1, 2012to June 30, 2013, for programs with any portion offered via distance education. Please separate the students into full distance education delivery (DE), blended delivery and residential,as applicable.

Program Name / Credential Awarded / Delivery method
Drop down to include: full distance education, blended, residential / Credentialing or Licensure Examination Name / Grads / How many graduated took exam (G) / How many graduates passed exam (first attempt) / How many graduates failed exam (first attempt) / How many graduates retook exam and passed (all attempts) (F) / Percentage of graduates passing (all attempts) (L%)

SECTION V - SURGICAL TECHNOLOGY PROGRAM ASSESSMENT AND OUTCOMES SATISFACTION

Identify all class completion dates during the period ofJuly 1, 2012 – June 30, 2013.

Class completion dates / # of Graduates

Please identify the pass/fail rates for the first-time takers of the Certified Surgical Technologist Exam (CST).

How many students took the exam
How many students passed the exam
How many students failed the exam
Pass rate percentage

How do the pass/fail rates for the first-time takers of the Certified Surgical Technologist Exam (CST) reported compare with that of the previous three years’ pass/fail rates?

Above / Comparable / Below / Not Applicable (Newer program)

Please provide credentialing statistics for the period of July 1, 2012 to June 30, 2013 using the ABHES formula.

Program Name / Credential Awarded / CIP Code / Credentialing Examination Name / Grads / How many graduates took exam (G) / How many graduates passed exam (first attempt) / How many graduates failed exam (first attempt) / How many graduates retook exam and passed (all attempts) (F) / Percentage of graduates passing (all attempts) (L%)

Please provide the following data based on the results of the ABHES Graduate Satisfaction Survey.

%
Graduate Rating:
Survey Return:

Provide an analysis of the results of the survey (identify which areas result in an average score of below 80%).

How do the graduate satisfaction survey results compare with that of the previous three years?

Above / Comparable / Below / Not Applicable (Newer program)

Please provide the following data based on the results of the ABHES Employer Satisfaction Survey.

%
Employer
Rating:
Survey Return:

Provide an analysis of the results of the survey (identify which areas result in an average score of below 80%).

How do the employer satisfaction survey results compare with that of the previous three years?

Above / Comparable / Below / Not Applicable (Newer program)

Describe the outcomes of the program’s evaluation of its most recent market survey relative to justification for continued enrollment and numbers of students enrolled during the reporting period into the Surgical Technology program(s).

During the reporting period, how many signed clinical affiliation agreements were active and maintained per student enrolled in the Surgical Technology program(s)?

(#)

SECTION VI – DEFAULT STATISTICS (INSTITUTIONAL MEMBERS ONLY)

What percentage of the students enrolled on June 30, 2013, were participating in federal student aid programs of any type?(%)(INSTITUTIONAL MEMBERS ONLY)

What percentage of the total tuition earned was derived from federal student aid programs of any type during the July 1, 2012 – June 30, 2013reporting period? (%) (INSTITUTIONAL MEMBERS ONLY)

Does your institution participate in Title IV programs?(INSTITUTIONAL MEMBERS ONLY)

 Yes No

If yes, what were your institution’s official annual cohort default rates provided by the Secretary for:

2009 / 2010 / 2011
% / % / %

Do you believe the above rates are accurate? (INSTITUTIONAL MEMBERS ONLY)

 Yes No

Have you filed an appeal with the Department of Education? (INSTITUTIONAL MEMBERS ONLY)

 Yes No

Are these rates in compliance with the Department of Education requirements?(INSTITUTIONAL MEMBERS ONLY)

 Yes No

SECTION - Financial Delineation Form (INSTITUTIONAL MEMBERS ONLY)

Name of Institution:
ABHES ID#:
Fiscal Year End Date:
Total Current Assets:
Total Current Liabilities:
Total Revenue:
Did your institution have a profit at year end: / Yes or No
Profit at Year End: (if applicable)
Loss at Year End: (if applicable)
Retained Earnings:
Equity:
Is the institution placed on Heightened Cash Monitoring 2? / Yes or No
Name and Title of Individual Completing This Form:
Date Completed:

SECTION – CALCULATION OF SUSTAINING FEES

Institutional Members Only

Your institution’s sustaining fees are based on the total gross annual tuition. Please provide the total gross annual tuition from July 1, 2012to June 30, 2013.

Your institution's sustaining fee is _____. (This will be auto populated.)

Please send a check for the above amount to the ABHES office. Your Annual Report is not complete until it has been submitted online AND the sustaining fee has been received.

Programmatic Members Only

Your program’s sustaining fees are based on the total number of students enrolled in the program(s). Please provide the total number of students enrolled in the program(s) from July 1, 2012to June 30, 2013.

Your sustaining fee is ____. (This will be auto populated.)

Please send a check for the above amount to the ABHES office. Your Annual Report is not complete until it has been submitted online AND the sustaining fee has been received.

ACTION PLANS

If any retention, placement or credentialing/licensure rates are below 70% you will be required to answer the following questions for one or more of the following programs.

Why does the institution believe the rates are below benchmark? As part of your response, please include an analysis of the trends that affected the rate.

What strategies are being implemented to increase the rates? As part of your response, for each of the strategies, please include the timeframe in which they will be implemented.

ADDENDUM (when increase of enrollment is greater than 50%)

For each program enrollment increase/decrease reported you will be required to complete an addendum when the increase is 50% or greater to explain how the increase impacts each of the following.

Availability of resources including class sizes, classroom facilities, and laboratories

Faculty

Student services, including orientation, educational guidance, and financial services

Availability of clinical education experiences, including contracts

Program retention

Graduate results on required licensing or credentialing exams

Program placement in the field of study

Additional information

Upload Documents

Annual Sustaining Fee (copy of check)

Credentialing/Licensure Back-Up Documentation (if applicable)*

Current Catalog

Placement Back-Up Documentation*

Retention Back-up Documentation*

* You must use the ABHES Back-Up Documentation Form found at

Annual Report Submission

Annual Report Submitted by:
Title:
CEO Name: