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Program Profile

Program Title:
Contact Name:
Contact Email:
Contact Phone:
Date(s):
Contact Hours:        Estimated # of Learners: 


Type of Continuing
Education Credit
Number of
Credit Hours
Fee (If Any)
Social Work $
Nursing $
MD/DO $
Allied Health $
Nursing Asst $
Pharmacology $
Other; specify:
$
Other; specify:
$
Other; specify:
$
General Program Fee $
Student Fee $
Senior Fee $
Meals $
Housing $


Program Delivery Information:
(check all that apply)
Live/In-person
CD-ROM
Web-based/online
Audio cassette
Video
Other; specify:
Program Type:
(check all that apply)
Continuing Ed
Faculty Development
Fellowship/Residency
Curriculum Development
Curriculum Dissemination
Clinical Experience
Academic Training
Interdisciplinary Team
Program Enrollment Goals: Number Expected:
Under-represented minorities
Trainees for primary care career
Clinical training in underserved area


Sponsors/Partnerships/Leveraging:
Name of Organization Role


What special topics, populations, or locations apply to this program? Check ALL that apply
Adolescent Health
Alternative Medicine
Ambulatory Care
Am Ind/ Alaskan Native Initiative
Behavioral Health
Bioterrorism
Border Health Activities
Community-Based Continuity of Care
Cultural Competence
Distance Learning
Domestic Violence
Evidence Based Med
Faith-Based
Faculty Development

Clinic Sites in Underserved Areas
Community Health Ctrs
Governor Designated Area
Health Departments
HPSA
Migrant Health Centers
Rural Health Clinics
Other Clinical Site

Diseases
Asthma
Diabetes
Cancer
Obesity
Tuberculosis
STD
Other

Health Promotion/Disease Prevention
Home Health
Homeless
Informatics
Genetics
Geriatrics
HIV/AIDS
Interdisciplinary Training
Long Term Care
Managed Care
Maternal Child Health
Medical Economics
Mental Health
Minority Health Issues
Nutrition
Oral Health
Patient Safety/Medical Errors
Quality Improvement In Health Profession
Research
Rural Health
Substance Abuse/Prev.
Telemedicine/health
Urban Health
Women's Health
Other

Minority Recruitment/Retention
Hispanic
African American
Am Ind/Alaskan Native
Native Hawaiian


What are the target audiences for this program? Check ALL that apply
Allopathic Med
Osteopathic Med
Chiropractic
Dentistry
Nursing
Pharmacy
Physician Assistant
Podiatry
Clinical Lab Sciences
Dental Hygiene/Asst
EMT
Health Information
Home Health Aide/Medical Asst
Nutrition and Food Services
Rehabilitation Therapies
Rehabilitation Specialties
Technician
Other Allied Health
Gerontology
Clinical Psych/Counseling
Other Counseling
Health Administration
Nursing Home Admin
Health Education
Law (Attorney, Paralegal)
Law Enforcement
Protective Services
Pastoral Care
Public Health
Dental Public Health
Recreational Therapies
Social/Beh Sciences
Social Work


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