PROFILE VERIFICATION

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					PROFILE VERIFICATION

Please carefully review the information in Section I. If any information is missing or incorrect, email the additions/corrections to
annualreport@abhes.org.

SECTION I

Name
ABHES ID
Address
Phone
Fax
Website
Fiscal Year End

CONTACT TYPE                          NAME                                  TITLE                               EMAIL
Primary

Please provide an alternate email and alternate phone number for the institution:

Alternate email address:
Alternate phone number:

ABHES Approved Separate Classrooms (if any)


Please carefully review the information in Section II. If any information is missing or incorrect, email the additions/corrections to
annualreport@abhes.org. See Annual Report instructions at www.abhes.org/annualreport for instructions on how to submit your
additions/corrections to annualreport@abhes.org. You will receive an email reply when the additions/corrections have been made.
Please DO NOT proceed to the Annual Report until you have verified that all of the programs offered during the reporting period
(including discontinued programs) are listed on this profile verification.
SECTION II
Programs offered between July 1, 2011and June 30, 2012. (includes discontinued programs if they had enrollment during the reporting
period)

Program Name-              CIP Code               Clock Hours               No. of Instructional    Credit Hours –           Credit Hours –
Credential                                                                  Weeks (Day,             Quarter                  Semester
Awarded                                                                     Evening, Weekend)



     I affirm that all the programs offered by my institution between July 1, 2011 – June 30, 2012 are listed on this Profile Verification.

                  Verify and Access the Annual Report                                           Cancel and Go to Home Page
SECTION I – GENERAL INFORMATION
OTHER ACCREDITATION

(I-A-1) Does your institution hold institutional or programmatic accreditation in addition to ABHES accreditation?

        Yes                    No

(I-A-2) Please provide the additional information for each accreditation held. (Question will only appear if you answer YES to I-A-1)

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


ENROLLMENT INFORMATION

(I-B-1) Please provide the total student enrollment per program.
                                                                   Total # of students     Total # of students % of Increase/Decrease from
            Program Name – Credential Awarded                       enrolled during      enrolled during current previous to the current
                                                                   previous reporting       reporting period         reporting period
                                                                         period

                            TOTAL

(I-B-2) 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


(I-B-3) Are degree program(s) offered?
 Yes             No

LEGAL STATUS, OWNERSHIP OR FORM OF CONTROL INFORMATION

(I-C-1) 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:


(I-C-2) Since July 1, 2011 have there been any changes in legal status, ownership or form of control?

 Yes              No

(I-C-2-a) If yes, please complete the chart documenting the changes.

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


(I-C-3) Were these changes considered a change in legal status, ownership or form of control by ABHES?

 Yes              No
(I-C-4) Did the U.S. Department of Education consider these changes a change of legal status, ownership or form of control?

 Yes              No

(I-C-5)Does the institution or sponsoring institution for the program(s) have pending litigation?

Yes/No

(I-C-6)

If yes, please explain.


SECTION II – PROGRAM INFORMATION
(II-1) Please provide the program synopsis for each program currently offered.

                                                                                                                     Method of Delivery:
                                                                                                                     Drop
                                                                                                                     down menu with the
                                                                                                                     following selections:

                                                                                                                     Full Distance Education;
                                                                                                                     Blended Distance Education;
                                                                                                                     Residential

                                                                                                                     Full Distance Education;
                                                                                                                     Blended Distance Education

                                                                                                                     Blended Distance
                                                                                                                     Education; Residential

                                                                                                                     Full Distance Education;
                                                                                                                     Residential

                                                                                                                     Blended Distance Education
                                                                                                                     only
Program Name –                            Number of     Number of         Number of
    Credential            CIP             Instructional Instructional     Instructional     Credit     Credit      Full Distance Education only
    Awarded               CODE   Clock    Weeks –       Weeks –           Weeks –           Hours -        Hours -
                                 Hours    Day           Evening           Weekend           Quarter    Semester    Residential only



(II-1-1) I affirm that the information provided in Question II-1 of the annual report is accurate to the best of my knowledge and that all program
names, CIP codes, hours, weeks, credits awarded, credential awarded and method of delivery for each program reported, has been approved by
ABHES.

 Yes              No

(II-2) Please provide the program(s) that were discontinued since July 1, 2011.
                                                        Credits, If     Credits, If       Length in   Length in     Length in
                               Credential    Clock Applicable - Applicable -               weeks       weeks         weeks             Date of
       Program Name             Awarded      Hours      Semester         Quarter            Day       Evening       Weekend        Discontinuation


(II-3) The following new program(s), requiring the New Program Application, have been approved by ABHES and added since July 1, 2011:
     (INSTITUTIONAL MEMBERS ONLY)

                                               Length in Length in Length in           Semester        Quarter                           Date
                                      Clock     weeks     weeks     weeks             Credits If      Credits, If     Credential      Approved by
          Program Name                Hours      Day     Evening Weekend              Applicable      Applicable      Awarded           ABHES
SECTION III – DISTANCE EDUCATION
(III-1) When was the distance delivery method originally approved by ABHES?

           Date


(III-2)
Please provide the student enrollment for programs with any portion offered via Distance Education. Please separate the students into full distance
education delivery (DE) and blended distance education delivery, as applicable (Full DE = entire program minus remote externships or labs, if
applicable. Blended DE = combination of on-campus and distance courses. See Accreditation Manual Glossary for detailed definitions.)

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



 (III-3) Please provide retention statistics for the period July 1, 2011 to June 30, 2012 for programs with any portion offered via distance
education. Please separate the students into full distance education delivery (DE) and blended distance education delivery, as applicable.

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


(III-4) Please provide placement statistics for the period of July 1, 2011to June 30, 2012 for programs with any portion offered via distance
education. Please separate the students into full distance education delivery (DE) and blended distance education delivery, as applicable.

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


(III-5) 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.

Yes / No

(III-5-1) Please provide credentialing and/or licensure statistics for the period of July 1, 2011 to June 30, 2012, for programs with any potion
offered via distance education. Please separate the students into full distance education delivery (DE) and blended distance education delivery,
as applicable.

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


SECTION IV – PROGRAM OUTCOMES
RETENTION STATISTICS

(IV-A-1) Please provide retention statistics for the period of July 1, 2011 to June 30, 2012.



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


PLACEMENT STATISTICS

(IV-B-1) Please provide placement statistics for the period of July 1, 2011to June 30, 2012.
                                                                                         Number          Number Not
                                                                      Number Number Placed in            Placed or
                                                          CIP         of       Placed in Related         Placed Out of Un-available Placement
Program Name – Credential Awarded                         Code        Grads(G) Field (F) Field (R)       Field         (U)          Rate (P%)


CREDENTIALING/LICENSURE STATISTICS
(IV-C-1) Is a credential or license required for graduates to work in the field?

 Yes              No

(IV-C-2) Please provide credentialing and/or licensure statistics for the period of July 1, 2011 to June 30, 2012.

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



SECTION V - SURGICAL TECHNOLOGY PROGRAM ASSESSMENT AND OUTCOMES SATISFACTION
(V-1) Identify all class completion dates during the period of July 1, 2011 – June 30, 2012.
             Class completion dates                                                # of Graduates


(V-2) 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
(V-3) 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)

(V-3-1) Please provide credentialing statistics for the period of July 1, 2011 to June 30, 2012 using the ABHES formula:

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



(V-4) Please provide the following data based on the results of the ABHES Graduate Satisfaction Survey:

                                             %
           Graduate Rating:
           Survey Return:

(V-5) Provide an analysis of the results of the survey (identify which areas result in an average score of below 80%):

(V-6) How do the graduate satisfaction survey results compare with that of the previous three years?

                   Above                    Comparable                   Below               Not Applicable (Newer program)

(V-7) Please provide the following data based on the results of the ABHES Employer Satisfaction Survey:

                                             %
           Employer
           Rating:
           Survey Return:

(V-7-1) Provide an analysis of the results of the survey (identify which areas result in an average score of below 80%):

(V-8) How do the employer satisfaction survey results compare with that of the previous three years?

                   Above                    Comparable                   Below              Not Applicable (Newer program)

(V-9) 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):

(V-10) 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)
(VI-1) What percentage of the students enrolled on June 30, 2012, were participating in federal student aid programs of any type?(%)
(INSTITUTIONAL MEMBERS ONLY)

(VI-2) What percentage of the total tuition earned was derived from federal student aid programs of any type during the July 1, 2011 – June 30,
2012 reporting period? (%) (INSTITUTIONAL MEMBERS ONLY)



(VI-3) Does your institution participate in Title IV programs? (INSTITUTIONAL MEMBERS ONLY)

 Yes             No
(VI-3-1) If yes, what was your institution’s official annual cohort default rates provided by the Secretary for:

                              2008                                 2009                                 2010
                      %                                     %                                    %

(VI-4) Do you believe the above rates are accurate? (INSTITUTIONAL MEMBERS ONLY)

 Yes             No

(VI-5) Have you filed an appeal with the Department of Education? (INSTITUTIONAL MEMBERS ONLY)

 Yes             No

(VI-6) Are these rates in compliance with the Department of Education requirements? (INSTITUTIONAL MEMBERS ONLY)

 Yes             No


SECTION VII – CALCULATION OF SUSTAINING FEES
Institutional Members Only
(VII-I-IM) Your institution’s sustaining fees are based on the total gross annual tuition. Please provide the total gross annual tuition from July
1, 2011 to June 30, 2012.

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
(VII-I-PM) 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, 2011 to June 30, 2012.

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.
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
Date Completed:
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?



What is the institution doing to increase the rates?



Provide the short-term percentage goals.



Provide the long-term percentage goals.



Upload Documents
Annual Sustaining Fee
Credentialing/Licensure Back-Up Documentation (if applicable)*
Current Catalog
Retention Back-up Documentation*
Placement Back-Up Documentation*

* You must use the ABHES Back-Up Documentation Form found at www.abhes.org/annualreport.

Annual Report Submission

Annual Report Submitted by:
Title:
CEO Name:

				
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