PC-4 | HRSA EHBs

PC-4 - Selecting Partnerships Developed Using BHW Funds

Select the Primary Purpose of the Grant Partnership(s) Developed or Enhanced using BHW Funding	Select Types of Partner Organizations for the Primary Purpose	Select Secondary Purpose(s) of the Grant Partnership(s)
(3a)	(3b)	(3c)

Figure 1. PC-4 - Selecting Partnerships Developed Using BHW Funds

Select the Primary Purpose of the Grant Partnership(s) Developed or Enhanced using BHW Funding: Select the primary purpose of the partnership used to develop or enhance the training program by clicking on the drop-down menu in column 3a and selecting the most applicable option.

Clinical/experiential training
Community outreach
Curriculum development
Didactic training
Establishing and maintaining apprenticeships
Field placements in medically underserved and/or rural areas
Interprofessional training
Job placement
Matriculation into health professions schools
Mentoring students/trainees
Providing faculty development
Providing faculty/clinical preceptors
Recruitment of trainees
Recruitment of URM/disadvantaged/rural trainees
Technical assistance
None of the above
No partnerships developed or expanded

Select Types of Partner Organizations for the Primary Purpose: Select the type(s) of organizations associated with the primary partnership purpose indicated in question 3a by clicking on the drop-down menu in column 3b and choosing all options that apply.

Academic Institution
Academic Medical Center
Area Health Education Center
Certified Community Behavioral Health Center (CCBHC)
Community Behavioral Health/Mental Health Center
Community Health Center (CHC)
Critical Access Hospital
Federal Government
FQHC or Look-Alike
Health Department (local/state/tribal)
Hospital (non-academic)
Indian Health Service (IHS)/Tribal/Urban Indian Health Center
Nursing Home
Other Clinical Health Setting
Other Community-Based Organization
Other Long-term Care Facility
Other Specialty Clinic
Private Industry
Private Practice
Residential Living Facility (including independent and assisted living)
Rural Health Clinic
School-based Clinic
State or Local Government
US Armed Forces
Veterans Affairs Healthcare (e.g. VA hospital or clinic)
N/A

Select Secondary Purpose(s) of the Grant Partnership(s): Select any additional purpose(s) of the partnerships used to develop or enhance the training program by clicking on the drop-down menu in column 3c and choosing all options that apply.

Clinical/experiential training
Community outreach
Curriculum development
Didactic training
Establishing and maintaining apprenticeships
Field placements in medically underserved and/or rural areas
Interprofessional training
Job placement
Matriculation into health professions schools
Mentoring students/trainees
Providing faculty development
Providing faculty/clinical preceptors
Recruitment of trainees
Recruitment of URM/disadvantaged/rural trainees
Technical assistance
N/A

PC-4 - Entering Enrollment Information

Warning
Multiple steps are required to complete this portion of the subform. Please read instructions carefully.

Enter Total # Enrolled (whether funded by BHW or not)	Enter Total # Enrolled (whether funded by BHW or not)	Enter Total # Enrolled (whether funded by BHW or not)
Total	URM	Disadvantaged Background and not URM
(4) Block 3	(5) Block 3a	(6) Block 3b

Figure 2. PC-4 - Entering Enrollment Information

Enter Total # Enrolled (whether funded by BHW or not): Total: In Column 4 (Block 3), enter the total number of students who participated in each internship program during the current reporting period. Count all students who participated in the internship program, regardless of whether or not the student directly received a BHW-funded financial award (i.e., stipend).
Enter Total # Enrolled (whether funded by BHW or not): URM: In Column 5 (Block 3a), enter the number of students who participated in the internship program during the current reporting period and were underrepresented minorities.
Enter Total # Enrolled (whether funded by BHW or not): Disadvantaged Background and not URM: In Column 6 (Block 3b), enter the number of students from disadvantaged backgrounds who participated in the internship program during the current reporting period but were not underrepresented minorities.

Note
Blocks 3a and 3b are subsets of Block 3.

Note
Students who permanently left their internship before completion (i.e. attrition) will be counted separately in Column 9 (Block 9).

Reference
Refer to the glossary for definitions of disadvantaged background and underrepresented minority.

The John Doe School of Psychology had 18 graduate-level psychology students participate in internships during the current annual reporting period. Among the 18 graduate-level psychology students who participated, 9 were underrepresented minorities. In addition, 3 students were from disadvantaged backgrounds, but were not under-represented minorities.

In Column 4 (Block 3), the reporting official would enter 18.

In Column 5 (Block 3a), the reporting official would enter 9.

In Column 6 (Block 3b), the reporting official would enter 3.

PC-4 - Entering Graduate Information

Warning
Multiple steps are required to complete this portion of the subform. Please read instructions carefully.

Enter Total # Graduated/Completed (whether funded by BHW or not)	Enter Total # Graduated/Completed (whether funded by BHW or not)
Total	URM
(7) Block 8	(8) Block 8a

Figure 3. PC-4 - Entering Graduate Information

Enter Total # Graduated/Completed (whether funded by BHW or not): Total: In Column 7 (Block 8), enter the total number of students who completed all internship requirements during the current reporting period. Count all students who completed the internship program, regardless of whether or not the student directly received a BHW-funded financial award (i.e., stipend).
Enter Total # Graduated/Completed (whether funded by BHW or not): URM: In Column 8 (Block 8a), enter the number of students who completed all internship requirements during the current reporting period and were underrepresented minorities.

Note
Block 8 is a subset of Block 3; Block 8a is a subset of Block 8.

Note
Students who permanently left their internship before completion (i.e. attrition) will be counted separately in Column 9 (Block 9).

Reference
Refer to the glossary for definitions of disadvantaged background and underrepresented minority.

The John Doe School of Psychology had 18 graduate-level psychology students participate in internships during the current reporting period. Among the graduate-level psychology students who participated in internships, 3 completed all internship requirements. Of those who completed internships, none were underrepresented minorities.

In Column 7 (Block 8), the reporting official would enter 3.

In Column 8 (Block 8a), the reporting official would enter 0.

PC-4 - Entering Attrition Information

Warning
Multiple steps are required to complete this portion of the subform. Please read instructions carefully.

Enter Total # Who left the Program Before Completion (whether funded by BHW or not)	Enter Total # Who left the Program Before Completion (whether funded by BHW or not)
Total	URM
(9) Block 9	(10) Block 9a

Figure 4. PC-4 - Entering Attrition Information

Enter Total # Who left the Program Before Completion (whether funded by BHW or not): Total: In Column 9 (Block 9), enter the total number of students who permanently left their internships before completion during the current reporting period. Count all students who permanently left their internship regardless of whether or not the student directly received a BHW-funded financial award (i.e., stipend).
Enter Total # Who left the Program Before Completion (whether funded by BHW or not): URM: In Column 10 (Block 9a), enter the number of students who permanently left their internships before completion during the current reporting period and were underrepresented minorities.

Note
Block 9a is a subset of Block 9. The total entered in Block 9 is exclusive of the total number of enrollees (Block 3).

Reference
Refer to the glossary for definitions of disadvantaged background and underrepresented minority.

The John Doe School of Psychology had 18 graduate-level psychology students participate in internships during the current reporting period. Among the graduate-level psychology students who participated in internships, 2 left the internship program before completion. Neither student was an underrepresented minority.

In Column 9 (Block 9), the reporting official would enter 2.

In Column 10 (Block 9a), the reporting official would enter 0.

To Complete the Form: Click on the “Save and Validate” button located on the bottom right corner of your screen. If no errors are found, the BPMH system will automatically route you to the next required subform.

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Graduate Psychology Education

PC-4: Program Characteristics – Internship Programs

PC-4 - Selecting Partnerships Developed Using BHW Funds

PC-4 - Selecting Partnerships Developed Using BHW Funds

PC-4 - Entering Enrollment Information

PC-4 - Entering Enrollment Information

PC-4 - Entering Graduate Information

PC-4 - Entering Graduate Information

PC-4 - Entering Attrition Information

PC-4 - Entering Attrition Information

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