Grayed fields are provided here for identification purposes only.
Select whether status/employment data are available for the individual 1-year post graduation/completion: Select whether current employment data are available for each faculty who received a BHW-funded financial loan repayment and completed their loan repayment program one year prior to this report by clicking on the drop-down menu under Block 23 and choosing
one of the following options:
Select Individual's Current Training/Employment Status: If "Yes" was selected in Block 23, choose each former faculty’s current employment location by clicking on the drop-down menu under Block 23a choosing
all that apply from the options listed below.
If "No" was selected in Block 23, choose "N/A" in Block 23a.
- Individual is not currently employed
- Individual is providing behavioral health services
- Individual is providing maternal health care
- Individual is serving individuals with OUD/SUD
- N/A
- None of the above
- Individual currently practices in a medically underserved area
- Individual currently practices in a primary care setting
- Individual currently practices in a rural area
- Individual is currently conducting research
- Individual is currently teaching
Select whether your organization hired this individual following training program completion by clicking on the drop-down menu under Column 16 and choosing one of the following options:
Select Whether a Partner Organization Hired this Individual - PY: description
Select Employment Location - PY: description
- Academic Institution
- Academic Medical Center
- Area Health Education Center
- Certified Community Behavioral Health Clinic (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)
- Pursuing Additional Education or Training
- Not Currently Employed
- N/A
If ‘Yes’ was selected in column 13, enter the zip code (5 digits) of the employment site.
If ‘No’ was selected, leave column 18a blank.
City PY: Employment City (column 18b) will auto-populate based on Employment Location Zip Code (column 18c) after you save and validate the form.
State PY: Employment State (column 18c) will auto-populate based on Employment Location Zip Code (column 18a) after you save and validate the form.
Note
Repeat these steps for all rows in the INDGEN-PY table and enter selections for all blank fields under Blocks 23 and 23a. If the employment site zip code is unknown, column 18a can be left blank for the AY 2023-2024 APR. This data will be required starting in AY 2024-2025.
