RESOURCE (Role(s) of the resource in the program) of measurements) RESULTS and ANALYSIS (Include the # meeting the cut score and the # that fell below the cut score) FOLLOW UP (What is to be done, Who is responsible, Due Date, Expected result) 1 FACULTY Provide instruction, supervision, and timely assessments of student progress in meeting program requirements. Work with advisory committee, administration, clinical/field internship affiliates and communities of interest to enhance the program. 2 SUPPORT PERSONNEL (clerical, academic, ancillary) Provide support personnel/services to ensure achievement of program goals and outcomes (e.g. admissions, registrar, advising, tutoring, clerical) 3 CURRICULUM Provide specialty core and support courses to ensure the achievement of program goals and learning domains. Meet or exceed the content and
competency demands of the latest edition of the documents referenced in Standard III.C. 4 FINANCIAL RESOURCES (fiscal support, acquisition /maintenance of equipment /supplies, continuing education) Provide fiscal support for personnel, acquisition and maintenance of equipment/supplies, and continuing education. 5 FACILITIES (classroom, lab, offices, ancillary); Provide adequate classroom, laboratory, and ancillary facilities for students and faculty. 6 EQUIPMENT /SUPPLIES Provide a variety of equipment and supplies to prepare students for clinical/field internship experiences. 7 CLINICAL/FIELD INTERNSHIP RESOURCES (affiliations) Provide a variety of clinical/field internship experiences to achieve the program goals and outcomes. 8 LEARNING RESOURCES (print, electronic reference materials; computer resources) Provide learning resources to support student learning and faculty instruction.
Are you involved in modifications of the curriculum? ☐Yes ☐No Have you been evaluated by your supervisor? Date of most recent evaluation? ☐Yes ☐No Are there systems in place to demonstrate the effectiveness of the program? ☐Yes ☐No Are adequate controls to assure quality of delegated responsibilities ☐Yes ☐No Are you responsible for: Administration of the educational program? ☐Yes ☐No If response is “no” to any of these 7 questions, describe below* who is responsible and how that responsibility is attained. Organization of the educational program? ☐Yes ☐No Supervision of the educational program? ☐Yes ☐No Continuous quality review and improvement of the educational program? ☐Yes ☐No Long range planning and on-going development of the program? ☐Yes ☐No Effectiveness of the program? ☐Yes ☐No Cooperative involvement of the medical director? ☐Yes ☐No * Who is responsible and how is that responsibility attained? Insert job description of the Program Director… here APPENDIX C3 – Curriculum Paid Faculty or Instructional Staff Information Name: ☐ Paid Faculty ☐ Instructional Staff, Specify: How long have you been serving in the present position with the program? Are you currently certified as a AT Professional? ☐Yes ☐No
Accessible transportation Orthotics / prosthetics / bracing Other Specify APPENDIX F2 – Internship Institutional Data Form Accreditation Self Study Report AFFILIATE #: [ ] FIELD INTERNSHIP AFFILIATION MATRIX Name: Address: Chief Administrative Officer: Telephone #: Distance from location of program? [ ] Is there a signed, current agreement with this affiliate? [ ] Yes [ ] No Who supervises the students? [ ] field agency personnel [ ] program personnel Are the preceptors formally trained? [ ] Yes [ ] No For how many hours? Is there a quality improvement program that reviews runs? [ ] Yes [ ] No Assistive Technology Areas # observations Seating and mobility AAC (Augmentative/alternative communication) Cognitive and Executive Function Aids Education/learning/accessible instructional materials Computer and mobile device access ADL (e.g., EADL-Electronic aids to daily living, dressing, bathing, etc.) Sensory aids
Sensory aids Recreation Environmental modification Accessible transportation Orthotics / prosthetics / bracing Other Specify APPENDIX F4 – Field Internship Institutional Data Form Accreditation Self Study Report AFFILIATE #: [ ] INTERNSHIP AFFILIATION MATRIX Name: Address: Chief Administrative Officer: Telephone #: Distance from location of program? [ ] Is there a signed, current agreement with this affiliate? [ ] Yes [ ] No Who supervises the students? [ ] field agency personnel [ ] program personnel Are the preceptors formally trained? [ ] Yes [ ] No For how many hours? Is there a quality improvement program that reviews runs? [ ] Yes [ ] No Assistive Technology Areas # observations Seating and mobility AAC (Augmentative/alternative communication) Cognitive and Executive Function Aids Education/learning/accessible instructional materials
Computer and mobile device access ADL (e.g., EADL-Electronic aids to daily living, dressing, bathing, etc.) Sensory aids Recreation Environmental modification Accessible transportation Orthotics / prosthetics / bracing Other Specify Insert the supplemental Appendix F file... here APPENDIX G/H – Student Client Contact Matrix (return t;) Complete the columns of this matrix based on clinical rotations and based on Field Internship. For columns “Average # per Student” and “Range per Student”, report the numbers for students who have completed the procedures to date (or graduated from the program, if applicable). For Clinical Rotations ONLY For Field Internship ONLY AssistiveTechnology Area # Required Per Student by Program Average # Per Student Range Per # Required Per Student by Program Average # Per Student Per Seating and mobility AAC (Augmentative/alternative communication) Cognitive and Executive Function Aids Education/learning/accessible instructional materials Computer and mobile device access ADL (e.g., EADL-Electronic aids to daily living, dressing, bathing, etc.) Sensory aids Recreation Environmental modification Accessible transportation
Orthotics / prosthetics / bracing Other Specify Field Internship Team Leads Comments: APPENDIX I – College Catalogue and Documents (return t;) Insert copy of the most recent college catalogue and any other documents related to Standard V.A.2. here ☐ A separate file for this Appendix has been placed on the CD/drive named: APPENDIX J – Additional College Materials (return t;) Insert additional materials related to Standard V.A.3. ... here