Submission Checklist Yes No I have completed the attached file providing all requested information for FT and ☐ PT faculty, graduates, curriculum, and cooperating agencies. Yes No I have verified that contact information for the CEO and Program are current. ☐ Yes No I have verified that all faculty (FT , PT and Preceptors) held current MA RN License ☐ in good standing. Yes No I have verified that all waivered faculty are correctly identified by option, and option ☐ #3 are assigned mentors. Yes No The numbers of admitted, enrolled and graduated students submitted in the ☐ report have been verified and calculations entered accurately. Yes No □ □ All clinical agencies have been added including agencies that are used outside of MA Yes No □ □ All and credit hours have been verified. Person Preparing Report Last Name First Name Title As program administrator, I certify under the pains and penalties of perjury, that this program complies with those requirements specified in state regulations, 244 CMR 6.00, respective to program type. If the nursing education program is not in compliance with state regulations, cite the regulations with which the program does not comply, and advise the Board of Registration in Nursing of the program’s plan for corrective action, including timeframes. Last Name First Name Title Signed: Date: Please email completed form and excel file to
Submission Checklist Yes ☐ No I have completed the attached file providing all requested information for FT and PT faculty, graduates, curriculum, and cooperating agencies. Yes ☐ No I have verified that contact information for the CEO and Program are current. Yes ☐ No I have verified that all faculty (FT , PT and Preceptors) held current MA RN License in good standing. Yes ☐ No I have verified that all waivered faculty are correctly identified by option, and option #3 are assigned mentors. Yes ☐ No The numbers of admitted, enrolled and graduated students submitted in the report have been verified and calculations entered accurately. □ Yes □ No All clinical agencies have been added including agencies that are used outside of MA □ Yes □ No All and credit hours have been verified. Person Preparing Report Last Name First Name Title As program administrator, I certify under the pains and penalties of perjury, that this program complies with those requirements specified in state regulations, 244 CMR 6.00, respective to program type. If the nursing education program is not in compliance with state regulations, cite the regulations with which the program does not comply, and advise the Board of Registration in Nursing of the program’s plan for corrective action, including timeframes. Last Name First Name Title Signed: Date: Please email completed form and excel file to
2018annuareporttomassachusettsbboardofregistrationiinnursingword.docx