BNATP Code & Name Prepared by Name & Title DATE: [mm/dd/yyyy] DATES OF PROG CLUSTER SCORES REPORT: Identification and Rationale Goals and Measures Monitoring Method(s) Responsible Evaluation Party Based on the Annual (12 month) State overall goal(s) for mean score Indicate how the program Indicate who is Identify how the Program Cluster Score Report, below 80%. plans to monitor its responsible to corrective actions will identify mean score below 80%, performance to ensure that implement the be evaluated. OR, State goal(s) for each specific Test implementation of the corrective any Test Content Cluster Area Content Cluster Area score below corrective action plan occurs action plan. Attach a sample of score below 75%, regardless of 75%, regardless of mean score. and is maintained. program’s evaluation mean score. Indicate who is form, if used. List and explain measure(s) to be Attach a sample of responsible to rationale(s) for mean score implemented or systemic changes to program’s monitoring form, monitor for below 80%. be made to ensure that the low if used. compliance. score(s) will not recur. State rationale(s) for each Test Content Cluster score below 75%. NOTE: Corrective Action Plan must be submitted to the Department within 30 days of receipt of the Annual Program Cluster Summary Report. Submit to: Illinois Department of Public Health Education & Training Unit 525 W. Jefferson, 4th Floor Springfield, IL 62761 Fax: 217 557 3363 – – Email: dph.bnatp@illinois.gov **do not mail*
BNATP Code & Name Prepared by Name & Title DATE: [mm/dd/yyyy] DATES OF PROG CLUSTER SCORES REPORT: Identification and Rationale Goals and Measures Monitoring Method(s) Responsible Party Evaluation Based on the Annual (12 month) Program Cluster Score Report, identify mean score below 80%, OR, any Test Content Cluster Area score below 75%, regardless of mean score. rationale(s) for mean score below 80%. State rationale(s) for each Test Content Cluster score below 75%. NOTE: Corrective Action Plan must be submitted to the Department within 30 days of receipt of the Annual Program Cluster Summary Report. Submit to: Illinois Department of Public Health Education & Training Unit 525 W. Jefferson, 4th Floor Springfield, IL 62761 Fax: 217 – 557 – 3363 Email: dph.bnatp@illinois.gov **do not mail* State overall goal(s) for mean score below 80%. State goal(s) for each specific Test Content Cluster Area score below 75%, regardless of mean score. List and explain measure(s) to be implemented or systemic changes to be made to ensure that the low score(s) will not recur. Indicate how the program plans to monitor its performance to ensure that implementation of the corrective action plan occurs and is maintained. Attach a sample of program’s monitoring form, if used. Indicate who is responsible to implement the corrective action plan. Indicate who is responsible to monitor for compliance. Identify how the corrective actions will be evaluated. Attach a sample of program’s evaluation form, if used.
CAP_Template_11_2017.docx