INFORMATION FORM FOR ACCREDITATION SITE VISIT
Spring 2016
The information provided will be used when assigning the site visit dates and team. Please return the
Information Form for Accreditation Site Visit and the Official Authorization for Accreditation to:
Accreditation Commission for Education in Nursing (ACEN)
3343 Peachtree Road NE, Suite 850
Atlanta, GA 30326
The deadline for Spring visits is November 1, 2015.
Purpose of Visit:
Initial Accreditation
Continuing Accreditation
Program(s) to be reviewed:
Clinical Doctorate
Master’s
Master’s with Post-Master’s Certificate
Baccalaureate
Associate
Diploma
Practical
Complete the following information:
Name of Governing Organization
Address:
Street
City/Town
State
Zip Code
Name, Credentials, and Title of Chief Executive Officer of the Governing Organization
CEO Phone Number
CEO Fax Number
CEO E-mail
Name of Nursing Education Unit
Address:
Street
City/Town
State
Zip Code
Name, Credentials, and Title of Nurse Administrator
Nurse Administrator Phone Number
Nurse Administrator E-mail
Emergency Contact Number
Nurse Administrator Fax Number
Schedule of visit dates:
The site visit will occur between January 25, 2016, and March 4, 2016. The visit is typically three days in
length, beginning on a Tuesday. Please provide the following dates:
First date of class:
First date of clinical:
Days of the week students are in clinical settings (if known):
Dates of any major events that will be occurring at the governing organization during the Spring 2016
Cycle:
If the program has not yet had a class graduate, please provide the anticipated date (month and year)
of the graduation for the first class:
General information – Governing Organization:
1. Indicate the agency by which the governing organization is accredited:
a. For clinical doctorate, master’s, baccalaureate, associate, or practical nursing programs:
Middle States Commission on Higher Education
New England Association of Schools and Colleges
North Central Association of Colleges and Schools
Northwest Commission on Colleges and Universities
Southern Association of Colleges and Schools
Western Association of Schools and Colleges
Accrediting Bureau of Health Education Schools
Accrediting Commission of Career Schools and Colleges
Accrediting Commission of the Distance Education and Training Council
Accrediting Council for Independent Colleges and Schools
b. For diploma or practical nursing programs:
The Joint Commission
DNV Healthcare
Healthcare Facilities Accreditation Program of the American Osteopathic Association
c.
For practical nursing programs:
Council on Occupational Education
State Department of Education/State Department of Vocation-Technical Education:
State agencies recognized by the USDOE for postsecondary vocational education:
Kansas State Department of Education
Minnesota State Colleges and Universities
Missouri State Board of Education
New York State Board of Regents (Vocational Education Unit)
Oklahoma Department of Vocational & Technical Education
Oklahoma State Regents for Higher Education
Puerto Rico Human Resources & Occupational Development Council
Utah State Board for Applied Technology Education
Spring 2016 Information Form for Accreditation Site Visit
2
2. Identify the Carnegie Classification* of the governing organization by checking the appropriate
box:
Doctorate-granting Universities: Includes institutions that award at least 20 doctoral degrees per year.
RU/VH
RU/H
DRU
Research Universities (very high research activity)
Research Universities (high research activity)
Doctoral/Research Universities
Master’s Colleges and Universities: Includes institutions that award at least 50 master’s degrees per year.
Excludes Special Focus Institutions and Tribal Colleges.
Master’s/L
Master’s/M
Master’s/S
Master’s Colleges and Universities (larger programs)
Master’s Colleges and Universities (medium programs)
Master’s Colleges and Universities (smaller programs)
Baccalaureate: Includes institutions in which baccalaureate degrees represent at least 10 percent of all
undergraduate degrees and fewer than 50 master’s degrees or fewer than 20 doctoral degrees are awarded per
year. Excludes Special Focus Institutions and Tribal Colleges.
Bac/A&S
Bac/Diverse
Bac/Assoc
Baccalaureate Colleges - Arts & Sciences
Baccalaureate Colleges - Diverse Fields
Baccalaureate/Associate’s Colleges
Associate’s Colleges: Includes institutions in which all degrees are at the associate level or baccalaureate
degrees account for less than 10 percent of all undergraduate degrees. Excludes institutions eligible for
classification as Tribal Colleges or Special Focus Institutions.
Assoc/Pub-R-S
Assoc/Pub-R-M
Assoc/Pub-R-L
Assoc/Pub-S-SC
Assoc/Pub-S-MC
Assoc/Pub-U-SC
Assoc/Pub-U-MC
Assoc/Pub-Spec
Assoc/PrivNFP
Assoc/PrivFP
Assoc/Pub2in4
Assoc/Pub4
Assoc/PrivNFP4
Assoc/PrivFP4
Associate’s - Public Rural-serving Small
Associate’s - Public Rural-serving Medium
Associate’s - Public Rural-serving Large
Associate’s - Public Suburban-serving Single Campus
Associate’s - Public Suburban-serving Multicampus
Associate’s - Public Urban-serving Single Campus
Associate’s - Public Urban-serving Multicampus
Associate’s - Public Special Use
Associate’s - Private Not-for-profit
Associate’s - Private For-profit
Associate’s - Public 2-year Colleges under Universities
Associate’s - Public 4-year, Primarily Associate’s
Associate’s - Private Not-for-profit 4-year, Primarily Associate’s
Associate’s - Private For-profit 4-year, Primarily Associate’s
Special Focus Institutions: Institutions awarding baccalaureate or higher-level degrees where a high
concentration of degrees is in a single field or set of related fields. Excludes Tribal Colleges.
Spec/Faith
Theological seminaries, Bible colleges, and other faith-related institutions
Spec/Medical
Medical schools and medical centers
Spec/Health
Other health profession schools
Spec/Engg
Schools of engineering
Spec/Tech
Other technology-related schools
Spec/Bus
Schools of business and management
Spec/Arts
Schools of art, music, and design
Spec/Law
Schools of law
Spec/Other
Other special-focus institutions
* Taken from the 2012 Higher Education Directory
Spring 2016 Information Form for Accreditation Site Visit
3
3. Total enrollment at the governing organization:
4. Attach a copy of the governing organization (institutional) accrediting agency letter. The letter should
verify current status, date of last visit, date of next visit, and due date for any reports if required.
Date of last institutional review:
Outcome of last review:
Date of next institutional review:
Dates for any reports requested:
5. Check all the following characteristics that describe the governing organization:
Private
Public
Religious-Affiliated
Single Purpose
Hospital
Vocational/Technical School
Public School System
For-Profit
General Information - Nursing Programs:
6. Attach a copy of the letter indicating the program’s current approval status by the State Board of
Nursing or other state regulatory agency (if applicable*).
Name of agency:
Date of last review:
Outcome of last review:
Date of next review:
*Not applicable (explain)
7. Year nursing program established:
8. Total enrollment of the nursing program (by program type if applicable):
9. Total number of faculty (by program type if applicable):
Full-time
Part-time
Spring 2016 Information Form for Accreditation Site Visit
4
10. Will this visit be combined with a visit conducted by another accrediting agency or the State Board of
Nursing? (Coordinated visit: a concurrent visit in which ACEN cooperates with another agency in
activities of mutual concern.)
No
Yes
If yes, please indicate agency:
11. Additional Locations

Number of additional locations offering the nursing program ______

Specify each additional location, including the distance from the main campus and the option(s)
offered:
12. Does the program utilize distance education? __________
13. Entry options (e.g., LPN-RN, RN-to-BSN, generic, accelerated, second degree)
14. Track options:
Nurse practitioner
Clinical specialist
Certified registered nurse anesthetist
Certified nurse midwife
Nurse educator
Nursing administration
Other, please specify
Post-Master’s Certificate
15. Does the program participate in a state-wide curriculum?
No
Yes
16. Recommended airport for use when making travel arrangements:
Signature of Individual Completing Form
Date
01/25/2015
Spring 2016 Information Form for Accreditation Site Visit
5
OFFICIAL AUTHORIZATION FOR ACCREDITATION
Name of Governing Organization
Name of Nursing Education Unit
Address: Street
City/Town
State
Zip Code
Authorizes the Accreditation Commission for Education in Nursing to conduct in Spring 2016 the
evaluation process for accreditation of its
nursing program(s).
(Program type e.g., baccalaureate)
A site visit by ACEN representatives is one step in the evaluation of the nursing unit's offerings. In the
interest of both groups concerned, the visit will be scheduled at a time that is mutually convenient.
Charges for the site visit will be made according to the prevailing accreditation fee schedule.* The
processing fee must accompany this form.
This authorization constitutes the initiation of planning between the school and the ACEN for the various
steps of the accreditation process. It is understood that the process can be terminated at any time in
accordance with ACEN policies and procedures.
By:
Signature of Chief Executive Officer of the Governing Organization Authorizing the Visit
Print Name, Credentials, and Title of Chief Executive Officer
By:
Signature of Nurse Administrator of the Nursing Unit
Print Name, Credentials, and Title of Nurse Administrator
Date:
*See Schedule of Accreditation Fees
01/25/2015
CHECKLIST
Please confirm that the following items are included with your Information Form for Accreditation Visit.
All items must be provided.
Completed Information Form for Accreditation Visit
Proof of current State Board of Nursing status
Proof of current governing organization accreditation status
Completed Official Authorization for Accreditation Form