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COLLEGE OF HEALTH AND HUMAN SERVICES
California State University, Long Beach
Health Care Administration Department
HCA 202 – Health Care in America
Spring, 2016
Instructor: Richard L. Tradewell, Ph.D.
E-mail: richard.tradewell@csulb.edu
Office Hours: 9-11amW; 2-6pmTh
HCA Office Location: HHS2-118
Phone: 949-400-0960 (Text for appt.)
Class Number: 1678
Class Meets: M/W 11-12:15pm
Room: HHS1-200
HCA Department Administrative
Coordinator: Deby McGill:
deby.mcgill@csulb.edu
Tel. 562/985-5694; fax 562/985-5886
Course/Catalog Description: Prerequisites: Completion of GE Foundation
requirements. U.S. health care system with its delivery and financing mechanisms,
as well as the technical, economic, political and social forces responsible for
changes in the health care system. Contemporary issues such as access, cost and
quality, health disparities among minority groups as well as gender disparities
including sexual orientation. Letter grade only (A-F).
Expected Learning Objectives & Outcomes; Activities, Assignments &
Assessments. The Health Care Administration Department has adopted a
competency-based curriculum, based on the American College of Health Care
Executives (ACHE) Competencies Assessment Tool and the Healthcare Leadership
Alliance (HLA) Competency Directory. The emphasis in this course is on acquiring
competencies in HLA Domain 4, knowledge of the healthcare environment.
Learning Objective
Domain
Competency
Activities (A1) ,
Assignments
(A2) &
Assessments
(A3)
Describe how
environmental,
economic, social and
political forces affect
access to health care in
America.
Identify the components
of the health care
continuum.
4Knowledge
of the hc
environment
Socioeconomic
environment in which
the organization
functions
A2: Critical essay
paper and
presentation
4Knowledge
of the hc
environment
4Knowledge
Organization and
delivery of healthcare
A3: Quizzes and
final exam
Managed care models,
structures,
A1: In-class
exercise: debate
Discuss the pros and
cons of integrated and
2
Learning Objective
Domain
managed care delivery
systems
of the hc
environment
4Knowledge
of the hc
environment
Examine the influence of
gender, race gender,
and ethnicity and one or
more additional markers
of social difference in
the USA within both the
U.S. health care system
and the general society
Discuss the problems of
the uninsured in
accessing care and
efforts to expand health
insurance coverage
Explain the reasons for
the long term increase
in health care costs
Distinguish between
public health and
personal medical care
and explain the distinct
role of each in life
expectancy and infant
mortality
Appreciate how
terrorism and
emergency
preparedness have
increased the
importance of
partnerships between
public health and public
and voluntary agencies
Define the major health
care professions and the
role of health care
administrators within
each
Competency
Activities (A1) ,
Assignments
(A2) &
Assessments
(A3)
(Focus discussion
question #9)
Community standards of
care
A2: Critical essay
paper and
presentation
4Knowledge
of the hc
environment
4Knowledge
of the hc
environment
4Knowledge
of the hc
environment
The interrelationships
among access, quality,
cost, resource
allocation, accountability
and community
Funding and payment
mechanisms of the
healthcare system
A1: Focus
discussion question
#2
Interaction and
integration among
healthcare sectors
A1: Focus
discussion question
#4
4Knowledge
of the hc
environment
Interaction and
integration among
healthcare sectors
A1: Focus
discussion question
#15
4Knowledge
of the hc
environment
Role of non-clinical
professionals in the
healthcare system
A1: Focus
discussion question
#5
A1: Focus
discussion
questions #6, 13
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Text: Shi, L. & Singh, D.A. (2017). Essentials of the US Health Care System
(Fourth Ed.). Sudbury, MA: Jones and Bartlett.
Goldhill, David. (2013). New York: Vintage. Catastrophic Care: Why Everything We
Think We Know about Health Care Is Wrong (Paperback; used about $8.00).
http://www.amazon.com/gp/offerlisting/034580273X/ref=tmm_pap_used_olp_sr?ie=UTF8&condition=used&qid=145
2026451&sr=1-1
Raube, Kristina. September 15, 2014. “Castlight Health: Disrupting the Healthcare
Industry.” Case B-5817. University of California, Berkeley/ Haas School of Business
Style Guide Reference: American Psychological Association. (2010). Publication
manual of the American Psychological Association. Washington, D.C.: Author.
Supplemental required readings
Austin, A and V. Wetle. 2010. The United States Health Care System, Chapter 12,
the Public Health System. Pearson. Page 159 (posted on BeachBoard).
American Academy of Family Physicians, American Academy of Pediatrics, American
College of Physicians, American Osteopathic Association. (2007, March). Joint
principles of the patient-centered home. Retrieved from:
http://www.medicalhomeinfo.org/downloads/pdfs/jointstatement.pdf.
Goldhill, D. (2009, September). How American health care killed my father. The
Atlantic. Retrieved from:
http://www.theatlantic.com/magazine/archive/2009/09/how-americanhealth-care-killed-my-father/7617/
Medical Home Data.Org. (n.d.) Data resource center for child and adolescent
health. Retrieved from: http://medicalhomedata.org/content/Default.aspx.
National Center for Medical Home Implementation (n.d.). Children and youth with
special health care needs (CYSHCN). Retrieved from:
http://medicalhomeinfo.org/quick_links/cyshcn.aspx.
Newhouse, J. (2010, September). Assessing health reform’s impact on four key
groups of Americans. Health Affairs Web First 29:9, 1-11. Retrieved from:
http://content.healthaffairs.org/cgi/content/abstract/hlthaff.2010.0595
Stonebraker, R. J. (2010, 11 March). Health care. In The Joy of Economics: Making
Sense Out of Life. Retrieved from:
http://faculty.winthrop.edu/stonebrakerr/book/medicalcare.htm.
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Video materials
“Sick in America” John Stossel, ABC 20/20 Special Programming
https://www.youtube.com/watch?v=gvJHUVAEU44
“Remaking American Medicine”: PBS Home Video. You are tested on all four
segments of the series. http://www.youtube.com/watch?v=ER1whkSvCps
Additional Information Resources:
All Healthcare: Making It in Medicine – health career information:
http://allhealthcare.monster.com/
Course Assignments:
Critical Essay
Essay presentation: Each student will briefly (5-10 minutes) present the key
findings of his or her paper. See posted rubric for grading criteria.
Quizzes: There will be 6 short, 10 question, multiple choice/true-false, online
quizzes on materials from the required readings and lectures.
Attendance: You must sign in for every class. A pattern of poor attendance will be
taken as evidence of lack of interest in class.
Class discussions: Most weeks there will be at least one Focus Discussion
Question (FDQ) based on the assigned readings. Be prepared to say something to
contribute to the discussion either on your own or when called on! A thoughtful,
substantive response will earn 1 point per class, up to a maximum of 30 points.
Students’ names will be drawn randomly to answer questions each week.
Final exam: The final exam will be 40 questions, or equal to two quizzes. Unlike
the quizzes, the final score cannot be dropped. Half the exam is a recap of the
previous six quizzes and half is new material.
Summary: Course Assignments, Due Dates and Grade Weights
Item
Due Date
Points % of
Grade
Critical analysis essay
March 23
50
17
Essay paper class presentation
Weeks 8-14
10
3
Quizzes 6@20pts ea; drop the lowest score
Varies
100
33
Attendance Quizzes 12@10pts; drop low two Weekly
100
33
Final exam (40 questions)
May 4
40
14
Total
300
100
5
Course grade thresholds: 90%= A; 80%= B; 70%= C; 60%= D; 50%= F. The total
# of points determines your percentage and grade. There will be no curving.
Grading Policies
 Rubrics (grading score sheets) will be provided for the written assignment.
 Late papers are subject to a 10 percent deduction. No paper that is over a
week late is accepted.
 There are absolutely no quiz or exam make-ups. Dropping the lowest quiz
allows you to cover one unavoidable emergency absence.
 Disabled students that qualify for alternative testing arrangements, please
advise the instructor at least 2 weeks prior to the exam.
Attendance Quizzes
For twelve of the sixteen weeks there will be an attendance quiz that you will write
in class, and hand in immediately following my lecture and our class discussion.
Each quiz is worth ten points; I drop your lowest two scores. There are normally
four-six questions on a duplexed handout sheet that I distribute at beginning of
class. Space is left for your short answers.
The purpose of the Attendance Quizzes is to encourage class attendance and to
help me focus with you on critical issues. After I enter your grade, the quiz is
returned to you for help in preparing for the six Scheduled Quizzes.
Critical Essay Guidelines
Introduction
The heart of this class is the short critical essay. Many of us today are overwhelmed
with electronic media, have the attention span of a nanosecond and have lost, or
you never developed, the ability to think deeply and analyze critical options. Google
lists 6,120,000 entries on the subject of “health care reform.” The internet is
drinking from a fire hose. It is not scholarship. The future requires thinkers. In this
class you will demonstrate critical thinking.
What is a critical essay?
A critical essay reflects critical thinking
http://en.wikipedia.org/wiki/Critical_thinking. It forces you to ponder. It provokes
and reflects thought. It examines solutions from multiple perspectives. It thinks
through both market and government failure, including how a program is
implemented and how and how it is evaluated for cost-effectiveness.
Look at Both Sides: Look for What Journalists Call the “Fight” or Key Conflict
Use competing journal articles, competing views from think tanks, competing views
in political debates, etc. Most of us read only liberal or conservative blogs that
reflect that biases. The truth is more complicated. You must make yourself see the
other side.
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Presenting Your Analysis
You will be orally summarizing your position and findings in a short essay for your
classmates that ends by asking them a question for discussion. Outline your key
points on a single sheet to hand to me prior to your talk. These presentations must
be short (5 minutes or less) and allow no more than five minutes for discussion.
Length and Format
Take a chance and buy a print newspaper. Look at the page opposite to the
editorial page of the Los Angeles Times or the Wall Street Journal. These “op-ed”
pieces are often great examples of fact and data-based argument. We are not
interested in cheap polemics, but in strong supported reasoning. So three-four
pages double-spaced (your references add a fifth page) should be adequate to
present your argument. Be brief but specific and make your report data and factladen. Limit personal opinion. I love charts and graphs that illustrate your point.
References
You must include at least two academic (peer reviewed) references (books, journal
articles) in addition to the text. Use a consistent and standard reference protocol,
APA is preferred. Newspaper and magazine articles that inform your understanding
may be cited but do not count toward journal article requirement. Our health care
Librarian will visit class to get you acquainted with Health Affairs and other journals
of the health care field.
Essay Topics Concerning the Historic Obama-Era Health Care Reform: You may
choose any topic that is covered in the text. These are a few ideas:
1. The U.S. has no Long Term Care program following the failure of the CLASS
Act. Based on what has been successful in other nations, what do you
suggest we do?
2. Arguably, ObamaCare’s chief failure is in controlling healthcare costs that
now consume nearly 20% of GDP and imperil our economic standard of
living. What would you do? (Focus; be specific; avoid opinion; cite evidence).
3. Prices of drugs, medical equipment, and most procedures in the U.S. are at
least twice that of most nations. How would you make consumer aware of,
and concerned with, price shopping and comparison?
4. Hospital prices in U.S. are a mystery – compared to shopping at a market
where prices are unavailable and but where you get a check six months after
the fact for whatever you bought. What can be done?
5. The FDA has been blamed for high drug prices in the U.S. How would you
reform the drug approval process?
6. Seniors in the U.S. use Medicaid, the program for the poor, to pay for
nursing home costs. What are the implications? What can be done?
7. Overtreatment and medical error take the lives of some 400,000 people in
the U.S. annually. Is that a good estimate? What can be done?
8. Goldhill fights the conventional wisdom that high treatment prices in the U.S.
are a result of high technology. (He argues technology, when coupled with
right incentives, lowers prices). Argue both sides.
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9. What is the future of managed care in U.S.? Why hasn’t it brought prices
down? Can Accountable Care Organizations do it better?
10. If you are convinced that ObamaCare will not solve our problems, what will?
Analyze a national health system that has the answers figured out.
Expectations of Student Skill Performance
 Write clearly and concisely, using correct grammar, punctuation and spelling.
 Cite all references using APA style.
 Communicate articulately in oral presentations; use appropriate audio-visual
aids.
 Search the web and research publications and apply the information found.
 Analyze information, both numeric and text; don’t just present data.
 Apply internationally-accepted metrics to compare health and healthcare
systems.
 Synthesize information about factors that impact health and healthcare
systems.
 Compare and contrast countries, situations, historic and current times.
 Participate in class discussions.
 Submit all assignments on time through BeachBoard Assignments.
Student Responsibilities and University Policies

Cheating and Plagiarism. Please be aware of and ensure that your
behavior conforms to University Policy, as contained in the California State
University, Long Beach Policy Statement. Although the University catalog
does not cover this aspect of plagiarism, please be aware that it is NOT
acceptable to submit the same paper for two courses. If you want to
write a paper on the same topic area for two different courses, you must
submit two different papers. If I discover that you have submitted the
same paper for another course, you will receive an “F” for your paper
in this course.

Disabilities. Please notify the instructor immediately if you need
accommodation for any type of condition. Instructor may require
confirmation of disability and evaluation of accommodation request from
Disabled Student Services.

Withdrawal policy. Withdrawal is the responsibility of student. Per
University policy:
http://www.csulb.edu/divisions/aa/grad_undergrad/senate/documents/policy
/2002/02/. Withdrawal after 2nd week and before final 3 weeks “permissible
for serious and compelling reasons;” instructor will evaluate student
withdrawal requests on a case by case basis.

Communications: Students are expected to check email and BeachBoard
accounts regularly for class announcements and their standing in the course.
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Commitment to Inclusion
California State University, Long Beach is committed to maintaining an inclusive learning
community that values diversity and fosters mutual respect. All students have the right to
participate fully in university programs and activities free from discrimination, harassment,
sexual violence, and retaliation. Students who believe they have been subjected to
discrimination, harassment, sexual violence, or retaliation on the basis of a protected status such
as age, disability, gender, gender identity/expression, sexual orientation, race, color, ethnicity,
religion, national origin, veteran/veteran status or any other status protected by law, should
contact the Office of Equity and Diversity at (562) 985-8256, University Student Union (USU)
Suite 301, http://www.csulb.edu/depts/oed.
Class Rules
 Turn off and put away laptops, cell phones or other electronic devices before
class begins.
 No eating during class.
 Arrive on time
 Actively participate in all classroom activities and discussions.
 Be respectful of others’ opinions and perspectives.
 You are responsible for ALL weekly reading assignments and are expected to
have read the chapter prior to attending the lecture.
 Check BeachBoard regularly, including the gradebook. If there is any
discrepancy between the posted grades and your records, advise the
instructor immediately.
 Rules on academic dishonesty will be strictly enforced. See “cheating and
plagiarism” above. Text messaging during a quiz or exam will result in
your exam being voided for presumed cheating and a grade of 0
points.
 Rules of the college catalog apply in this classroom.
Week
1
2
3
4
5
Class Schedule Spring 2016
Introduction, course overview
Market, single payer, and
mandate health systems around
the world
Health system overview; market
vs. social justice
Finance and Irrationality
Quiz 1 Paying for Health Care
Health care foundation
Health care history
Public Heath
Providers & professionals
Quiz 2 Public Health
“Ten
Characteristics”
PowerPoint
Ch. 1 and 2
Ch. 6;
Stonebraker
Tradewell class
handout
Ch. 3
Austin/Wetle text
Ch. 4
Turn in student information
sheet from syllabus
FDQ #1 – Market and
Government Failure in
health care
FDQ #2 – US healthcare
system problems
FDQ #2 – Health care
costs and payment systems
FDQ #3 – Healthcare as
public or private good
FDQ #4 – Acute/PH history
FDQ #5 – HC careers
Quiz 2
9
6
Technology;
Ch. 5
7
Financing & payment
Ch. 6; article by
Stonebraker
Video: “IOU USA”
Outpatient & primary care
8
Quiz 3 Primary care/Tech
Hospitals
9
Ch. 7; AAFP et al.
Joint principles;
Medicaldata.org
FDQ # 6 – Technology cost
Quiz #2 – Chapters 4-6
FDQ #8 – Medical home
Ch. 8
FDQ #9 – Hospital safety
Ch. 9
FDQ #10 – Managed care
debate
DRAFT ESSAY DUE
10
Managed care & integrated
systems
Quiz 4 Hospitals/Mang. Care
SPRING BREAK
Long-term care; drugs
Quiz 5 LTC; Drugs
Cost, access, quality
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12
13
Health policy
14
Quiz 6: Quality
Future outlook
15
Final exam review
16
Final Exam
Ch. 10
Ch. 12; Johnson
et al. article
Ch. 13;
Newhouse article
Ch. 14
Readings in
Content
ENJOY
FDQ #11 – LTC choices
HDP presentations
FDQ #13 – Cost control
Quiz #4: Chapters 10-12
FDQ #14 – Health reform
HDP presentations
HDP presentations
FDQ #15 – Bioterrorism
HDP presentations
HDP presentations
Focus discussion questions week by week: The questions below relate to the
week’s reading assignments. Be prepared to answer them!
Week
1
2
3
4
5
6
Questions
Do you know the cost of anything in health care? Cost of office visit?
Cost of an MRI if you are injured? Have you even compared prices?
Do Americans personally pay for health care? Has the out of pocket
portion of the total bill increased or decreased in recent years? What
does it do to costs when somebody else pays the bill?
Is healthcare a right? Is healthcare a public or a private good? Who
should pay for it? Can government successfully provide health care to all
citizens? How high should taxes be raised to pay for this care?
Why do acute medical care (body repair) and public health have such
different histories and cultures?
What skills and competencies are required for various health care jobs?
What are the growth projections for health care employment?
Is high technology the primary reason health costs are out of control? Is
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7
8
9
10
11
12
13
14
15
all technology created equal or is some technology more cost beneficial
than others?
Why is the US health care market referred to as "imperfect"? How did
some of these imperfections result in poor care for Mr Goldhill’s father?
What is a medical home? Do you or does any member of your family
have one? Why would a medical home be especially important for
children with special health care needs? How well does California meet
medical home criteria for children with and without special health care
needs?
Are hospitals at the heart of health care problems of cost and quality? Do
you feel safe going into a hospital? Having surgery there? How can
consumers learn how safe a given hospital is?
Is managed care the answer to cost control? Does managed care
sacrifice quality of care to cost control?
Why are nursing homes often so poorly run? What are some alternatives
to nursing home placement for an extremely frail or disabled person?
Why are some groups of health care patients considered vulnerable
populations? What makes them What special protections do they enjoy?
Why are health care prices so much higher in the U.S. than in Europe or
Japan? What attempts have been made to bring prices down?
What do you see as the primary benefits and risks of the 2010 Patient
Protection and Affordable Care Act?
How has the fear of bioterrorism transformed the image of public health?
Information Resources
Selected Health Administration & Policy Journals:
American Journal of Managed Care
American Journal of Medical Quality
American Journal of Public Health
Business and Health
Harvard Business Review
Cambridge Quarterly of Healthcare Ethics
Health Affairs
Health Care Financing Review
Health Policy
Health Services Research
Health Technology Trends
Inquiry
Journal of the American Medical Assn.
J of Health Services Research & Policy
Journal of Health, Politics, Policy and Law Medical Care
Medicine and Health
Milbank Memorial Fund Quarterly
New England Journal of Medicine
J of HC for the Poor & Underserved
Public Health Reports
Journal of Public Health Policy
Journal of Ambulatory Care Management Social Science and Medicine
Journal of Law, Medicine & Ethics
Medical Care Research and Review
Policy Studies Journal
Modern Healthcare1
Web sites:
Topic
Health policy (national)
1
Web Sites
Department of Health and Human Services: www.hhs.gov/
Healthcare.gov: www.healthcare.gov/index.html
Medicare: www.medicare.gov
Free student subscription available at: http://www.aupha.org/i4a/forms/form.cfm?id=51&pageid=3829&showTitle=1
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Topic
Health policy (California)
Information resources
Health policy formation, agenda
setting
Policy implementation &
modification
Financing health services
Managed care, insurance &
benefits
Ambulatory health services
Hospitals & health systems
Long Term Care; Politics of
Aging & Disability
Web Sites
Office of Consumer Information and Insurance Oversight:
www.hhs.gov/ociio/index.html
Kaiser Family Foundation: www.kff.org
Center for Health Improvement: www.healthpolicyguide.org
Academy for Health Services Research & Health Policy:
www.academyhealth.org/
Health Hippo: hippo.findlaw.com/hippohome.html
CATO Institute http://www.cato.org/health-welfare-entitlements
http://www.downsizinggovernment.org/hhs
California HealthCare Foundation: www.chcf.org
Insure The Uninsured Project: www.itup.org
Health Access: health-access.org/
Public Policy Institute of CA: www.ppic.org
National Library of Medicine: www.nlm.nih.gov
Virtual reference style manuals:
www.csulb.edu/library/eref/vref/style.html
APA electronic citations: www.apastyle.org/apa-style-help.aspx.
Robert Wood Johnson Foundation: www.rwjf.org
The Urban Institute: www.urban.org; Families USA:
www.familiesusa.org
Center for Health Care Strategies: www.chcs.org
Center for Studying Health System Change: www.hschange.com
National Academy for State Health Policy: www.nashp.org
UCLA Center for Health Policy Research: www.healthpolicy.ucla.edu
California HealthCare Foundation: www.chcf.org
Kaiser Family Foundation: www.kff.org; Rand Corporation:
www.rand.org
Mathematica Policy Research: www.mathematica-mpr.com/
The Commonwealth Fund: www.commonwealthfund.org/HealthReform.aspx
Center for Medicare & Medicaid Services: www.cms.gov
Center on Budget & Policy Priorities: www.cbpp.org
Kaiser Family Foundation: www.kff.org
CA Legislative Analyst's Office: www.lao.ca.gov
Healthcare Financial Management Assn: www.hfma.org
Employee Benefits Research Institute: www.ebri.org
America’s Health Insurance Plans: www.ahip.org
CA Assn. Of Health Plans: www.calhealthplans.com
CA Dept. of Managed Health Care: www.dmhc.ca.gov
CA Office of the Patient Advocate: www.opa.ca.gov/index.aspx
National Governors Association: www.nga.org/
National Association of Insurance Commissioners: www.naic.org/
American Academy of Urgent Care Medicine: www.aaumc.com
National Association for Ambulatory Care:
http://www.urgentcare.org/
Medical Group Management Association: www.mgma.com
American Hospital Assn.: www.aha.org
Blue Cross/Blue Shield Assn.: www.bluecares.com
Kaiser Permanente: www.kaiserpermanente.org/
American Association of Retired Persons: www.aarp.org
Disability Rights Education & Defense Fund: www.dredf.org
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Topic
Mental health
Pharmaceuticals
Public health
Health professionals
Quality of care
Ethical issues
Web Sites
National Institute of Mental Health: www.nimh.nih.gov
Bazelon Center for MH Law: www.bazelon.org
Medline Plus: www.nlm.nih.gov/medlineplus/mentalhealth.html
Pharmaceutical Research & Manufacturers of America:
www.phrma.org
American Society of Health-System Pharmacists: www.ashp.org/
Centers for Disease Control & Prevention: www.cdc.gov
American Public Health Association: www.apha.org
Am. Medical Assn.: www.ama-assn.org; Am. Nurses Assn.
www.ana.org
Am. Academy of Physician Assistants: www.aapa.org
Am. Pharmaceutical Assn.: www.pharmacist.com
Institute of Medicine: www.iom.edu
National Committee for Quality Assurance: www.ncqa.org
Joint Commission (accreditation): www.jointcommission.org
California Healthcare Foundation Quality Initiative: www.chcf.org
Alliance for Health Reform: www.allhealth.org
Hastings Center: www.thehastingscenter.org
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STUDENT INFORMATION SHEET
HCA 202 – Spring 2016
(TURN IN TO INSTRUCTOR)
Name___________________________________________________________
Name you prefer to use____________________________________________
Address_________________________________________________________
________________________________________________________________
Phone(s):________________________________________________________
Best time/place to reach you:_______________________________________
E-mail address:__________________________________________________
Please describe briefly:
a.
Your educational background and work experience:
b.
Future educational and career plans:
c.
Your reasons for taking this course, what you hope to learn from it:
d.
Other HCA classes you are taking or have completed:
Special condition/disability accommodation needs?
Questions or concerns about this class?