NWCCU REPORTS | BASIC INSTITUTIONAL DATA FORM
I
nformation and data provided in the institutional self-evaluation are usually for the academic and fiscal year preceding the year of the evaluation
committee visit. The purpose of this form is to provide Commissioners and evaluators with current data for the year of the visit. After the self-
evaluation report has been finalized, complete this form to ensure the information is current for the time of the evaluation committee visit. Please
provide a completed copy of this form with each copy of the self-evaluation report sent to the Commission office and to each evaluator. This form
should be inserted into the appendix of the self-evaluation report (see the guidelines).
Institutional Information
Name of Institution:
Mailing Address:
Address 2:
City:
State/Province:
Zip/Postal Code:
Main Phone Number:
Country:
Chief Executive Officer
Title (Dr., Mr., Ms., etc.):
First Name:
Last Name:
Position (President, etc.):
Phone:
Fax:
Email:
Accreditation Liaison Officer
Title (Dr., Mr., Ms., etc.):
First Name:
Last Name:
Position (President, etc.):
Phone:
Fax:
Email:
Chief Financial Officer
Title (Dr., Mr., Ms., etc.):
First Name:
Last Name:
Position (President, etc.):
Phone:
Fax:
Email:
Institutional Demographics
I
nstitutional Type
(Choose all that apply)
Comprehensive
Specialized
Health-Centered
Religious-Based
Native/Tribal
Other (specify):
D
egree Levels
(Choose all that apply)
Associate
Baccalaureate
Master
Doctorate
If part of a multi-institution system,
name of system:
C
alendar Plan
(Choose one that applies)
Semester
Quarter
4-1-4
Trimester
Other (specify):
Institutional Control (Choose all t
hat apply)
City County State Federal Tribal
Public OR Private/Independent
Non-Profit OR For-Profit
Students (all locations)
Full-Time Equivalent (FTE) Enrollment (Formula used to compute FTE: IPEDS)
Official Fall: (most recent year) FTE Student Enrollments
Classification Current Year: _____________ One Year Prior: _____________ Two Years Prior: _____________
Undergraduate
Graduate
Professional
Unclassified
Total all levels
F
ull-Time Unduplicated Headcount Enrollment. (Count students enrolled in credit courses only.)
Official Fall: (most recent year) Student Headcount Enrollments
Classification Current Year: _____________ One Year Prior: _____________ Two Years Prior: _____________
Undergraduate
Graduate
Professional
Unclassified
Total all levels
Faculty (all locations)
Numbers of Full-Time and Part-Time Instructional and Research Faculty & Staff
Numbers of Full-Time (only) Instructional and Research Faculty & Staff by Highest Degree Earned
Include only professional personnel who are primarily assigned to instruction or research.
Total Number: Number of Full-Time (only) Faculty and Staff by Highest Degree Earned
Rank
Full-Time
Part-Time
Less than
Associate
Associate
Bachelor
Masters
Specialist
Professor
Associate Professor
Assistant Professor
Instructor
Lecturer and Teaching
Assistant
Research Staff and Research
Assistant
Undesignated Rank
Faculty (all locations)
Mean Salaries and Mean Years of Service of Full-Time Instructional and Research Faculty and Staff. Include only full-time personnel with professional status who
are primarily assigned to instruction or research.
Rank
Mean Salary
Mean Years of Service
Professor
Associate Professor
Assistant Professor
Instructor
Lecturer and Teaching Assistant
Research Staff and Research Assistant
Undesignated Rank
Institutional Finances
Financial Information. Please provide the requested information for each of the most recent completed fiscal year and the two prior completed fiscal years (three years total).
Please attach the following as separate documents submitted with the Basic Institutional Data Form
Statement of Cash Flows
Balance Sheet collapsed to show main accounts only; no details
Operating Budget
Capital Budget
Projections of Non-Tuition Revenue
New Degree / Certificate Programs
Subst
antive Changes
Substantive changes including degree or certificate programs planned for - (YYYY-YYYY) approved by the institution’s governing body. If NONE, so
indicate. (Add additional pages if necessary. Please feel free to use the hyperlinked Excel spreadsheet to supplement the Basic Information Data Form and submit them together.)
* This listing does not substitute for a formal substantive change submission to NWCCU
Substantive Change
Certificate/Degree Level
Program Name
Discipline or Program Area
Domestic Off-Campus Degree Programs and Academic Credit Sites
Report information for off-campus sites within the United States where degree programs and academic credit coursework is offered.
(Add additional pages if necessary. Please feel free to use the hyperlinked Excel spreadsheet to supplement the Basic Information Data Form and submit them together.)
Degree Programslist the names of degree programs that can be completed at the site.
Academic Credit Courses report the total number of academic credit courses offered at the site.
Student Headcountreport the total number (unduplicated headcount) of students currently enrolled in programs at the site.
Faculty Headcountreport the total number (unduplicated headcount) of faculty (full-time and part-time) teaching at the site.
Programs and Academic Credit Offered at Off-Campus Sites within the United States
Name of Site
Physical Address
City, State/Province,
Zip/Postal Code
Degree Programs
Academic
Credit Courses
Student
Headcount
Faculty
Headcount
Distance Education
Degree and Certificate Programs of 30 semester or 45 quarter credits or more where at least 50% or more of the curriculum is offered by Distance Education,
including ITV, online, and competency-based education. Adjust entries to category listings below as appropriate.
(Add additional pages if necessary. Please feel free to use the hyperlinked Excel spreadsheet to supplement the Basic Information Data Form and submit them together.)
* This listing does not substitute for a formal substantive change submission to NWCCU
Name of Site
Physical Address
Degree/Certificate
Name/Level
Program Name
Student
Enrollment
(Unduplicated
Headcount)
On-Site
Staff
(Yes or
No)
Co-Sponsoring
Organization (if
applicable)
Programs and Academic Courses Offered at Sites Outside the United States
Report information for sites outside the United States where degree programs and academic credit coursework is offered, including study abroad programs and
educational operations on military bases.
(Add additional pages if necessary. Please feel free to use the hyperlinked Excel spreadsheet to supplement the Basic Information Data Form and submit them together.)
Degree Programslist the names of degree programs that can be completed at the site.
Academic Credit Courses report the total number of academic credit courses offered at the site.
Student Headcountreport the total number (unduplicated headcount) of students currently enrolled in programs at the site.
Faculty Headcountreport the total number (unduplicated headcount) of faculty (full-time and part-time) teaching at the site.
Pr
ograms and Academic Credit Offered at Sites outside the United States
Name of Site
Physical Address
City, State/Province,
Zip/Postal Code
Degree Programs
Academic
Credit Courses
Student
Headcount
Faculty
Headcount
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