Forms to Be Completed with The

Forms to Be Completed with The







March 2013

Recent changes are highlighted

Commission on Accreditation in Physical Therapy Education

American Physical Therapy Association

1111 North Fairfax Street

Alexandria, Virginia22314

(703) 706-3245

DIRECTIONS: Portal Submission

These forms have been developed by the Commission on Accreditation in Physical Therapy Education (CAPTE) to ensure that information is provided in a consistent format across programs. Please do not hesitate to contact staff members in the Department of Accreditation for assistance if needed.

The following forms are included in this document:

Document / Majority of Data Pre-populates from AAR / Document
Uploaded into Portal / Provided to On-site Team
Start of Visit / Include in Paper Version if provided onsite
*General Information Form (2 pages) / Yes / No / Yes / Yes
Core & Associated Faculty Information Sheet / Yes / No / **
CV format / n/a / Yes / Yes
Income & Expense Statements / No / No / Yes
Curriculum List/Course Details / Yes / No / **
Graduation Rate Table / Yes / No / Yes
* Materials Provided On Site / No / Yes / No
* Persons Interviewed / No / Yes / No
Table of Contents / n/a / n/a / Yes

* Also available on the Portal, click Access to Additional Needed Materials above the Self-study Report grid, then click Items Provided On Site found under the On-site Visit Materials section. .

** Downloaded forms from Portal (once all data is entered) will provide data in a different format than used to collect data. If providing a paper version of the self study on site for the team, place the forms downloaded from CAPTE Portal Preview/Print page as an Appendix of the Self-study Report.

GENERAL INSTRUCTIONS: Once data has been entered for a particular ‘form’, click the Validation button on the bottom of the page or under the Self-study Report grid to check for related validation errors. Use the preview/print function, to download the ‘forms only’ document to check data for accuracy.


1.The General Information Form

For Portal report, this form is created from data entered.

For Hard Copy of Self-study Report:

  • place after the Table of Contents

This is one of 3 forms provided to the team at start of visit in BOTH hard copy and as a file on disk. This is required even if there are no changes to the form.

Definitions to be used to determine the type of academic calendar:

Semesters =calendar system with 2 semesters during academic year with about 16 weeks for each semester of instruction; may have additional summer term.

Quarters = calendar system with 3 sessions called quarters of about 12 weeks each. May range from 10-15 weeks; may be additional summer quarter.

Trimesters =calendar system with 3 terms of about 15 weeks each.

The Introduction section of the Evaluative Criteria includes definitions related to faculty; these are to be used in determining faculty classifications regardless of how the individual is classified at your institution. CAPTE is aware that many institutions offer other programs in which the faculty may have responsibilities; please try to allocate the correct full-time equivalency (FTE) to each faculty member as it relates to the professional (entry-level) program. Add additional lines to the table as needed for listing additional faculty.

Calculation of FTE Allocations: For consistency, and because typical academic appointments in PTA programs are 9-9.5 months, we are asking that all programs base calculations on 9 months = 1.0 FTE. The following chart provides examples of how to calculate FTEs as requested.

12 month full-time appointment / 1.33
11 month full-time appointment / 1.22
10 month full-time appointment / 1.11
10 month full-time appointment with routine additional 2-month summer appointment / 1.33
9 to 9.5 month full-time appointment with routine additional 2-month summer appointment / 1.22
9 to 9.5 month full-time appointment / 1.0
Part-time appointment: half time for 12 months / 0.67
Part-time appointment: half-time for 9 months / 0.5
Part-time appointment: half-time for one semester / 0.19

2.*** Persons Interviewed Form: This form identifies the names, credentials, and titles (or areas of responsibility) of those individuals whom the team will interview during the site visit. The team will update the form during the visit to reflect those who were actually interviewed, as well as identifying those who attended the Exit Summary.

3. *** Materials Provided On Site: This form identifies the materials available on site for the team to review. The items listed are those items requested in the Evidence of Compliance listings in the Evaluative Criteria and must be available for on-site review unless the item does not exist, in which case, the form should indicate that the item does not exist. The program should add any additional materials being made available for review on-site to the form.

*** These three forms (General Information, Persons Interviewed, and Materials Provided On Site) must be provided to the team at the very beginning of the on-site visit in both hard copy and electronic copy. The electronic copy should have all three forms as one document - you can access these three forms as one document on the Portal. The Team Leader will submit these forms; they become part of the final Visit Report.

4.Income and Expense Statements: This form is divided into Income (Allocation)and Operating Expenses sections. The three columns represent the same information for the:

  • previous academic year,
  • academic year of the on-site visit; and
  • what is budgeted (will be proposed) for next academic year.

Income refers to the amount allocated to the program each year; it does NOT refer to the total income to the institution that is generated by the program. Generally the amount of money allocated to the program covers all program expenses. The amount entered in the income section on the Portal should never total zero ($00.00).

If the income (Allocation)and operating expenses provided are for multiple programs, provide an explanation in the Narrative regarding the resources available for each program. The Commission is aware that institutions have various ways to present budget materials; however, the Commission requests that a uniform format be used so that a better understanding of the resources available for the program will be achieved.

5.Curriculum Vitae (CV): The required CV format is included in this Forms Packet. This format MUST be used by each core faculty. In addition, use this format for each associated faculty member who teaches 50% or more of the contact hours of a course. On the Portal it is uploaded on the Faculty Detail page for each faculty member. If the program is providing the team with a paper version of the Self-study Report on site, the CVs are placed in the Appendices with a separate tab for each faculty member.

A consistent format must be used for all CVs provided. It is acceptable to change the format; however all CVs must follow the same format. For example, providing information from the earliest to the most recent instead of the requested most recent to earliest (i.e., scholarship, employment) is acceptable. The last section must include current teaching responsibilities.

For TBD faculty: If you had to create a dummy faculty member (TBD Core or TBD Associated) in order to identify a primary faculty member in the Course Details page for a course in which the faculty are to be determined, attach a blank document named: Do Not Bother To Open.pdf.

6.Course List/Course Details: see instructions below. Additionally, the Course Outcomes and Objectives Form (COOF)previously required with the submission of a Self study Report has been eliminated. Use the Curriculum Summary Form to document the data for entry into the fields of the Self study report on the portal. See page 22 of this packet for the requested and preferred documentation of course content and related objectives.

7.Table of Contents is ONLY required IF you are providing a hard copy of the Self-study Report on site for the team. Insert the page number corresponding to the item being addressed; this includes the page number for each appendix listed! Place this form at the beginning of each notebook.

Required materials (Exhibits or Appendices) are already listed. Additional items included in the Appendices must be added to the Table of Contents, identifying the page or appendix where each item can be located. Whenever multiple documents are provided within one Appendix, each document must be listed with the corresponding page where it can be found.

Note: For a paper version of the Self-study Report, tabs are required for each heading listed in the Table of Contents, as well as each CV and each course (for syllabi and exams).

8.Graduation Rate Table: Three years of data must be provided; the Portal will identify the graduation cohorts that are requested for the Portal fields based on the years that all programs can complete given the definition for graduation rate. Data for more current graduating cohorts should be provided in the Narrative response to 2.1.A Graduation Rate Table is provided for the collection of data. The formula within this table must be used to determine the graduation rate; this formula is based on the government’s IPED definition of graduation rate. This rate is always determined based on the number of students who originally matriculated in the first course of the program (2+2 programs) or the technical phase program (1+1 programs).

The Portal now requires data to be provided for each cohort separately. CAPTE defines a cohort of students as a group of students who matriculate into the professional/technical courses at the same time with the expectation that they will also complete the program at the same time.

If there are no graduates for a year requested in the Portal, the response to Portal question #1.1 should be set to ‘No’.

9.Assessment Documentation Grid: The grid is still a required appendix to accompany and support the program response for criteria 4.1.1 through 4.1.12. and must be uploaded and attached in the portal. The Grid is not a stand- alone document as the narrative requires explanations about identified measures and rationales for the thresholds established for measuring programmatic effectiveness.

10.Core and Associated Faculty Information Sheet:The majority of this data will pre-populate from the AAR. Revise data as needed to reflect changes since the submission of the last AAR.

Additional notes regarding faculty information:

If faculty for a course is unknown: You will need to create a dummy/to be determined faculty member named: TBD Core or TBD Associated. You will be required to provide all the data; therefore, enter zero (0) or the most appropriate response. This is necessary because all courses must have at least one primary faculty assigned to it.

11. Workload Distribution Form: It is imperative that there be consistency in calculations across all core faculty workloads when determine % of workload. CAPTE does not have a formula for calculations, but expects programs to use a consistent format. Percentages should be provided based on workload at your institution. If not part of workload, do not include. For example, if a core faculty member has time allotted for clinical practice, then include. But if the institution does not consider this activity as part of the individual’s workload, do not include. The total time will auto calculate on the Portal and must equal100% or a validation error will show on the Validation Page.

*The forms included in this packet should be used only to gather the requisite information for entry on the CAPTE Accreditation Portal. The only form (in addition to any other documentation required in the evidence lists) that will be uploaded to the CAPTE Accreditation Portal is the Assessment Process Documentation Grid. The Faculty Workload Distribution, Curriculum Summary, and Program Expenses and Income formsare now each part of the first section of the self-study report and are not appended as supporting documentation that was previously required in hard copy submissions.


(2 pages)

Institution name
Name of Chief Executive Officer
Administrative title
Institutional accrediting agency
Current accreditation status
Date granted
Unit or school in which the program resides
Name of administrative official of the unit or school in which the program resides
Administrative title
Name of Program Director/ Administrator
Administrative title
Title of program
Year program graduated first class
Program accreditation status
Date status was originally granted
Date of last on-site visit
Degree awarded
Identify type of term:
e.g., Semesters, Quarters / # of terms in academic year / Total # of terms to complete degree
Length of professional/technical coursework in weeks (including exam week and count exam week as one week)
Total hours of clinical education / # of weeks of full time clinical education
Number of core faculty / PT full-time core / Non-PT full-time core
PT part-time core / Non-PT part-time core
Number of vacancies in currently approved (or) funded core faculty positions / Full-time
Part-time FTEs
PTA: Number of adjunct and supporting faculty
PT: Number of associated faculty
List the names and credentials of core and associated/adjunct faculty members who currently teach in the program. Identify the F.T.E. for each person. 12 months = 1.0 FTE (See instructions below regarding calculation of F.T.E. allocations.) (insert rows as needed)
NAME / F.T.E. / NAME / F.T.E.
For PT: List ASSOCIATED FACULTY (responsible for 50% or more of a course)
For PTA: List all Adjunct & Supporting Faculty
NAME / F.T.E. / NAME / F.T.E.
Number of students in the professional/technical program
Freshmen / Grad 1
Sophomore / Grad 2
Junior / Grad 3
Senior / Grad 4
(Provide data for the program, regardless of the degree conferred)
For the most recent cohort / For the most recent three cohorts
Data being reported for / Class of: / Classes of:
Graduation rate (150% of normally expected time to complete program) / Graduation rate / % / Graduation rate / %
Performance on Licensure Exam
(regardless of degree offered) / Number of graduates who took the examination at least once / Total number of graduates who took the examination at least once
Number of graduates who passed the exam after all attempts / Total number of graduates who passed the exam after all attempts
Pass rate based on above numbers / % / Pass rate based on above numbers / %
Employment rate (see definitions) / Employment rate / % / Employment rate / %


The program is to list the names and titles, or areas of responsibility, of those individuals with whom the team meets during the on-site visit. Please PLACE AN ASTERISK (*) beside the name of each person who attends the Exit Summary on the last day of the on-site visit.

Name of Institution:

Administrative Officers:

Program Administrator (Director, Chair etc.):

Core Faculty:

Adjunct Faculty:

General Education/Supportive Faculty:

Clinical Education Faculty (CCCEs and CIs):

Students enrolled in an early phase of the program (e.g., 1st year in program):

Students enrolled in a late phase of the program (e.g., last year in program):

Recent graduates of the program:

Employers of graduates of the program:


This form should be used to document the materials that substantiate compliance with the Evaluative Criteria that were not included in the Self-study Report. Additional rows may be added to the form if the program includes materials not on this form.

The Materials Provided On Site Form should be provided in both hard copy and on disk to the Team Leader at the beginning of the on-site visit.

Name of Institution:
Document / Provided by program / Reviewed by on-site team
Verification of authority for institution to operate as an institution of higher education (e.g., copy of letter from agency granting authority)
Verification that the institution has authority to offer the physical therapist assistant program and to award degree (e.g., copy of letter from agency granting authority)
If institution is in a collaborative arrangement with another institution to award degree, provide verification of collaborative arrangement and of the institution’s authority to award degree
Verification of institutional accreditation status (e.g., most recent letter from institutional accreditor that reaffirmed accreditation status)
Documentation that contains verification of the degree awarded to graduates of the PTA program (e.g., college catalog, program student handbook, printed copy of page from college or program website)
Documentation of institutional or program policies and procedures for:
 nondiscrimination
 privacy and confidentiality of those associated with the program
 informed consent for those associated with the program
 due process for students and faculty
 complaints that fall outside of due process
 safety of persons involved in on-campus educational experiences
 safety of persons involved in off-campus educational experiences
 ensuring student competence prior to the clinical assignment
 compliance with accreditation requirements
 ongoing development activities for the academic faculty
 ongoing development activities for the clinical education faculty
 student retention and progression through the program
Copies of recent complaints received
Current (unexpired) written agreements for all active clinical sites
Documentation that the written agreements for all active clinical sites have been reviewed (e.g., documentation from assessment process, minutes from meetings where the written agreement was reviewed)
Documentation that the program faculty have opportunities to participate in governance and planning of the program and institution (e.g., faculty handbook, faculty contract)
Documentation that the program faculty have participated in governance and planning of the program and institution (e.g., lists of institution committee membership, applicable meeting minutes)
Documents that contain the mission and philosophy statements of the institution and the program
Documents that contain the program goals and objectives
Documentation of institutional approval for program policies and procedures listed in the Narrative that differ from those of the institution
Documentation related to communication by the program with individuals and departments involved with the program
Documentation related to communication by the program with individuals involved with the clinical education portion of the curriculum (e.g., copies of letters from the program to clinical sites, clinical education handbook, course syllabi for clinical education courses)
Documentation that contains the rights and privileges of academic faculty
Documentation that contains the rights and privileges of clinical education faculty
Documentation that contains the admission process and the admissions criteria
Documentation that contains the following information available to prospective and enrolled students:
accreditation status of the institution and the program
 acceptance and matriculation rates
 graduation rates (including Graduation Rate Table required in 2.1. and related data)
 career opportunities
 employment rates
 pass rates of program graduates on licensing examinations
 costs of the program (including tuition, fees and refund policies)
 travel expectations to clinical sites
 financial aid
 health services
 health and professional liability insurance requirements
 grading policies
 progression through the program
 withdrawal and dismissal procedures
due process
 other academic policies and procedures
 clinical sites
 clinical education policies and procedures
 access to and responsibility for the cost of emergency services in off-campus educational experiences
Documentation that addresses how the faculty workload and need for faculty for the program are determined
Summary of data collected about the qualifications of the clinical faculty (e.g., years of experience, specialist certification, or other characteristics expected by the program) for the clinical education faculty in the active clinical education sites
Documentation that contains information about student access to financial aid
Documentation that contains information about student access to counseling and testing services
Examples of the mechanisms used by the program to provide students with formative and summative evaluations of their academic and clinical performance and progress.
Copy of agreement for use of off-campus facilities (if off-campus facilities are used for scheduled laboratories)
Copy of agreement for use of equipment and supplies provided by vendors or by facilities other than the institution if loaned equipment is used by the program, including proof that the agreement ensures uninterrupted use of the equipment and supplies, ensures equipment and supplies are properly maintained, and ensures equipment and supplies are available and accessible for student practice and remediation
Provide evidence of implementation of the curriculum development, review and revision process that includes, but is not limited to, meeting minutes and completed curriculum assessment tools, such as those used in 4.1.6
Documentation that contains the curriculum plan
Documentation that contains the curriculum for the PTA program
Documentation that contains the statements of expected students outcomes
Provide additional course materials that contain instructional objectives not contained in syllabi
Provide examples of student work that reflect the different types of instructional methodology and the different learning experiences used in the curriculum to facilitate students’ achievement of the objectives
Provide all tests, skills checks forms, practical exam forms, clinical evaluation forms, and other mechanisms used by the program to measure students’ achievement of objectives
Documentation that contains the list of skills in which students must be determined to be competent and safe
Provide evidence of data collected and analyzed to identify program strengths and weaknesses and to determine necessary program changes
Provide evidence that the program has implemented changes based on the results of the evaluation process and that the effectiveness of these changes has been assessed