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CPR Web Form Example

This is a non-functional preview of the CPR Report Form with sample entries. All fields will require an entry except #12 and #16. See also the examples.

CPR Report Form (part 1)
1	Your Name:
2	Title:
3	Daytime Phone:
4	Email:
5	Institution:	Institution name will be pre-populated
6	Review Status:	Non-triggered review Triggered review
7	Degree level:	– select one – Core Curriculum Career Associate (AAS) Transfer Associate (AA or AS) Bachelors Masters Education Specialist Doctorate Other [ examples ]
8	Degree acronym:	[ Degrees & Majors ]
9	Degree & Major:	[ DMA ]
10	CIP Code:	(8 digits) [ DMA ]
11	Name of College, School/Division:	(e.g., College of Agriculture, School of Nursing, etc.)
12	Department:	(if applicable)
13	Was CPR Plan followed?:	(Have you followed the process outlined in your institutional CPR Plan which is on file in the System Office for review of this program?) Yes    No
14	Future institutional plans for this program: (select all that apply)	Expand and enhance Maintain at present level Reduce in scope Discontinue Other (clarify in supplemental document)

CPR Report Form (part 2)   (fields 15 & 16 will appear on a separate web page)
15	Attach your supplemental document with this report. (Format: Word, PDF, Rich Text, ZIP, or WordPerfect)     NOTE: File name must have an appropriate extension (e.g., .doc .pdf .zip .rtf .wpd)
16	Web Address for more detailed information. (if applicable, enter complete URL)

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