LSAMP Crosswalk

Appendix B:

Crosswalk of LSAMP Survey Data Elements

DATA ELEMENTS OF THE LOUIS STOKES ALLIANCES FOR MINORITY PARTICIPATION ONLINE DATA COLLECTION EFFORT

Common Collection Categories Question	Staff and Project Participant Characteristics 1	Project Implementation Characteristics2	Project Outputs 3
Respondent Contact Information : Name: First, Last Phone Email	X
1. Student Enrollment
Count of Chemistry student enrollment (report Freshmen, Sophomores, Juniors, Seniors, and unknown class students separately, and part-time and full-time students separately) by: Race Black or African American Native American Alaska Native Native Hawaiian or Other Pacific Islander Asian White More Than One Race Reported: Students reporting a) two or more race categories and b) one or more of the reported categories include: Native American, Alaska Native, Black or African American, Native Hawaiian or Other Pacific Islander. More Than One Race Reported: Students reporting a) both White and Asian, and b) no other categories in addition to White and Asian. Race Not Reported or Unknown Ethnicity Hispanic or Latino Not Hispanic or Latino Not Reported Gender Male Female Not Reported			X
Count of Physics/Astronomy student enrollment (report Freshmen, Sophomores, Juniors, Seniors, and unknown class students separately, and part-time and full-time students separately) by: Race Black or African American Native American Alaska Native Native Hawaiian or Other Pacific Islander Asian White More Than One Race Reported: Students reporting a) two or more race categories and b) one or more of the reported categories include: Native American, Alaska Native, Black or African American, Native Hawaiian or Other Pacific Islander. More Than One Race Reported: Students reporting a) both White and Asian, and b) no other categories in addition to White and Asian. Race Not Reported or Unknown Ethnicity Hispanic or Latino Not Hispanic or Latino Not Reported Gender Male Female Not Reported			X
Count of Mathematics student enrollment (report Freshmen, Sophomores, Juniors, Seniors, and unknown class students separately, and part-time and full-time students separately) by: Race Black or African American Native American Alaska Native Native Hawaiian or Other Pacific Islander Asian White More Than One Race Reported: Students reporting a) two or more race categories and b) one or more of the reported categories include: Native American, Alaska Native, Black or African American, Native Hawaiian or Other Pacific Islander. More Than One Race Reported: Students reporting a) both White and Asian, and b) no other categories in addition to White and Asian. Race Not Reported or Unknown Ethnicity Hispanic or Latino Not Hispanic or Latino Not Reported Gender Male Female Not Reported			X
Count of Computer science student enrollment (report Freshmen, Sophomores, Juniors, Seniors, and unknown class students separately, and part-time and full-time students separately) by: Race Black or African American Native American Alaska Native Native Hawaiian or Other Pacific Islander Asian White More Than One Race Reported: Students reporting a) two or more race categories and b) one or more of the reported categories include: Native American, Alaska Native, Black or African American, Native Hawaiian or Other Pacific Islander. More Than One Race Reported: Students reporting a) both White and Asian, and b) no other categories in addition to White and Asian. Race Not Reported or Unknown Ethnicity Hispanic or Latino Not Hispanic or Latino Not Reported Gender Male Female Not Reported			X
Count of Geosciences student enrollment (report Freshmen, Sophomores, Juniors, Seniors, and unknown class students separately, and part-time and full-time students separately) by: Race Black or African American Native American Alaska Native Native Hawaiian or Other Pacific Islander Asian White More Than One Race Reported: Students reporting a) two or more race categories and b) one or more of the reported categories include: Native American, Alaska Native, Black or African American, Native Hawaiian or Other Pacific Islander. More Than One Race Reported: Students reporting a) both White and Asian, and b) no other categories in addition to White and Asian. Race Not Reported or Unknown Ethnicity Hispanic or Latino Not Hispanic or Latino Not Reported Gender Male Female Not Reported			X
Count of Engineering student enrollment (report Freshmen, Sophomores, Juniors, Seniors, and unknown class students separately, and part-time and full-time students separately) by: Race Black or African American Native American Alaska Native Native Hawaiian or Other Pacific Islander Asian White More Than One Race Reported: Students reporting a) two or more race categories and b) one or more of the reported categories include: Native American, Alaska Native, Black or African American, Native Hawaiian or Other Pacific Islander. More Than One Race Reported: Students reporting a) both White and Asian, and b) no other categories in addition to White and Asian. Race Not Reported or Unknown Ethnicity Hispanic or Latino Not Hispanic or Latino Not Reported Gender Male Female Not Reported			X
Count of Life/Biological Sciences student enrollment (report Freshmen, Sophomores, Juniors, Seniors, and unknown class students separately, and part-time and full-time students separately) by: Race Black or African American Native American Alaska Native Native Hawaiian or Other Pacific Islander Asian White More Than One Race Reported: Students reporting a) two or more race categories and b) one or more of the reported categories include: Native American, Alaska Native, Black or African American, Native Hawaiian or Other Pacific Islander. More Than One Race Reported: Students reporting a) both White and Asian, and b) no other categories in addition to White and Asian. Race Not Reported or Unknown Ethnicity Hispanic or Latino Not Hispanic or Latino Not Reported Gender Male Female Not Reported			X
Count of Agricultural Sciences student enrollment (report Freshmen, Sophomores, Juniors, Seniors, and unknown class students separately, and part-time and full-time students separately) by: Race Black or African American Native American Alaska Native Native Hawaiian or Other Pacific Islander Asian White More Than One Race Reported: Students reporting a) two or more race categories and b) one or more of the reported categories include: Native American, Alaska Native, Black or African American, Native Hawaiian or Other Pacific Islander. More Than One Race Reported: Students reporting a) both White and Asian, and b) no other categories in addition to White and Asian. Race Not Reported or Unknown Ethnicity Hispanic or Latino Not Hispanic or Latino Not Reported Gender Male Female Not Reported			X
Count of Environmental Sciences student enrollment (report Freshmen, Sophomores, Juniors, Seniors, and unknown class students separately, and part-time and full-time students separately) by: Race Black or African American Native American Alaska Native Native Hawaiian or Other Pacific Islander Asian White More Than One Race Reported: Students reporting a) two or more race categories and b) one or more of the reported categories include: Native American, Alaska Native, Black or African American, Native Hawaiian or Other Pacific Islander. More Than One Race Reported: Students reporting a) both White and Asian, and b) no other categories in addition to White and Asian. Race Not Reported or Unknown Ethnicity Hispanic or Latino Not Hispanic or Latino Not Reported Gender Male Female Not Reported			X
Count of Non-SMET student enrollment (report Freshmen, Sophomores, Juniors, Seniors, and unknown class students separately, and part-time and full-time students separately) by: Race Black or African American Native American Alaska Native Native Hawaiian or Other Pacific Islander Asian White More Than One Race Reported: Students reporting a) two or more race categories and b) one or more of the reported categories include: Native American, Alaska Native, Black or African American, Native Hawaiian or Other Pacific Islander. More Than One Race Reported: Students reporting a) both White and Asian, and b) no other categories in addition to White and Asian. Race Not Reported or Unknown Ethnicity Hispanic or Latino Not Hispanic or Latino Not Reported Gender Male Female Not ReportedNot Reported			X
2. Degree Awards
Count of Chemistry degrees (report Bachelor’s, Master’s, and Doctoral degrees separately) by: Race Black or African American Native American Alaska Native Native Hawaiian or Other Pacific Islander Asian White More Than One Race Reported: Students reporting a) two or more race categories and b) one or more of the reported categories include: Native American, Alaska Native, Black or African American, Native Hawaiian or Other Pacific Islander. More Than One Race Reported: Students reporting a) both White and Asian, and b) no other categories in addition to White and Asian. Race Not Reported or Unknown Ethnicity Hispanic or Latino Not Hispanic or Latino Not Reported Gender Male Female Not Reported			X
Count of Physics/Astro degrees (report Bachelor’s, Master’s, and Doctoral degrees separately) by: Race Black or African American Native American Alaska Native Native Hawaiian or Other Pacific Islander Asian White More Than One Race Reported: Students reporting a) two or more race categories and b) one or more of the reported categories include: Native American, Alaska Native, Black or African American, Native Hawaiian or Other Pacific Islander. More Than One Race Reported: Students reporting a) both White and Asian, and b) no other categories in addition to White and Asian. Race Not Reported or Unknown Ethnicity Hispanic or Latino Not Hispanic or Latino Not Reported Gender Male Female Not Reported			X
Count of Mathematics degrees (report Bachelor’s, Master’s, and Doctoral degrees separately) by: Race Black or African American Native American Alaska Native Native Hawaiian or Other Pacific Islander Asian White More Than One Race Reported: Students reporting a) two or more race categories and b) one or more of the reported categories include: Native American, Alaska Native, Black or African American, Native Hawaiian or Other Pacific Islander. More Than One Race Reported: Students reporting a) both White and Asian, and b) no other categories in addition to White and Asian. Race Not Reported or Unknown Ethnicity Hispanic or Latino Not Hispanic or Latino Not Reported Gender Male Female Not Reported			X
Count of Computer science degrees (report Bachelor’s, Master’s, and Doctoral degrees separately) by: Race Black or African American Native American Alaska Native Native Hawaiian or Other Pacific Islander Asian White More Than One Race Reported: Students reporting a) two or more race categories and b) one or more of the reported categories include: Native American, Alaska Native, Black or African American, Native Hawaiian or Other Pacific Islander. More Than One Race Reported: Students reporting a) both White and Asian, and b) no other categories in addition to White and Asian. Race Not Reported or Unknown Ethnicity Hispanic or Latino Not Hispanic or Latino Not Reported Gender Male Female Not Reported			X
Count of Geosciences degrees (report Bachelor’s, Master’s, and Doctoral degrees separately) by: Race Black or African American Native American Alaska Native Native Hawaiian or Other Pacific Islander Asian White More Than One Race Reported: Students reporting a) two or more race categories and b) one or more of the reported categories include: Native American, Alaska Native, Black or African American, Native Hawaiian or Other Pacific Islander. More Than One Race Reported: Students reporting a) both White and Asian, and b) no other categories in addition to White and Asian. Race Not Reported or Unknown Ethnicity Hispanic or Latino Not Hispanic or Latino Not Reported Gender Male Female Not Reported			X
Count of Engineering degrees (report Bachelor’s, Master’s, and Doctoral degrees separately) by: Race Black or African American Native American Alaska Native Native Hawaiian or Other Pacific Islander Asian White More Than One Race Reported: Students reporting a) two or more race categories and b) one or more of the reported categories include: Native American, Alaska Native, Black or African American, Native Hawaiian or Other Pacific Islander. More Than One Race Reported: Students reporting a) both White and Asian, and b) no other categories in addition to White and Asian. Race Not Reported or Unknown Ethnicity Hispanic or Latino Not Hispanic or Latino Not Reported Gender Male Female Not Reported			X
Count of Life/Biological Sciences degrees (report Bachelor’s, Master’s, and Doctoral degrees separately) by: Race Black or African American Native American Alaska Native Native Hawaiian or Other Pacific Islander Asian White More Than One Race Reported: Students reporting a) two or more race categories and b) one or more of the reported categories include: Native American, Alaska Native, Black or African American, Native Hawaiian or Other Pacific Islander. More Than One Race Reported: Students reporting a) both White and Asian, and b) no other categories in addition to White and Asian. Race Not Reported or Unknown Ethnicity Hispanic or Latino Not Hispanic or Latino Not Reported Gender Male Female Not Reported			X
Count of Agricultural Sciences degrees (report Bachelor’s, Master’s, and Doctoral degrees separately) by: Race Black or African American Native American Alaska Native Native Hawaiian or Other Pacific Islander Asian White More Than One Race Reported: Students reporting a) two or more race categories and b) one or more of the reported categories include: Native American, Alaska Native, Black or African American, Native Hawaiian or Other Pacific Islander. More Than One Race Reported: Students reporting a) both White and Asian, and b) no other categories in addition to White and Asian. Race Not Reported or Unknown Ethnicity Hispanic or Latino Not Hispanic or Latino Not Reported Gender Male Female Not Reported			X
Count of Environmental Sciences degrees (report Bachelor’s, Master’s, and Doctoral degrees separately) by: Race Black or African American Native American Alaska Native Native Hawaiian or Other Pacific Islander Asian White More Than One Race Reported: Students reporting a) two or more race categories and b) one or more of the reported categories include: Native American, Alaska Native, Black or African American, Native Hawaiian or Other Pacific Islander. More Than One Race Reported: Students reporting a) both White and Asian, and b) no other categories in addition to White and Asian. Race Not Reported or Unknown Ethnicity Hispanic or Latino Not Hispanic or Latino Not Reported Gender Male Female Not Reported			X
Count of Non-SMET degrees (report Bachelor’s, Master’s, and Doctoral degrees separately) by: Race Black or African American Native American Alaska Native Native Hawaiian or Other Pacific Islander Asian White More Than One Race Reported: Students reporting a) two or more race categories and b) one or more of the reported categories include: Native American, Alaska Native, Black or African American, Native Hawaiian or Other Pacific Islander. More Than One Race Reported: Students reporting a) both White and Asian, and b) no other categories in addition to White and Asian. Race Not Reported or Unknown Ethnicity Hispanic or Latino Not Hispanic or Latino Not Reported Gender Male Female Not Reported			X
3. Activity Data (Complete an activity information screen for each activity conducting during reporting period.)
Activity Title			X
Target Student Faculty Student and Faculty Other			X
Time Period Academic Year Only Summer Year Only Calendar Year			X
Coordinators (choose up to three)			X
Category Teaching Research Service			X
Subcategory Curriculum Reform Faculty Enrichment Other Curriculum Reform Faculty Enrichment Assistantships Research Pedagogy Courses Research Seminars Special Techniques Training Mentoring Recruitment Environmental Improvement Peer-Group Learning Academic Counseling Special Acad Supp			X
Field All Clubs Courses Faculty Field Trips Industry Material Development Mod of Degree Requirements Off-Site On-Site Other Peer Recruiters Seminars Short-Courses Social Events Tutoring Visiting Appointments Workshops			X
Activity Description (text box)			X
Activity Goals and Objectives (text box)			X
Activity Outcome (text box)			X
Count of students participating in each activity by: Race Black or African American Native American Alaska Native Native Hawaiian or Other Pacific Islander Asian White More Than One Race Reported: Students reporting a) two or more race categories and b) one or more of the reported categories include: Native American, Alaska Native, Black or African American, Native Hawaiian or Other Pacific Islander. More Than One Race Reported: Students reporting a) both White and Asian, and b) no other categories in addition to White and Asian. Race Not Reported or Unknown Ethnicity Hispanic or Latino Not Hispanic or Latino Not Reported Gender Male Female Not Reported			X
Count of faculty and Graduate Students participating in each activity by: Race Black or African American Native American Alaska Native Native Hawaiian or Other Pacific Islander Asian White More Than One Race Reported: Students reporting a) two or more race categories and b) one or more of the reported categories include: Native American, Alaska Native, Black or African American, Native Hawaiian or Other Pacific Islander. More Than One Race Reported: Students reporting a) both White and Asian, and b) no other categories in addition to White and Asian. Race Not Reported or Unknown Ethnicity Hispanic or Latino Not Hispanic or Latino Not Reported Gender Male Female Not Reported			X
4. Individual Data
Student Participants (complete a screen for each student)
Name: Last, First, Middle Initial	X
Social Security Number	X
Gender Male Female Not Reported	X
Ethnicity Hispanic or Latino Not Hispanic or Latino Not Reported	X
Race (Choose one or more responses): Native American Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Not Reported	X
Disability Status (Choose one or more responses): Hearing Impairment Visual Impairment Mobility/Orthopedic Impairment Other None Not Reported	X
Discipline (choose 1 from list)	X
Class (choose 1 from list)	X
GPA (data box)	X
Graduated this Year? Yes/No	X
Mentor (choose 1 from list)	X
Academic Year Financial Support? Yes/No		X
Summer Financial Support? Yes/No		X
Activities in which the individual participated (select all that apply from list generated in section 3)		X
Partner activities in which the individual participated (select all that apply from list generated in section 3)		X
Faculty Participants
Name: Last, First, Middle Initial	X
Social Security Number	X
Gender Male Female Not Reported	X
Ethnicity Hispanic or Latino Not Hispanic or Latino Not Reported	X
Race (Choose one or more responses): Native American Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Not Reported	X
Disability Status (Choose one or more responses): Hearing Impairment Visual Impairment Mobility/Orthopedic Impairment Other None Not Reported	X
Discipline (select 1 from list)	X
Faculty Rank (select 1 from list)	X
5. Students Entering Graduate School Information
Count of students who received Direct Support by: Race Black or African American Native American Alaska Native Native Hawaiian or Other Pacific Islander Asian White More Than One Race Reported: Students reporting a) two or more race categories and b) one or more of the reported categories include: Native American, Alaska Native, Black or African American, Native Hawaiian or Other Pacific Islander. More Than One Race Reported: Students reporting a) both White and Asian, and b) no other categories in addition to White and Asian. Race Not Reported or Unknown Ethnicity Hispanic or Latino Not Hispanic or Latino Not Reported Gender Male Female Not Reported			X
Count of students who did not receive direct support by: Race Black or African American Native American Alaska Native Native Hawaiian or Other Pacific Islander Asian White More Than One Race Reported: Students reporting a) two or more race categories and b) one or more of the reported categories include: Native American, Alaska Native, Black or African American, Native Hawaiian or Other Pacific Islander. More Than One Race Reported: Students reporting a) both White and Asian, and b) no other categories in addition to White and Asian. Race Not Reported or Unknown Ethnicity Hispanic or Latino Not Hispanic or Latino Not Reported Gender Male Female Not Reported			X
5. Abstract and Budget Information
Summaries of alliance, alliance goals and objectives, and alliance impact and systemic changes (3 text boxes)			X
Summaries of student activities, faculty development activities, curriculum development activities, and summer bridge and related outreach activities , and other activities (5 text boxes)		X
Summaries of alliance highlights, accomplishments, and obstacles (3 text boxes)			X
Alliance Budget: Dollar amounts and person-months, divided into NSF and Matching funding, for the following categories: Senior Personnel Post Doctoral Associates Other Professionals Graduate Students Undergraduate Students Secretarial/Clerical Other staff Fringe Benefits Permanent Equipment Travel Part Supp Costs Other Costs Indirect Costs		X
Text summaries of budget, matching funds, and subcontracts and contract amounts (3 text boxes)		X
Non-Academic Partners: Name Type of Partner National Science Foundation Institution State of Local Government Federal Agency Federal Lab Foreign Government Corporation Foundation and Other Non-Profit Project Generated Other Description			X

Crosswalk of LSAMP Bridge to the Doctorate Data Elements

(See below for separate crosswalk illustrating differences from collection cleared in 2005)

Common Collection Categories Question	Staff and Project Participant Characteristics	Project Implementation Characteristics	Project Outputs
BASELINE DATA
Student Name (First, MI, Last)	X
Previous Name (BD students only)	X
LSAMP Institution the student was enrolled in (BD students only)	X
LSAMP Alliance the institution was associated with (BD students only)	X
Bachelor’s Degree-awarding Institution (peer comparison students only)	X
Social Security Number (not required)	X
Gender—choose one Male Female Not reported	X
Ethnicity—choose one Not Hispanic or Latino Hispanic or Latino Not reported	X
Race—mark one or more American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Not reported	X
Disability— mark one or more Hearing impairment Mobility or orthopedic impairment Visual impairment Other (please specify) None Not reported	X
Citizenship—choose one: U.S. Citizen/U.S. National U.S. Permanent Resident/Green Card holder Other (please specify)	X
Undergraduate Major— check all that apply Agricultural Science Chemistry Computer Science Engineering Environmental Science Geosciences Life/Biological Sciences Mathematics Physics/Astronomy Other (please specify)	X
Undergraduate GPA	X
Undergraduate GPA Scale—choose one 4 point scale 5 point scale	X
LSAMP Level I or II Status:
Research experience during the undergraduate program-choose one Yes No	X
GRE Scores Verbal Quantitative Analytical	X
Date entered STEM Graduate Program Month Year	X
Date began receiving BD funding Month Year	X
Did this student complete any graduate work before entering the current graduate program —choose one: Yes No (peer comparison students only)	X
Did this student complete any graduate work before receiving LSAMP BD funding—choose one: Yes No	X
Broad Field Area
Field
Degree —choose one No specific degree or certificate Post baccalaureate Certificate Masters (including MBA) Post Masters Certificate Doctorate (Ph.D., D.S.C., D.Sc., Ed.D.) Other professional degree (JD, L.L.B., Th.D., M.D, DDS) Other (please specify)	X
Date degree awarded Month Year	X
If no prior graduate degrees please provide the number of graduate credits completed prior to receiving LSAMP BD funding	X
Teaching Assistantship awarded prior to receiving LSAMP BD funding Yes No Not Applicable	X
Research Assistantship awarded prior to receiving LSAMP BD funding Yes No Not Applicable	X
ANNUAL DATA
Graduate Program	X
Intended Broad Major Area	X
Intended Major	X
Intended Degree — check all that apply No specific degree or certificate Post baccalaureate Certificate Masters (including MBA) Post Masters Certificate Doctorate (Ph.D., D.S.C., D.Sc., Ed.D.) Other professional degree (JD, L.L.B., Th.D., M.D, DDS) Other (please specify)	X
Amount of support received during the current reporting period (BD students only)	X
Disbursement Method —choose one (BD students only) Monthly Quarterly By Semester Yearly	X
Is the stipend or payment based on academic performance —choose one (BD students only) Yes No	X
Did the LSAMP BD funding end for this student during the current Reporting period—choose one: (BD students only) Yes No If yes, please provide the date funding ended: Month Year	X
Number of graduate courses credits completed during the current reporting period			X
Teaching Assistantship awarded during the current reporting period —chose one: Yes No Not Applicable			X
Research Assistantship awarded during the current reporting period —choose one: Yes No Not Applicable			X
Year entered Ph.D. track - (completed 2 years of graduate coursework, equivalent to MA or MS and entered 3rd year of graduate coursework, i.e. post MS and into Ph.D. track): 2001 2002 2003 2004 2005 2006			X
Thesis Proposal - Date Approved: Month Year			X
Master’s Degree - Date Awarded: Month Year			X
Ph.D. Qualifying Examinations - Date passed: Month Year			X
Ph.D. Candidacy - Date attained: Month Year			X
Dissertation Defense - Date passed: Month Year			X
Doctoral Dissertation - Date Approved: Month Year			X
Doctoral Degree - Date Awarded: Month Year			X
Doctoral Dissertation Abstract			X
Did the student receive post-LSAMP BD funding to continue graduate studies during the current reporting period (BD students only)—choose one: Yes No If yes, please provide funding source —choose one: Institution attending Government fellowship: federal/state/local Private fellowship		X
Did the student leave the program or drop out during the current reporting period —choose one: Yes No		X
Date left or dropped Out: Month Year		X
If he or she left, was it to continue Ph.D. elsewhere? Yes No Don’t know		X
If yes, please provide the following information Transfer Date: Month Year Institution Name:		X
Please provide the permanent contact information for this student. Student’s personal email address Address City State Zip Code Country Phone Ext.	X
Name and address (U.S. postal and e-mail) of a person likely to know how to reach this student after he or she graduates Name Relationship to this student Email address Address City State Zip Code Country Phone Ext.	X
Has the individual received a post doctorate appointment —choose one Yes No If yes, please complete the following items Date: Month Year Institution Department Field			X
Is the individual currently employed —choose one Yes No			X
When did the individual begin this job? Month Year			X
Is this job full-time —choose one Yes No			X
Which of the following categories best describes this individual’s employer in this job? A private, for-profit company, business or individual, paying your wages, salary or commissions A Private not-for-profit, tax-exempt or charitable organization Self-employment in own Not Incorporated business, professional practice, or farm Self-employment in own Incorporated business, professional practice, or farm Local Government (e.g., city, county) State Government U.S. Military Service, active duty, or Commissioned Corps (e.g., USPHS, NOAA) U.S. Government as a civilian employee Other (please specify)			X
Regarding about this individual’s employer's main business (i.e. what the employer makes or does), please indicate the single category that best fits the employer's main business. If the employer has more than one type of business, please answer for the type of work primarily performed at the location where this individual works. Agriculture, forestry or fishing Biotechnology Construction or mining Education Finance, insurance, or real estate services Health services Information technology or computer services Other services (e.g., social, legal, business) Manufacturing Public administration/government Research (please specify) Transportation services, utilities, or communications Wholesale or retail trade Other (please specify)			X
Position/Job Title (Broad category)			X
Position/Job Title			X
Is job STEM related —choose one Closely related Somewhat related Not related			X
Is employer an educational institution —choose one Yes No			X
Type of Educational Institution—choose one Preschool, elementary, or middle school system Secondary school system Two-year college, community college, technical institute Four-year college or university, other than a medical school Medical school (including university-affiliated hospital or medical center University-affiliated research institute Other (please specify)			X
Faculty Rank—choose one Professor Associate professor Assistant professor Instructor Lecturer Adjunct Faculty Other (please specify) Not applicable at the institution Not applicable for my position			X
Tenure Status—choose one Tenured On tenure track but not tenured Not on tenure track Not applicable: no tenure system at this institution Not applicable: no tenure system for my position			X

Changes in LSAMP Bridge collection since previous clearance in 2005

Data Elements Cleared under LSAMP Task in 3145-0136 2005	Data Elements in Revised System
Graduate Student Data (completed by PI)	ALL questions in system completed by PI
Name (text boxes): First, Middle Initial Last	Student Name (First, MI, Last)
	Maiden Name
	LSAMP Institution (the student was enrolled in)
	LSAMP Alliance (the institution was associated with)
	LSAMP Level I or II Status
	Date entered STEM Graduate Program (Month/Year)
Mark if the student was supported by funds during the current project year and provide the number of months for which support was received (check box and data box)	Amount of support received during the current reporting period Disbursement Method —choose one Monthly Quarterly By Semester Yearly Is the stipend or payment based on academic performance (Yes/No)
Current Advisor (text box)
The student is a U.S. Citizen/U.S. National or Permanent Resident. (Yes/No).
When the student first enrolled in graduate study in an LSAMP Bridge department. (Date box)
When the student first began receiving funding. (Date box)	Date began receiving BD funding (Month/Year) Has BD funding ended for this student (Yes/No) If yes, date funding ended (Month/Year)
Did the student obtain a Ph.D. associated with the LSAMP project? (Yes/No) Year Ph.D. received. (Date box)	Year entered PhD track —choose one: (completed 2 years of graduate coursework, equivalent to MA or MS and entered 3rd year of graduate coursework, i.e. post MS and into PhD track) 2003 2004 2005 2006 Thesis Proposal - Date Approved (Month/Year) (Thesis not required) Master’s Degree Abstract Master’s Degree - Date Awarded (Month/Year) Qualifying Examinations - Date passed (Month/Year) PhD Candidacy - Date attained (Month/Year) Dissertation Defense - Date passed (Month/Year) Doctoral Dissertation - Date Approved (Month/Year) Doctoral Degree - Date Awarded (Month/Year) Doctoral Dissertation Abstract
	Has the student received post-BD funding to continue graduate studies (Yes/No) If yes, please provide funding source —choose one Institution attending Government fellowship (federal/state/local) Private fellowship
If the student did not receive a Ph.D, did the trainee stop pursuing a Ph.D. with the NSF-LSAMP project? (choose one) Yes, and they have left the institution Yes, though they are still enrolled at this institution No	Has student left the program or dropped out (Yes/No)
If the student stopped pursuing a Ph.D. with the project, when did the student leave the program? (Date box)	Date left or dropped out (Month/Year)
If the student left the program, did the student receive a terminal master’s degree? (Yes/No)
If the student stopped pursuing a Ph.D with the program, why did pursuit stop? (Choose one) Left to pursue other academic interests Failed to meet program requirements Left to pursue employment, Left due to family and/or economic constraints Intended to pursue Masters Degree only Unknown Other	If left, did so to continue Ph.D. elsewhere? —choose one Yes No Don’t know If yes, please provide the following information Transfer Date (Month/Year) Institution Name
If the student stopped pursuing a Ph.D., what was the student’s primary employment and education status after incompletion of Ph.D.? (Choose one)? Private sector employment Academic research employment Education (teaching) employment Public sector employment Graduate study Unknown Other

Data Elements Cleared under LSAMP Task in 3145-0136	Data Elements in Revised System
Graduate Student Data Collection Module (to be completed by student)	ALL questions in system completed by PI
Name (text boxes): First, Middle Initial Last
Contact Information (text or data boxes): Dept. at Institution Current Address Current City Current State Current ZIP Phone Extension Fax E-mail Address Web URL
Ethnicity (choose one): Hispanic or Latino Not Hispanic or Latino Not reported	Ethnicity—choose one Not Hispanic or Latino Hispanic or Latino Not reported
Race (choose one or more): American Indian or Alaska Native Asian Black or African American Native Hawaiian or other Pacific Islander White Not Reported	Race—choose one or more American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Not reported
Gender (Choose one): Male Female Not reported	Gender—choose one Male Female Not reported
Disability Status (Choose one or more): Hearing Impairment Visual Impairment Mobility/Orthopedic Impairment Other None Not reported	Disability—choose one or more: Hearing impairment Mobility or orthopedic impairment Visual impairment Other (please specify) None Not reported
Citizenship (Choose one): U.S. Citizen/U.S. National U.S. Permanent Resident Other non-U.S. Citizen Not Reported
Current Advisor(s) (Check all that apply). Selections pre-populated by PI data.
	Graduate Program: Intended Broad Major Area Intended Major Intended Degree No specific degree or certificate Post baccalaureate Certificate Masters (including MBA) Post Masters Certificate Doctorate (Ph.D., D.S.C., D.Sc., Ed.D.) Other professional degree (JD, L.L.B., Th.D., M.D, DDS, etc.) Other (please specify)
Permanent Contact Information Social Security number Personal E-mail Person likely to know how to reach you in three years: Name Relationship to you Address City State ZIP Country Phone Extension Email Address	Social Security Number Student’s personal email address (Other than his or her current school address, if available) Please select whose contact information is provided below —choose one The student’s A person likely to know how to reach this student Name (If “A person likely to know how to reach this student” is selected above) Relationship to this student (If “A person likely to know how to reach this student” is selected above) Address City State, Zip Code Country Phone Email address
Academic/Professional Background Prior to Program
Undergraduate Degree Prior Program: Undergraduate Major (choose one of many majors) Double Major (choose one of many majors) Undergraduate Institution (text box) Undergraduate Inst. City (text box) Undergrad. Inst. State (text box) When did you receive your first undergraduate degree? (date box)	Date of Bachelor’s Degree (Month/Year) Undergraduate Major—choose one Agricultural Science Chemistry Computer Science Engineering Geosciences Life/Biological Sciences Mathematics Physics/Astronomy Environmental Science Other (please specify)
	Undergraduate GPA
	Research experience during the undergraduate program (Yes/No)
	GRE Scores Verbal Quantitative Analytical
Did you obtain a post-undergraduate degree prior to Program? (Yes/No) Degree Type (choose one of several degree types) When received (date box) Institution (text box)	Did the student complete any graduate work before receiving LSAMP BD funding? (Yes/No) If yes, please provide the following data Broad Field Area Field Degree —choose one No specific degree or certificate Post baccalaureate Certificate Masters (including MBA) Post Masters Certificate Doctorate (Ph.D., D.S.C., D.Sc., Ed.D.) Other professional degree (JD, L.L.B., Th.D., M.D, DDS, etc.) Other (please specify) Date degree awarded (Month/Year) If no prior graduate degrees: Number of graduate credits completed prior to receiving LSAMP BD funding
Were you employed in the public/private sector for one or more years after receiving your first undergraduate degree and prior to becoming an LSAMP Bridge student? (Yes/No)
	Teaching Assistantship awarded prior to receiving LSAMP BD funding —choose one Yes No Not Applicable
	Research Assistantship awarded prior to receiving LSAMP BD funding—choose one Yes No Not Applicable
Total number of years (equal to or greater than one year, to the nearest year) you were employed in the public or private sector after receiving your first undergraduate degree and prior to becoming an LSAMP Bridge student. (data box)
Academic Achievement
Counts of any professional publications, or patents applied for or won during the current reporting period. (data boxes for each item) Publications (Excluding Articles in Refereed Journals) Journal Articles in Refereed Journals Books Book Chapters Patent Applications Approved Patents	Number of Publications Peer-reviewed non-peer reviewed
Provide citations for each item counted above and estimate the percentage of the product cited that resulted from your personal effort. (text box)
Provide counts of any presentations, awards, or scholarly achievements you have received during the current reporting period. (data boxes for each item) Presentations at Regional Conferences Presentations at National Conferences Presentations at International Conferences Awards and Recognition Received Other Scholarly Achievements	Number of Presentations (Oral) Number of Poster Presentations
	Number of graduate course credits completed
	Teaching Assistantship awarded —choose one Yes No Not Applicable
	Research Assistantship awarded —choose one Yes No Not Applicable
Provide descriptions of the items counted above for the current reporting period. (text box)
Ability To Communicate Professionally
Indicate whether you have engaged in any of the following educational/professional activities during the current reporting period. (check all that apply) Training/coursework in professional writing Training/coursework in professional speaking/presentation skills Presentations made at the LSAMP institution Professional conferences attended Poster sessions/presentations outside the IGERT institution Oral presentations outside the LSAMP institution Other activities to develop or increase your ability to communicate professionally (specify in text box) You were not engaged in any of the activities listed above during the current reporting period.
Provide counts for any of the following professional activities that you checked above. (data boxes for each item) Presentations made at your home institution Professional conferences attended Poster sessions/presentations outside your home institution Oral presentations outside your home institution Other activities to develop or increase your ability to communicate professionally
Expand on any of the educational/professional activities identified above that have significantly enhanced your ability to communicate professionally. (text box)
Professional Skills To Conduct High-Quality Research
Indicate whether you have engaged in any of the following educational/professional activities during the current reporting period. (Mark all that apply) Training/coursework in responsible conduct of research Training/coursework in statistics Training/coursework in research methods Training/coursework in state-of-the-art instrumentation Participation in research projects within your own discipline area but outside your dissertation research Other activities to develop or increase professional skills to conduct high-quality research (specify in text box) You were not engaged in any of the activities listed above during the current reporting period.
Expand on any of the educational/professional activities identified above that have significantly enhanced your ability to conduct high-quality research. (text box)
Professional Skills in Education
Indicate whether you have engaged in any of the following educational/professional activities during the current reporting period (check all that apply). Teaching assistantships Mentoring of high school, undergraduate, or other graduate students Courses developed and/or major teaching roles Participation in any multidisciplinary/ interdisciplinary course development, teaching, or other educational effort Participation in any group education efforts (e.g., team teaching, teamwork on course development) Other activities to develop or increase professional skills in education. (specify in text box) You were not engaged in any of the activities listed above during the current reporting period.
Expand on any of the educational/ professional activities identified above that have significantly enhanced your professional skills in education (text box)
Professional Skills Applicable to Careers in Industry, Government, or the Public Sector
Considering all of your activities in the past year, except for those associated with internships, indicate whether you have engaged in any of the following educational/professional activities during the current reporting period (mark all that apply). Participation in any research project involving multiple disciplines Participation/experience in team research efforts Participation in any interaction between academic research and industrial applications or between academic research and public policy development or application Training/experience in communications across disciplines and to different audiences (including the general public) Educational-interactions (e.g., courses, workshops, seminars) with industry professionals or with Government or other public-sector professionals Research interactions (other than internships) with industry professionals or with government or other public-sector professionals Other activities to enhance your professional skills applicable to careers (specify in text box) You were not engaged in any of the activities listed above during the current reporting period.
Expand on any of the educational/ professional activities identified above that have significantly enhanced your professional skills applicable to careers in industry, government, or the public sector. (text box)
Off-Campus Internships/Industrial Rotations
Have you taken part in any internship(s) lasting a month or more with private-sector industries or businesses, with public sector laboratories or agencies, or in any other setting during the current reporting period? (Yes/No)
If yes, please indicate the type of setting and the duration (to the nearest month) of the internship(s). Internship Setting (choose one of several) Number of Months (data box) Spaces for several internship settings are available on survey.
Indicate whether any of the following benefits resulted from your internship(s) during the current reporting period. (Mark all that apply) Experience with applied research Experience with team approaches to problem solving Experience communicating and working with people from different disciplinary or professional backgrounds Increased awareness of non-academic job opportunities available to people with similar education and interests Development of a thesis and/or dissertation research topic Financial or equipment support to complete thesis research Likelihood of a job offer after graduation Other benefits (specify in text box) No benefits resulted from internship(s) during the current reporting period.
Expand on any of the benefits selected above that have significantly enhanced your professional skills in areas important in industry or other public/private sector careers. (text box)
International Perspective
Indicate whether you have engaged in any of the following educational/professional activities during the current reporting period. (Mark all that apply) Experience working with scientist(s) of other nationalities within the United States Experience communicating and working with people of different cultures, nationalities, or backgrounds Internships or other experiences working with scientist(s) of other nationalities in their own countries Experience, outside of your studies, living and/or working in a foreign country Other internationally oriented educational/ professional activities (specify in text box) You were not engaged in any of the activities listed above during the current reporting period
Expand on any of the educational/professional activities selected above that have significantly enhanced your understanding of other cultures in the text box below.
Breadth and Depth of Knowledge
Will your degree be granted by a multidisciplinary/ interdisciplinary program or a traditional single-discipline department? Multidisciplinary/interdisciplinary program Traditional single-discipline department
What is the name of the home department/program that will grant your degree? (text box)
Are there any other educational/professional experiences in which you have participated (that have not been mentioned in this survey) that have contributed materially to the depth and breadth of your scientific knowledge/understanding? (Yes No)
If yes, provide a brief description of these educational/professional experiences (text box)
Mentoring and Other Special Assistance
During your time as an LSAMP Bridge student, have you received any form of special assistance (e.g., mentoring, academic, personal) beyond the support typically received by graduate students you know in other Ph.D. programs at this university? (Yes/No)
Indicate whether you have received any mentoring or special assistance during the current reporting period. (Mark all that apply) No mentoring/assistance was received during the current reporting period Especially helpful mentoring from a faculty member, postdoc, or other graduate student(s) Special academic assistance (e.g., tutoring, arrangements to take supporting courses, time extensions) Help with personal problems or in making social connections Other types of mentoring or special assistance (specify in text box)
Expand on any of the types of assistance selected above that have significantly improved the quality of your experience at this institution. (text box)
	Has the individual received a post doctorate appointment (Yes/No) If yes, please complete the following items Date (Month/Year) Institution Department Field
	Is the individual currently employed (Yes/No)
	If yes, please answer the following questions about this individual’s main job When did the individual begin this job? (Month/Year) Is this job full-time (Yes/No) Employer type: Which of the following categories best describes this individual’s employer in this job? —choose one or more A private, for-profit company, business or individual, paying your wages, salary or commissions A Private not-for-profit, tax-exempt or charitable organization Self-employment in own Not Incorporated business, professional practice, or farm Self-employment in own Incorporated business, professional practice, or farm Local Government (e.g., city, county) State Government U.S. Military Service, active duty, or Commissioned Corps (e.g., USPHS, NOAA) U.S. Government as a civilian employee Other (please specify) Employment sector Thinking about this individuals’ main business (i.e. what the employer makes or does), please indicate the single category that best fits the employer's main business. If the employer has more than one type of business, please answer for the type of work primarily performed at the location where this individual works. —choose one Agriculture, forestry or fishing Biotechnology Construction or mining Education Finance, insurance, or real estate services Health services Information technology or computer services Other services (e.g., social, legal, business) Manufacturing Public administration/government Research (please specify) Transportation services, utilities, or communications Wholesale or retail trade Other (please specify) Position/Job Title (Broad category) —choose one Position/Job Title —choose one Is job STEM related —choose one Closely related Somewhat related Not related
	Is employer an educational institution (Yes/No)
	If yes, answer the following questions Type of Educational Institution—choose one Preschool, elementary, or middle school system Secondary school system Two-year college, community college, technical institute Four-year college or university, other than a medical school Medical school (including university-affiliated hospital or medical center) University-affiliated research institute Other (please specify) Faculty Rank—choose one Not applicable at the institution Not applicable for my position Professor Associate professor Assistant professor Instructor Lecturer Adjunct Faculty Other (please specify) Tenure Status—choose one Not applicable: no tenure system at this institution Not applicable: no tenure system for my position Tenured On tenure track but not tenured Not on tenure track
Student Commentary
Describe what you consider to be the most beneficial and exciting elements of being an LSAMP Bridge student. These might include (1) an opportunity you have had as a result of being an LSAMP Bridge students that has significantly affected your professional development, (2) an aspect of the project that provided exceptional "added value" to your educational experience, or (3) an aspect of the project that has been especially successful and/or represents a real change from the usual way graduate students are educated at your institution. (text box)
Describe what you consider to be the least successful or least well-developed (to date) elements of the PhD program with which you are associated. Offer any suggestions you may have for making PhD a stronger and more effective graduate education program. (text box)

1 Elements of these characteristics include: Name, address, date of birth, gender, ethnicity, race, disability status, class, major, grade point average, yearly fellowship or stipend amount, or project role.

2 Elements of these characteristics include: Sources and amount of funds, fellowships, scholarships, traineeships, partnerships, training, research methods.

3 Elements of these characteristics include: research findings, publications, presentations, degrees granted, educational materials.

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