For each eligible sampled student, please provide the following data.
Section Name |
Subsection Name |
Column Header/Question Wording |
Contact Information |
Permanent Contact Information |
Address 1 |
Contact Information |
Permanent Contact Information |
Address 2 |
Contact Information |
Permanent Contact Information |
City |
Contact Information |
Permanent Contact Information |
State |
Contact Information |
Permanent Contact Information |
ZIP |
Contact Information |
Permanent Contact Information |
Country (if not USA) |
Contact Information |
Permanent Contact Information |
|
Contact Information |
Permanent Contact Information |
Phone |
Contact Information |
Permanent Contact Information |
International Phone |
Contact Information |
Local Contact Information |
Local Address Same as Permanent? |
Contact Information |
Local Contact Information |
Address 1 |
Contact Information |
Local Contact Information |
Address 2 |
Contact Information |
Local Contact Information |
City |
Contact Information |
Local Contact Information |
State |
Contact Information |
Local Contact Information |
ZIP |
Contact Information |
Local Contact Information |
Campus E-Mail |
Contact Information |
Local Contact Information |
Phone |
Contact Information |
Local Contact Information |
Cell Phone |
Contact Information |
Local Contact Information |
Permanent resident of <school state>? |
Contact Information |
Parent's Contact Information |
First Name |
Contact Information |
Parent's Contact Information |
Middle Initial |
Contact Information |
Parent's Contact Information |
Last Name |
Contact Information |
Parent's Contact Information |
Suffix |
Contact Information |
Parent's Contact Information |
Address is the same as.. |
Contact Information |
Parent's Contact Information |
Address 1 |
Contact Information |
Parent's Contact Information |
Address 2 |
Contact Information |
Parent's Contact Information |
City |
Contact Information |
Parent's Contact Information |
State |
Contact Information |
Parent's Contact Information |
ZIP |
Contact Information |
Parent's Contact Information |
Country (if not USA) |
Contact Information |
Parent's Contact Information |
|
Contact Information |
Parent's Contact Information |
Phone |
Contact Information |
Parent's Contact Information |
Cell Phone |
Contact Information |
Parent's Contact Information |
International Phone |
Contact Information |
Other Contact Information |
First Name |
Contact Information |
Other Contact Information |
Middle Initial |
Contact Information |
Other Contact Information |
Last Name |
Contact Information |
Other Contact Information |
Suffix |
Contact Information |
Other Contact Information |
Relationship to Student |
Contact Information |
Other Contact Information |
Address 1 |
Contact Information |
Other Contact Information |
Address 2 |
Contact Information |
Other Contact Information |
City |
Contact Information |
Other Contact Information |
State |
Contact Information |
Other Contact Information |
ZIP |
Contact Information |
Other Contact Information |
Country (if not USA) |
Contact Information |
Other Contact Information |
|
Contact Information |
Other Contact Information |
Phone |
Contact Information |
Other Contact Information |
Cell Phone |
Contact Information |
Additional Contact |
First Name |
Contact Information |
Additional Contact |
Middle Initial |
Section Name |
Subsection Name |
Column Header/Question Wording |
Contact Information |
Additional Contact |
Last Name |
Contact Information |
Additional Contact |
Suffix |
Contact Information |
Additional Contact |
Phone |
Contact Information |
Additional Contact |
Relationship to Student |
Student Info and Budget |
Personal Information |
First Name |
Student Info and Budget |
Personal Information |
Middle Initial |
Student Info and Budget |
Personal Information |
Last Name |
Student Info and Budget |
Personal Information |
Suffix |
Student Info and Budget |
Personal Information |
Social Security Number |
Student Info and Budget |
Personal Information |
DOB Month |
Student Info and Budget |
Personal Information |
DOB Year |
Student Info and Budget |
Personal Information |
Gender |
Student Info and Budget |
Driver's license |
License Number |
Student Info and Budget |
Driver's license |
License State |
Student Info and Budget |
Marital Status |
Marital Status |
Student Info and Budget |
Marital Status |
Maiden Name |
Student Info and Budget |
Marital Status |
Spouse First Name |
Student Info and Budget |
Marital Status |
Spouse Middle Initial |
Student Info and Budget |
Marital Status |
Spouse Last Name |
Student Info and Budget |
High School Information |
Degree Type |
Student Info and Budget |
High School Information |
Degree Year |
Student Info and Budget |
Ethnicity and Race (For Race, select all that apply) |
Ethnicity |
Student Info and Budget |
Ethnicity and Race (For Race, select all that apply) |
White |
Student Info and Budget |
Ethnicity and Race (For Race, select all that apply) |
African-American or Black |
Student Info and Budget |
Ethnicity and Race (For Race, select all that apply) |
Asian |
Student Info and Budget |
Ethnicity and Race (For Race, select all that apply) |
American Indian or Alaska Native |
Student Info and Budget |
Ethnicity and Race (For Race, select all that apply) |
Hawaiian or Other Pacific Islander |
Student Info and Budget |
Citizenship |
Citizenship |
Student Info and Budget |
ISIR |
Last name from ISIR |
Student Info and Budget |
ISIR |
Social Security Number from ISIR |
Student Info and Budget |
Budget |
Local residence |
Student Info and Budget |
Budget |
Tuition/fees |
Student Info and Budget |
Budget |
Books/supplies |
Student Info and Budget |
Budget |
Room and board |
Student Info and Budget |
Budget |
Health insurance |
Student Info and Budget |
Budget |
Transportation |
Student Info and Budget |
Budget |
Computer technology |
Student Info and Budget |
Budget |
All other expenses |
Student Info and Budget |
Budget |
Total cost of attendance |
Student Info and Budget |
Budget |
Budget period |
Enrollment |
Degree Program and Progress |
Degree Program |
Enrollment |
Degree Program and Progress |
Associate’s Type (Only applicable if degree program is Associate's) |
Enrollment |
Degree Program and Progress |
Master’s Type (Only applicable if degree program is Master's) |
Enrollment |
Degree Program and Progress |
Doctoral Type (Only applicable if degree program is Doctoral) |
Section Name |
Subsection Name |
Column Header/Question Wording |
Enrollment |
Degree Program and Progress |
Class Level |
Enrollment |
Degree Program and Progress |
Expected to complete degree requirments by 6/30/2011? |
Enrollment |
Degree Program and Progress |
Cumulative (unweighted) GPA |
Enrollment |
Baccalaureate Degree (Only applicable for graduate students) |
Month Received (mm) |
Enrollment |
Baccalaureate Degree (Only applicable for graduate students) |
Year Received (yyyy) |
Enrollment |
Baccalaureate Degree (Only applicable for graduate students) |
None Received |
Enrollment |
Major (Only complete one) |
CIP code |
Enrollment |
Major (Only complete one) |
Current Major |
Enrollment |
Major (Only complete one) |
Undeclared |
Enrollment |
Initial Enrollment |
First Enrolled at this Institution Month (mm) |
Enrollment |
Initial Enrollment |
First Enrolled at this Institution Year (yyyy) |
Enrollment |
Initial Enrollment |
First-time Beginning Student? |
Enrollment |
Initial Enrollment |
Transferred Credits from Another Institution? |
Enrollment |
Number of Required Clock Hours (Only applicable for clock hour programs) |
For Program |
Enrollment |
Number of Required Clock Hours (Only applicable for clock hour programs) |
Per Week |
Enrollment |
Tuition Charged |
Total tuition charged |
Enrollment |
Tuition Charged |
Residency for Tuition Purposes |
Enrollment |
Enrollment status |
[Term Name 1 (Start Date – End Date)] |
Enrollment |
Enrollment status |
[Term Name 2 (Start Date – End Date)] |
Enrollment |
Enrollment status |
[Term Name 3 (Start Date – End Date)] |
Enrollment |
Enrollment status |
[Term Name 4 (Start Date – End Date)] |
Enrollment |
Enrollment status |
[Term Name 5 (Start Date – End Date)] |
Enrollment |
Enrollment status |
[Term Name 6 (Start Date – End Date)] |
Enrollment |
Enrollment status |
[Term Name 7 (Start Date – End Date)] |
Enrollment |
Enrollment status |
[Term Name 8 (Start Date – End Date)] |
Enrollment |
Enrollment status |
[Term Name 9 (Start Date – End Date)] |
Enrollment |
Enrollment status |
[Term Name 10 (Start Date – End Date)] |
Enrollment |
Enrollment status |
[Term Name 11 (Start Date – End Date)] |
Enrollment |
Enrollment status |
[Term Name 12 (Start Date – End Date)] |
Enrollment |
Placement Tests |
[Placement test 1] Score |
Enrollment |
Placement Tests |
[Placement test 1] Name |
Enrollment |
Placement Tests |
[Placement test 1] Date |
Enrollment |
Placement Tests |
[Placement test 2] Name |
Enrollment |
Placement Tests |
[Placement test 2] Date |
Enrollment |
Placement Tests |
[Placement test 2] Score |
Enrollment |
Placement Tests |
[Placement test 3] Name |
Enrollment |
Placement Tests |
[Placement test 3] Date |
Enrollment |
Placement Tests |
[Placement test 3] Score |
Enrollment |
Placement Tests |
[Placement test 4] Name |
Enrollment |
Placement Tests |
[Placement test 4] Date |
Enrollment |
Placement Tests |
[Placement test 4] Score |
Enrollment |
Placement Tests |
[Placement test 5] Name |
Section Name |
Subsection Name |
Column Header/Question Wording |
Enrollment |
Placement Tests |
[Placement test 5] Date |
Enrollment |
Placement Tests |
[Placement test 5] Score |
Aid Awarded |
Federal Aid |
Pell grant |
Aid Awarded |
Federal Aid |
Academic Competitiveness grant (ACG) |
Aid Awarded |
Federal Aid |
SMART grant |
Aid Awarded |
Federal Aid |
Subsidized Stafford loan |
Aid Awarded |
Federal Aid |
Unsubsidized Stafford loan |
Aid Awarded |
Federal Aid |
Parent PLUS loan |
Aid Awarded |
Federal Aid |
Graduate PLUS loan |
Aid Awarded |
Federal Aid |
Federal TEACH grant |
Aid Awarded |
Federal Aid |
Perkins loan |
Aid Awarded |
Federal Aid |
Federal SEOG grant |
Aid Awarded |
Federal Aid |
Federal work-study |
Aid Awarded |
Federal Aid |
Veteran benefits |
Aid Awarded |
Federal Aid |
Robert Byrd honors scholarship |
Aid Awarded |
Federal Aid |
Federal health professions loan |
Aid Awarded |
Federal Aid |
Federal health professions disadvantaged loan |
Aid Awarded |
State Aid |
[State aid program 1] |
Aid Awarded |
State Aid |
[State aid program 2] |
Aid Awarded |
State Aid |
[State aid program 3] |
Aid Awarded |
State Aid |
[State aid program 4] |
Aid Awarded |
State Aid |
[State aid program 5] |
Aid Awarded |
State Aid |
[State aid program 6] |
Aid Awarded |
State Aid |
[State aid program 7] |
Aid Awarded |
State Aid |
[State aid program 8] |
Aid Awarded |
State Aid |
[State aid program 9] |
Aid Awarded |
State Aid |
[State aid program 10] |
Aid Awarded |
State Aid |
[State aid program 11] |
Aid Awarded |
State Aid |
[State aid program 12] |
Aid Awarded |
Institution Aid |
[Institution aid program 1] |
Aid Awarded |
Institution Aid |
[Institution aid program 2] |
Aid Awarded |
Institution Aid |
[Institution aid program 3] |
Aid Awarded |
Institution Aid |
[Institution aid program 4] |
Aid Awarded |
Institution Aid |
[Institution aid program 5] |
Aid Awarded |
Institution Aid |
[Institution aid program 6] |
Aid Awarded |
Institution Aid |
[Institution aid program 7] |
Aid Awarded |
Institution Aid |
[Institution aid program 8] |
Aid Awarded |
Institution Aid |
[Institution aid program 9] |
Aid Awarded |
Institution Aid |
[Institution aid program 10] |
Aid Awarded |
Institution Aid |
[Institution aid program 11] |
Aid Awarded |
Institution Aid |
[Institution aid program 12] |
Aid Awarded |
Graduate Aid (Only applicable for graduate students) |
Graduate fellowship/scholarship |
Aid Awarded |
Graduate Aid (Only applicable for graduate students) |
Graduate Federal fellowship |
Aid Awarded |
Graduate Aid (Only applicable for graduate students) |
Graduate Federal traineeship |
Aid Awarded |
Graduate Aid (Only applicable for graduate students) |
Graduatet teaching assistantship/stipend |
Aid Awarded |
Graduate Aid (Only applicable for graduate students) |
Graduate research assistantship/stipend |
Aid Awarded |
Graduate Aid (Only applicable for graduate students) |
Other graduate assistants/tutors/readers stipends |
Section Name |
Subsection Name |
Column Header/Question Wording |
Aid Awarded |
Graduate Aid (Only applicable for graduate students) |
Graduate student tuition waivers |
Aid Awarded |
Graduate Aid (Only applicable for graduate students) |
Graduate faculty/staff tuition waivers |
Aid Awarded |
Graduate Aid (Only applicable for graduate students) |
Graduate institutional work study |
Aid Awarded |
Graduate Aid (Only applicable for graduate students) |
Graduate institutional loan |
Aid Awarded |
Private Aid and Other Government Aid |
Scholarships/grants from private organizations |
Aid Awarded |
Private Aid and Other Government Aid |
Employer paid tuition |
Aid Awarded |
Private Aid and Other Government Aid |
ROTC/armed forces grants |
Aid Awarded |
Private Aid and Other Government Aid |
WIA/job training/vocational rehabilitation |
Aid Awarded |
Private Aid and Other Government Aid |
Bureau of Indian Affairs grants |
Aid Awarded |
Private Aid and Other Government Aid |
Scholarships/grants from outside state agency |
Aid Awarded |
Private Aid and Other Government Aid |
Private loans |
Aid Awarded |
Private Aid and Other Government Aid |
DC tuition assistance grant |
Aid Awarded |
Other/Specify Aid |
Other aid 1 name |
Aid Awarded |
Other/Specify Aid |
Other aid 1 type |
Aid Awarded |
Other/Specify Aid |
Other aid 1 source |
Aid Awarded |
Other/Specify Aid |
Other aid 1 amount |
Aid Awarded |
Other/Specify Aid |
Other aid 2 name |
Aid Awarded |
Other/Specify Aid |
Other aid 2 type |
Aid Awarded |
Other/Specify Aid |
Other aid 2 source |
Aid Awarded |
Other/Specify Aid |
Other aid 2 amount |
Aid Awarded |
Other/Specify Aid |
Other aid 3 name |
Aid Awarded |
Other/Specify Aid |
Other aid 3 type |
Aid Awarded |
Other/Specify Aid |
Other aid 3 source |
Aid Awarded |
Other/Specify Aid |
Other aid 3 amount |
Aid Awarded |
Other/Specify Aid |
Other aid 4 name |
Aid Awarded |
Other/Specify Aid |
Other aid 4 type |
Aid Awarded |
Other/Specify Aid |
Other aid 4 source |
Aid Awarded |
Other/Specify Aid |
Other aid 4 amount |
Aid Awarded |
Other/Specify Aid |
Other aid 5 name |
Aid Awarded |
Other/Specify Aid |
Other aid 5 type |
Aid Awarded |
Other/Specify Aid |
Other aid 5 source |
Aid Awarded |
Other/Specify Aid |
Other aid 5 amount |
NPSAS:12
Supporting Statement Request for OMB Review J-
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | Chapter 2 |
Author | spowell |
File Modified | 0000-00-00 |
File Created | 2021-02-01 |