Institutional Contacts

Survey of Earned Doctorates

Att. 8.6 - Missing information roster

Institutional Contacts

OMB: 3145-0019

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Sample Missing Information Roster

Please complete and return by
xx/xx/xxxx
to NORC
Survey of Earned Doctorates
Upload to ICAT
https://sed-icat.norc.org
Phone 1-800-248-8649
Email: [email protected]

Citizenship Type:
1= U.S. Native
2= U.S. Naturalized
3= U.S. Type Unknown
4= Non U.S. Perm Resident ("Green Card")
5= Non U.S. Temp Visa Resident
6= Non U.S. Resident; Status Unknown

Race: (Select one or more)
1= American Indian or Alaska Native
2= Native Hawaiian or Pacific Islander
3= Asian
4= Black or African American
5= White

Hispanic:

Bachelor's Institution:

1=No, not Hispanic
2=Yes, Mexican or Chicano
3=Yes, Puerto Rican
4= Yes, Cuban
5= Yes, other Hispanic,
specify/Yes, Hispanic origin
unknown

US: Name/City or Branch
Foreign: Name/Country
No B.A.: "No B.A."

OMB No.: 3145-0019

Approval Expires: XX/XX/XXXX

X = Information already received
IPID
12345
12345
12345
12345

PROG
*
*
*
*

SU_ID
16111111
16111112
16111113
16111115

11/13/2014 8:55:04 AM

STUDENT
Student A name
Student B name
Student C name
Student D name

DOCTORAL
DATE
Aug-15
Aug-15
Dec-15
May-16

BIRTHDAY
MON DAY YEAR

SEX

CITIZENSHIP
TYPE COUNTRY

RACE

BA
HISP
BACHELORS INSTITUTION
NAME
LOCATION YEAR
CODE OTHER SPECIFY

DOCTORAL
FIELD OF STUDY
X
X
X
X

POST DEGREE LOCATION
IN U.S. VS. OUT OF U.S.?

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