Annual IHE Survey for Comprehensive and Targeted MSPs - IHE Partners

Attachment C
Annual IHE Survey

OMB # 3145-0199
Expires: X/XX/XX

Math and Science Partnership Program
Annual Institution of Higher Education (IHE) Survey
for Comprehensive and Targeted MSPs

Sponsored by the
National Science Foundation
Conducted by
Westat
1650 Research Boulevard
Rockville, Maryland 20850

Privacy Notice
Information from this monitoring system will be retained by the National Science Foundation, a federal agency, and will be an
integral part of its Privacy Act System of Records in accordance with the Privacy Act of 1974 and maintained in the Education
and Training System of Records 63 Fed. Reg. 264, 272 (January 5, 1998). These are confidential files accessible only to
appropriate National Science Foundation (NSF) officials, their staffs, and their contractors responsible for monitoring, assessing,
and evaluating NSF programs. Only data in highly aggregated form, or data explicitly requested as "for general use," will be
made available to anyone outside of the National Science Foundation for research purposes. Data submitted will be used in
accordance with criteria established by NSF for monitoring research and education grants, and in response to Public Law 99-383
and 42 USC 1885c.
Public Burden
Paperwork Reduction Act Notice. The Paperwork Reduction Act of 1995 says we must tell you why we are collecting this
information, how we will use it and whether you have to give it to us. The reasons and purpose of this survey are described in the
introduction and instructions for this survey and your response is voluntary. Failure to provide full and complete information,
however, may reduce the possibility of NSF continuing support for the award or project subject to this monitoring survey. An
agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a
valid OMB control number. The OMB control number for this survey is 3145-0199. The estimated average burden associated
with this collection of information is 8 hours per response, depending on individual circumstances. Comments concerning the
accuracy of this burden estimate and suggestions for reducing the burden should be sent to Suzanne Plimpton, Reports Clearance
Officer for OMB 3145-0199, NSF/OGC, 4201Wilson Boulevard, Arlington, VA 22230.

Annual Institution of Higher Education (IHE) Survey
For the [INSERT SCHOOL YEAR] School Year
The National Science Foundation (NSF) is conducting a survey of its Math and Science Partnership
(MSP) projects. The purpose is to assess the overall implementation of the MSP program and to monitor
the progress of individual MSP grants. This survey has been designed to collect information about each
Institution of Higher Education (IHE) that is serving as a lead, core or supporting partner in the Math and
Science Partnership (MSP) Program.

INSTRUCTIONS FOR COMPLETING THE SURVEY
It is recommended that you review the Primer (which can be accessed electronically by clicking on
"Help" in the menu on the top of the page) before beginning the survey. The Primer provides general
instructions and navigation information.
As you are completing the survey, please click the Save & Continue button after you respond to each
item. Once an item or section is saved, you may use the menu below or the Question Guide to return to an
item and revise your response. If you exit the system without saving, you will lose any unsaved data.
To print and view completed sections of this survey, click on "Reports" in the menu on the top of the
page.

Please complete each of the following sections as they pertain to the following Institution of Higher
Education (IHE) by November XX, 200X: [INSERT NAME OF IHE]

Contact Information

IHE Participants in the MSP

MSP-supported Pre-service Courses

Report Status: Not Complete

If you have any questions about how to respond to a particular item you should contact your principal
investigator. Questions about how to navigate the system should be referred to:
Molly Hershey-Arista
1-800-937-8281, ext. 4908
[email protected]
Westat
1550 Research Boulevard
Rockville, Maryland 20850

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Contact Information
This section obtains information on the individual who should be contacted for any followup questions about this submission.

1. Provide the following contact information for the individual primarily responsible for
completing this survey:
Name:

_________________________________________________________________

Title:

_________________________________________________________________

Street address:

_________________________________________________________________

City:

_________________________________________________________________

State:

_________________________________________________________________

Zip code:

_________________________________________________________________

Phone number:

_________________________________________________________________

Fax number:

_________________________________________________________________

E-mail:

_________________________________________________________________

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IHE Participants in the MSP
This section is designed to obtain information on the number of individuals at your IHE
that participated in your MSP during the [INSERT SCHOOL YEAR] school year.
1. Indicate the number of IHE individuals who:


Were involved in the development and/or delivery of MSP activities during the [INSERT
SCHOOL YEAR] school year (e.g., IHE education faculty who revised a pre-service course to align

with state standards, IHE STEM faculty who presented at a professional development seminar).



Were recipients of MSP activities during the [INSERT SCHOOL YEAR] school year (e.g.,
IHE STEM faculty who received professional development, pre-service students who enrolled in/completed
an MSP-revised pre-service course)

NOTE—individuals who developed/delivered MSP activities and were also recipients of MSP activities should
be counted under both columns. However, no individual should be counted more than once in each column.

Enter an “X” in all cells where information is not currently available.
Number of IHE individuals
involved in the development
and/or delivery of MSP
activities
IHE STEM faculty (tenure track)
IHE STEM faculty (non-tenure track)
IHE education faculty (tenure track)
IHE education faculty (non-tenure track)
IHE administrators with or without
instructional/research responsibilities (e.g.,
deans, department chairs)
K-12 teachers in residence
MSP liaisons/coordinators
STEM undergraduate students
Pre-service undergraduate and alternative
certification students
Graduate students (including doctoral
candidates)
Postdoctoral students
Other (specify):

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Number of IHE individuals
who were recipients of MSP
activities

MSP-supported Pre-service Courses
This section obtains information about each MSP-supported pre-service undergraduate or
graduate course/seminar that was developed or offered at your IHE during the [INSERT
SCHOOL YEAR] school year. For the purpose of this collection, MSP-supported refers to
the following types of contributions:


MSP funds were used to develop a new pre-service course/seminar



MSP funds were used to modify or enhance a pre-existing pre-service course/seminar

To add an MSP-supported course, click on the Add Course button below.
To provide information on a course listed below, click on the link in the matrix (in the column titled
Name of Course/Seminar)

Name of
Course/Seminar

Number of
Course/Seminar

Department

Information Complete?

(from Item 1)

(from item 2)

(from item 3)

(yes or no)

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1. Provide the name of the MSP-supported undergraduate or graduate course/seminar: 1

2. Provide the number (e.g., MATH210) of the MSP-supported undergraduate or graduate
course/seminar:

3. Provide the department for the MSP-supported undergraduate or graduate course/seminar:

4. What was the nature of MSP’s contribution to this course during the [INSERT SCHOOL
YEAR] school year? (Check all that apply for the [INSERT SCHOOL YEAR] school year)

 A new course/seminar was developed using MSP funds
 A pre-existing course/seminar was modified or enhanced using MSP funds
 Other (specify): ______________________________________________________________

1

Questions 1, 2, 3, 4, 5, 6, and 7 are only asked the first time a course is entered. These questions are not repeated in subsequent years.

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5. What subject matter does this course cover? (check all that apply)














Astronomy
Atmospheric Sciences
Biological Sciences
Chemistry
Computer Science
Education (specify area of education) ______________________
Engineering
Geosciences
Mathematical Sciences
Ocean Sciences
Physics
Other (specify): ______________________________________

6. What was the level for this course? (check one response)
 Undergraduate
 Graduate

7. Provide a brief description (i.e., 250 words or less) of the purpose and scope/content of this
course:

8. Were any students enrolled in this course during the [INSERT SCHOOL YEAR] school year?
(check one response)

 Yes (complete Q9)
 No, course still under development (end of section)
 No, course was fully developed, but not offered during the [INSERT SCHOOL YEAR] school
year (end of section)

 No, course was eliminated 2
 No, other (specify): ___________________________________________ (end of section)

2

Question 8, option d (“No, course was eliminated”) is only asked if the course was listed in a previous year.

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9.

How many students took this course/seminar during the [INSERT SCHOOL YEAR] school
year? (Provide this information for all students who were enrolled in all sections of this course during the
[INSERT SCHOOL YEAR] school year.)

Enter an “X” in all cells where information is not currently available.
Total number of students enrolled in all
sections of the course during the [INSERT
SCHOOL YEAR] school year
Total
Gender
Male
Female
Not Reported

Hispanic
or Latino

NOT
Hispanic or
Latino
OR
Ethnicity
NOT
Reported 4

Race/Ethnicity
Race Not Reported 3
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
More than One Race Reported
SUB-TOTAL: Hispanic or Latino
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
More than One Race Reported
SUB-TOTAL: Non-Hispanic or Latino

(auto total)

(auto total)

Neither Race nor Ethnicity Reported 5

3

Use “Race Not Reported” to provide information about Hispanic or Latino students for whom race is not reported or unknown.

4

Use “NOT Hispanic or Latino OR Ethnicity NOT Reported” to provide race information for those students (1) that are not
Hispanic or Latino, or (2) for whom ethnicity is not reported or unknown.

5

Use “Neither Race nor Ethnicity Reported” for those students for whom both race and ethnicity are unknown.

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