Form 1 OMBFT- HiSTEP- Alumni

DRAFT - OMB FAST TRACK REGISTRATION - HISTEP ALUMNI
OMB Number: 0925-0740 (Expiration Date: May 2019)
Public reporting burden for this collection of information is estimated to average 10-minutes per
submission. An agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a currently valid OMB control number. Send comments
regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC
7974, Bethesda, MD 20892-7974, ATTN: PRA 0925-0740. Do not return the completed form to this
address.

GENERAL INFORMATION
First Name (Given Name):*

Last Name (Family Name):*

Email Address:*
(check accuracy)

What year did you participate in HiSTEP?*
(a 4-digit numeric response required; enter 0000 if you did not participate in HiSTEP)

What year did you participate in HiSTEP 2.0?*
(a 4-digit numeric response is required; enter 0000 if you did not participate in HiSTEP 2.0)

Alumni Database Report Date*
(select the appropriate season and year)

COLLEGE / UNIVERSITY APPLICATION INFORMATION

Are you planning on attending college in Fall 2017?*
Yes

No

If attending college, have you declared your major for Fall 2017?
(displayed if answered YES to attending college in Fall 2017)
Yes

No

If yes, what is your major Fall 2017?
(displayed if answered YES to attending college in Fall 2017)

Which colleges / universities did you apply for admission (write NA if already in
college)?
(displayed if answered YES to attending college in Fall 2017)

Which colleges / universities offered you acceptance (write NA if already in college)?
(displayed if answered YES to attending college in Fall 2017)

Which college / university will you be attending, if known at this time?
(displayed if answered YES to attending college in Fall 2017)

College Level for Fall 2017:
(display if answered YES to attending college in Fall 2017)

Do you plan on applying to college in the near future?
(displayed if answered NO to attending college in Fall 2017)
Yes

No

If not applying to college for the fall, what are your plans?
(displayed if answered NO to attending college in Fall 2017)

If other plans, please specify in the space provided:
(displayed if answered OTHER to plans for the fall)

What is your career goal once you graduate from college?

Are you conducting research during your academic school year (whether you are in
high school or in college)?
Yes

No

If yes, where are you conducting research (institution or university or college, etc...)?
(displayed if answered YES to conducting research during academic school year)

If yes, what area of research?
(displayed if answered YES to conducting research during academic school year)

SCHOLARSHIP / FELLOWSHIP INFORMATION
Have you applied for any scholarships or fellowships?*
Yes

No

Which scholarships or fellowships have you applied?
(display if answered YES to applying to scholarships or fellowships)

Have you been awarded a scholarship or fellowship?
(display if answered YES to applying to scholarships / fellowships)
Yes

No

Which scholarships or fellowships you have been awarded?
(display if answered YES to applying to scholarships / fellowships)

Have you accepted a scholarship or fellowship?*
(display if answered YES to applying to scholarships / fellowships)
Yes

No

Which scholarships / fellowships have you accepted?
(display if answered YES to applying to scholarships / fellowships)

SUMMER PLANS
What did you do this past summer?

What are your plans for next summer?

Have you applied for any internships or programs?*
Yes

No

List all the internships or programs you have applied for admission.
(display if answered YES to applying for summer internship / programs)

Have you been accepted into an internship or program?
(display if answered YES to applying for summer internship / programs)
Yes

No

List all the internships or programs that you have been accepted for admission.

(display if answered YES to applying for summer internship / programs)

Have you decided which internship or program you will accept?
(display if answered YES to applying for summer internship / programs)
Yes

No

Which internship or program have you accepted?
(display if answered YES to applying for summer internship / programs)

MEETINGS WITH COLLEGE ADVISOR
Have you met with the HiSTEP College Advisor?*
Yes

No

How many times do you meet with the HiSTEP College Advisor?
(display if answered YES to meeting with college advisor)
10

9

8

7

6

5

4

3

2

1

How did these meetings help you navigate and prepare for the college application
process?
(display if answered YES to meeting with a HiSTEP College Advisor)

Is there any reason why you chose not to meet with our college advisor?
(display if answered NO to meeting with a HiSTEP College Advisor)

FINAL THOUGHTS

What was the most significant helpful item that you learned from HiSTEP?

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