Attachment F1
Louis Stokes Alliances for Minority Participation Bridge to the Doctorate (LSAMP-BD)
Monitoring System
LSAMP-BD: Number of Respondents, Frequency of Response, and Annual Hour Burden 13
LSAMP-BD: Hour Burden Estimates by Each Form and Aggregate Hour Burdens 14
LSAMP-BD: Estimates of Annualized Cost to Respondents for the Hour Burdens 15
Common Collection Categories
Questions |
Staff and Project Participant Characteristics1 |
Project Implementation Characteristics2 |
Project Outputs3 |
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 |
|
|
Bachelor’s Degree-awarding Institution (peer comparison students only) |
X |
|
|
LSAMP Alliance (to which the above LSAMP institution belongs) (BD students only) |
X |
|
|
Social Security Number (not required) |
X |
|
|
Student ID at the Institution (requested/optional) |
X |
|
|
Gender
|
X |
|
|
Ethnicity
|
X |
|
|
Race (choose one or more)
|
X |
|
|
Disability Yes (check yes if any of the following apply):
No Do not wish to provide |
X |
|
|
Citizenship—choose one:
|
X |
|
|
Date of bachelor's degree Month Year |
X |
|
|
Undergraduate Major (choose one or more)
|
X |
|
|
Undergraduate GPA |
X |
|
|
Undergraduate GPA Scale 4 point scale 5 point scale |
X |
|
|
LSAMP Level I or II Status: (BD students only) |
|
|
|
GRE Scores Verbal Reasoning Quantitative Reasoning Analytical Writing |
X |
|
|
Research experience during the undergraduate program-choose one
|
X |
|
|
GRE Scores Verbal Reasoning Quantitative Reasoning Analytical Writing
Please mark the checkbox if this student did not take the GRE |
X |
|
|
Date entered the STEM Graduate Program Month Year |
X |
|
|
Date began receiving BD funding (BD students only) Month Year |
X |
|
|
Date entered current graduate program (peer comparison students only) Month Year |
X |
|
|
Did this student complete any graduate work before receiving LSAMP BD funding (BD students only)
|
X |
|
|
Did this student complete any graduate work before entering the current program (peer comparison students only)
|
X |
|
|
Broad Field Area |
|
|
|
Field |
|
|
|
Degree —Choose Degree
|
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 (BD students only) |
X |
|
|
If no prior graduate degrees please provide the number of graduate credits completed prior to entering the current graduate program (peer comparison students only) |
X |
|
|
Teaching assistantship awarded prior to receiving LSAMP BD funding (BD students only)
|
X |
|
|
Teaching assistantship awarded prior to entering the current graduate program (peer comparison students only)
|
X |
|
|
Research assistantship awarded prior to receiving LSAMP BD funding (BD students only)
|
X |
|
|
Research assistantship awarded prior to entering the current graduate program (peer comparison students only)
|
X |
|
|
ANNUAL DATA |
|
|
|
As an undergraduate, did this student participate in LSAMP activities (peer comparison students only)
|
|
|
|
LSAMP Level I or II Status (peer comparison students only) |
|
|
|
Graduate Program |
X |
|
|
Intended Broad Major Area |
X |
|
|
Intended Major |
X |
|
|
Intended Degree (choose one or more)
|
X |
|
|
From which of these sources did this student receive financial support during the current reporting period (BD students only) NSF LSAMP BD Fellowship Yes/No Amount NSF other grant/fellow Yes/No Program Name Amount Institution attending Yes/No Type of support Government (federal/state/local) Yes/No Type of support Private funding Yes/No Type of support Other sources (please specify) Yes/No Amount No financial support received |
X |
|
|
From which of these sources did this student receive financial support during the current reporting period (peer comparison students only) NSF grant/fellow Yes/No Program Name Other sources (please specify) Yes/No No financial support received |
X |
|
|
From which of these sources did this student receive financial support to pursue graduate studies (i.e., participate in the graduate program listed in the baseline data form) at your institution at any time BEFORE this reporting period (peer comparison students only) NSF grant/fellow Yes/No Program Name Other sources (please specify) Yes/No No financial support received |
X |
|
|
LSAMP-BD Disbursement Method —choose one (BD students only) Monthly Quarterly By Semester Yearly |
X |
|
|
Is the LSAMP-BD 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
|
|
|
X |
Research Assistantship awarded during the current reporting period
|
|
|
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):
|
|
|
X |
Thesis Proposal - Date Approved: Month Year Not applicable; thesis proposal is not required |
|
|
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:
If yes, please provide funding source —choose one:
|
|
X |
|
Did the student leave without completing the program during the current reporting period:
|
|
X |
|
If yes, please provide the date the student left the program: Month Year |
|
X |
|
If he or she left, was it to continue Ph.D. elsewhere?
|
|
X |
|
If he or she left to continue Ph.D. elsewhere, please provide the transfer date: Month Year |
|
X |
|
Transfer institution name:
|
|
X |
|
Graduate program at transfer institution:
|
|
X |
|
Intended broad major area at transfer institution:
|
|
X |
|
Intended major at transfer institution:
|
|
X |
|
Intended degree at transfer institution:
|
|
X |
|
Current status at transfer institution:
Date graduated from transfer institution: Month Year
Date dropped out from transfer institution: Month Year
|
|
X |
|
If the student transferred, how were the responses to the transfer questions obtained?(choose one)
|
|
X |
|
Please provide the permanent contact information for this student. Student’s email address 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 |
|
|
FOLLOWUP DATA |
|
|
|
You indicated that you left the BD program. Did you return to complete your graduate studies? (BD students only)
|
|
X |
|
You indicated that you left the institution. Did you return to complete your graduate studies? (peer comparison students only)
|
|
X |
|
When did you return to continue your graduate studies? Month Year |
|
X |
|
If you returned to continue your graduate studies, in which program did you enroll? (choose one or more)
|
|
X |
|
Graduate program |
|
X |
|
Intended broad major area |
|
X |
|
Intended major |
|
X |
|
Did you return to [student’s original institution name]?
|
|
X |
|
If No, please provide the name of the institution in which you enrolled: |
|
X |
|
Please mark the checkbox if no followup data are available for this individual |
X |
|
|
Did you receive financial support for your M.S./Ph.D. from the following sources? (BD students only) NSF LSAMP BD Fellowship Yes/No Amount NSF other grant/fellow Yes/No Program Name Amount Institution attending Yes/No Type of support Government (federal/state/local) Yes/No Type of support Private funding Yes/No Type of support Other sources (please specify) Yes/No Amount No financial support received |
X |
|
|
Have you received a post doctorate appointment —choose one Yes No
If yes, please complete the following items Date: Month Year Institution Department Field |
|
|
X |
Are you currently employed —choose one
|
|
|
X |
When did you begin this job? Month Year |
|
|
X |
Is this job full-time —choose one
|
|
|
X |
Which of the following categories best describes your employer for this job? (choose one or more)
|
|
|
X |
Regarding your 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 you work.
|
|
|
X |
Position/Job Title (Broad category) |
|
|
X |
Position/Job Title (Specific category) |
|
|
X |
Is job STEM related —choose one
|
|
|
X |
Is your employer an educational institution —choose one
|
|
|
X |
Type of Educational Institution—choose one
|
|
|
X |
What is your faculty rank—choose one
|
|
|
X |
What is your tenure status—choose one
|
|
|
X |
How were the responses to the questions on this survey obtained —please choose one
|
|
X |
|
The estimated average number of annual respondents is 50, with an estimated annual response burden of 3,600 hours. The Web-based data collection is an annual activity of the LSAMP-BD initiative. There are approximately 50 participating institutions. New institutions participating in the LSAMP-BD initiative will be added to the program over the next three years. New institutions are selected to participate in the initiative at approximately the same rate as institutions leave the initiative as their funding expires. The respondents are BD data coordinators. The estimated annual hour burden per respondent was determined by taking the average number of data respondents for each participating BD institution from the previous collection cycles and the actual reported response burden for the BD and peer student data, based on a question in the Web-based data collection system asking how long it takes data respondents to complete the instrument.
The burden estimate is outlined below:
Respondent Type |
Estimated Average Annual No. of Respondents |
Estimated Average Annual Burden Hours Per Respondent |
Estimated Annual Burden Hour Total |
BD data coordinators |
50 |
72 |
3,600 |
Total |
50 |
|
3,600 |
There is only one form. This form accounts for the entire annual response burden of 3,600 hours. The annual burden by form was calculated as follows:
Form Type |
Respondent Type |
No. of Respondents |
Burden Hours Per Respondent |
Total Burden Hours |
BD data collection form |
BD data coordinators |
50 |
72 |
3,600 |
Total |
|
50 |
|
3,600 |
The overall annualized cost to the respondents is estimated to be $147,600. The following table shows the annualized estimate of cost to data coordinator respondents, who are generally university professors. This estimated hourly rate is based on a report from the American Association of University Professors, “Annual Report on the Economic Status of the Profession, 2011-12,” Academe, March–April 2012, Survey Report Table 4. According to this report, the average salary of an associate professor across all types of doctoral-granting institutions (public, private-independent, religiously affiliated) was $86,319. When divided by the number of standard annual work hours (2,080), this calculates to approximately $41 per hour.
Respondent |
No. of Respondents |
Burden Hours Per Respondent |
Average Hourly Rate |
Estimated Annual Cost |
|
BD data coordinators |
50 |
72 |
$41 |
$147,600 |
|
Total |
50 |
|
|
$147,600 |
Computing the annualized cost to NSF for the LSAMP BD data collection was done by taking the budgets for three years and calculating the costs for each of the following operational activities involved in producing, maintaining, and conducting the LSAMP BD data collection:
Operational Activities |
Cost Over Three Years |
System Development (includes initial development of the database and Web-based application, and later changes requested by the program, e.g., increased reporting tools, additional validations) |
$202,737 |
System Maintenance, Updates, and Technical Support (system requires updates each year before opening the collection; maintenance is required to keep the system current with technology, e.g., database servers, operating systems) |
$98,476 |
Data Collection Opening and Support (e.g., online and telephone support to respondents and contacting respondents to encourage completion of the questions), Reporting (as defined by HRD), and Followup Activities (e.g., providing data to other consultants) |
$127,475 |
Three-Year Total for All Operational Activities |
$428,688 |
The annualized cost was computed as one-third of the total three-year costs; thus, the annualized cost to NSF for the LSAMP BD data collection is $142,896.
BASELINE DATA |
Student Name (First, MI, Last) |
Previous Name (BD students only) |
LSAMP Institution the student was enrolled in (BD students only) |
Bachelor’s Degree-awarding Institution (peer comparison students only) |
LSAMP Alliance (to which the above LSAMP institution belongs) (BD students only) |
Social Security Number (not required) |
Student ID at the Institution (requested/optional) |
Gender
|
Ethnicity
|
Race (choose one or more)
|
Disability Yes (check yes if any of the following apply):
No Do not wish to provide |
Citizenship—choose one:
|
Date of bachelor's degree Month Year |
Undergraduate Major (choose one or more)
|
Undergraduate GPA |
Undergraduate GPA Scale 4 point scale 5 point scale |
LSAMP Level I or II Status: (BD students only) |
GRE Scores Verbal Reasoning Quantitative Reasoning Analytical Writing |
Research experience during the undergraduate program-choose one
|
GRE Scores Verbal Reasoning Quantitative Reasoning Analytical Writing
Please mark the checkbox if this student did not take the GRE |
Date entered the STEM Graduate Program Month Year |
Date began receiving BD funding (BD students only) Month Year |
Date entered current graduate program (peer comparison students only) Month Year |
Did this student complete any graduate work before receiving LSAMP BD funding (BD students only)
|
Did this student complete any graduate work before entering the current program (peer comparison students only)
|
Broad Field Area |
Field |
Degree —Choose Degree
|
Date degree awarded Month Year |
If no prior graduate degrees please provide the number of graduate credits completed prior to receiving LSAMP BD funding (BD students only) |
If no prior graduate degrees please provide the number of graduate credits completed prior to entering the current graduate program (peer comparison students only) |
Teaching assistantship awarded prior to receiving LSAMP BD funding (BD students only)
|
Teaching assistantship awarded prior to entering the current graduate program (peer comparison students only)
|
Research assistantship awarded prior to receiving LSAMP BD funding (BD students only)
|
Research assistantship awarded prior to entering the current graduate program (peer comparison students only)
|
ANNUAL DATA |
As an undergraduate, did this student participate in LSAMP activities (peer comparison students only)
|
LSAMP Level I or II Status (peer comparison students only) |
Graduate Program |
Intended Broad Major Area |
Intended Major |
Intended Degree (choose one or more)
|
From which of these sources did this student receive financial support during the current reporting period (BD students only) NSF LSAMP BD Fellowship Yes/No Amount NSF other grant/fellow Yes/No Program Name Amount Institution attending Yes/No Type of support Government (federal/state/local) Yes/No Type of support Private funding Yes/No Type of support Other sources (please specify) Yes/No Amount No financial support received |
From which of these sources did this student receive financial support during the current reporting period (peer comparison students only) NSF grant/fellow Yes/No Program Name Other sources (please specify) Yes/No No financial support received |
From which of these sources did this student receive financial support to pursue graduate studies (i.e., participate in the graduate program listed in the baseline data form) at your institution at any time BEFORE this reporting period (peer comparison students only) NSF grant/fellow Yes/No Program Name Other sources (please specify) Yes/No No financial support received |
LSAMP-BD Disbursement Method —choose one (BD students only) Monthly Quarterly By Semester Yearly |
Is the LSAMP-BD stipend or payment based on academic performance —choose one (BD students only) Yes No |
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 |
Number of graduate courses credits completed during the current reporting period |
Teaching assistantship awarded during the current reporting period
|
Research Assistantship awarded during the current reporting period
|
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):
|
Thesis Proposal - Date Approved: Month Year Not applicable; thesis proposal is not required |
Master’s Degree - Date Awarded: Month Year |
Ph.D. Qualifying Examinations - Date passed: Month Year |
Ph.D. 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 |
Did the student receive post-LSAMP BD funding to continue graduate studies during the current reporting period (BD students only)—choose one:
If yes, please provide funding source —choose one:
|
Did the student leave without completing the program during the current reporting period:
|
If yes, please provide the date the student left the program: Month Year |
If he or she left, was it to continue Ph.D. elsewhere?
|
If he or she left to continue Ph.D. elsewhere, please provide the transfer date: Month Year |
Transfer institution name:
|
Graduate program at transfer institution:
|
Intended broad major area at transfer institution:
|
Intended major at transfer institution:
|
Intended degree at transfer institution:
|
Current status at transfer institution:
Date graduated from transfer institution: Month Year
Date dropped out from transfer institution: Month Year
|
If the student transferred, how were the responses to the transfer questions obtained?(choose one)
|
Please provide the permanent contact information for this student. Student’s email address Student’s personal email address Address City State Zip Code Country Phone Ext. |
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. |
FOLLOWUP DATA |
You indicated that you left the BD program. Did you return to complete your graduate studies? (BD students only)
|
You indicated that you left the institution. Did you return to complete your graduate studies? (peer comparison students only)
|
When did you return to continue your graduate studies? Month Year |
If you returned to continue your graduate studies, in which program did you enroll? (choose one or more)
|
Graduate program |
Intended broad major area |
Intended major |
Did you return to [student’s original institution name]?
|
If No, please provide the name of the institution in which you enrolled: |
Please mark the checkbox if no followup data are available for this individual |
Did you receive financial support for your M.S./Ph.D. from the following sources? (BD students only) NSF LSAMP BD Fellowship Yes/No Amount NSF other grant/fellow Yes/No Program Name Amount Institution attending Yes/No Type of support Government (federal/state/local) Yes/No Type of support Private funding Yes/No Type of support Other sources (please specify) Yes/No Amount No financial support received |
Have you received a post doctorate appointment —choose one Yes No
If yes, please complete the following items Date: Month Year Institution Department Field |
Are you currently employed —choose one
|
When did you begin this job? Month Year |
Is this job full-time —choose one
|
Which of the following categories best describes your employer for this job? (choose one or more)
|
Regarding your 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 you work.
|
Position/Job Title (Broad category) |
Position/Job Title (Specific category) |
Is job STEM related —choose one
|
Is your employer an educational institution —choose one
|
Type of Educational Institution—choose one
|
What is your faculty rank—choose one
|
What is your tenure status—choose one
|
How were the responses to the questions on this survey obtained —please choose one
|
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, and research methods.
3 Elements of these characteristics include: Research findings, publications, presentations, degrees granted, and educational materials.
Page
File Type | application/msword |
File Title | Common |
Author | Larry Suter |
Last Modified By | 21773 |
File Modified | 2012-12-20 |
File Created | 2012-12-20 |