Institutional Contacts

Please complete and return by xx/xx/xxxx to RTI International Survey of Earned Doctorates Upload to ICAT https://sed-ncses-icat.org/ Phone 1-877-256-8167 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: 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

Bachelor's Institution: US: Name/City or Branch Foreign: Name/Country No B.A.: "No B.A."

OMB No.: 3145-0019

Approval Expires: 05/31/2018

X = Information already received

DOCTORAL

BIRTHDAY

CITIZENSHIP

HISP

BACHELORS INSTITUTION

BA

DOCTORAL

POST DEGREE LOCATION

SCHOOL ID

SU_ID

STUDENT

DEGREE DATE

MON

DAY

YEAR

SEX

TYPE

COUNTRY

RACE

CODE

OTHER SPECIFY

NAME

LOCATION

YEAR

FIELD OF STUDY

IN U.S. VS. OUT OF U.S.?

12345

16111111

Student A name

Aug-16

X

12345

16111112

Student B name

Aug-16

X

12345

16111113

Student C name

Dec-16

X

12345

16111115

Student D name

May-17

X