mods to BUILD Student Annual Followup Survey

DPC (BUILD) Student Annual Follow-Up Survey

Gray highlight Wording and order changes for flow, clarity, human subjects concerns, and appropriateness for undergraduate respondents

Green highlight Added from YFCY

Yellow highlight Deleted for undergraduates (note that only undergraduates will be completing the survey in 2017)

Blue highlight Skip for freshmen

BUILD DPC Student Annual Follow-Up Survey

You have been selected to be a part of a national study on student experiences. Your schooluniversity, <Name of institution>, is part of the Diversity Program Consortium, involved in a nationallarge effort funded by the National Institutes of Health (NIH) to improved the educational and career success of students and facultyencourage student and faculty participation in biomedical, behavioral, clinical, and social science fields. This effort, the NIH Diversity Consortium, is seeking to understand what programs and strategies benefit students interested in these careers to inform funding and programs. By taking time to complete this survey, you will help increase knowledge and improve education for the next generation of students

The University of California, Los Angeles (UCLA) serves as the coordinating center of this national effort and is in charge of will be collecting information about the experiences and career choices of a variety of studentsse programs. For some analyses, iIt iswill be important to compare students and faculty in biomedical majors at <Name of institution> to those at other institutions as well as students and faculty interested in other fields.

<Name of institution> has provided UCLA your name and contact information. because yYou may have participated in activities on your campus that are part of the Consortium’s work. previously contributed to this effort by completing on of the national student surveys offered at your institution this past academic year. By taking this survey, you are giving permission for your school to share information from your student record such as demographics, the courses you take, and the grades you receive in your courses with the UCLA team. You are also giving the UCLA team permission to share the information you provide with your institution for research purposes and to contact you every year or so for follow-up surveys to understand your career choices after you leave (institution). Only with the continued participation and support of students such as yourself will we be able to show the value of the various programs offered through your institution to help students such as yourself succeed. All of the information you provide will be protected and secured to the extent permitted by law.

In this survey, we will ask you about publications and grants. You have the option to upload a document that includes such information (such as a resume) instead of entering this information directly for each publication or grant in the survey.

Public reporting burden for this collection of information is estimated to average 25 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 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 (0925-0747*). Do not return the completed form to this address.

1. Current position School and work

First, we would like to ask you about any current school or work activities.

1. Last year, you told us you were _____ level at _____ institution. Has that changed? Are you still in school?

No (skip to question #1e)

Yes and I am still in school (go to #1a)

Yes and I am not still in school I choose not to answer (skip to question #2)

1. Level

Undergraduate

Graduate

a. Expected completion date for degree program (year): _____

b. Status:

Full Time

Part Time

c. Institution: _________________

d. Major: _________________ [Pull down menu – see final page for list]

Go to question #2

e. Please tell us your current status

I graduated from my previous institution

I did not graduate but do have plans to attend school in the next 2 years

I did not graduate and do NOT have plans to attend school in the next 2 years

Go to question #2

2. Now we would like to ask you about any employment or internships. Last year, you told us you were ___ at ___. Has that changed? Are you current working (for pay), interning, or volunteering?

No (skip to question #3)

Yes (go to #2a)

I choose not to answer (skip to question #3)

a. Please review the list below and check all that apply.

Working (including internships and significant volunteer positions)

Retired

Unemployed, looking for work

Otherwise not in labor force

Other (specify): _________________

b. Paid Employment a. Please describe any work, internship, or volunteering (check all that apply):

Full Time

Part Time

Internship or student placement

Seasonal (full-time or part-time)

No paid position Volunteer, unpaid internship, or other unpaid position (If this is only response checked, Skip to question #2d)

b. Please briefly describe your paid position(s):

Position: ________________________

Company/Institutioin: __________________

c. Is this paid position related to research?

No

Yes

If no volunteer activity, go to #3

d. Is this new job/position considered a promotion or advancement?

No

Yes

e. d. Volunteer

Please briefly describe your volunteer / unpaid position:

Position: _________________

Company: _________________

No volunteer position

f. e. Is this volunteer position related to research?

No

Yes

3. During the past year, did you complete any degree or certificate program? Certificate programs are those that require completion of multiple units over extended months or years. Do not include one-time workshops.

No (skip to question #4)

Yes

I choose not to answer (skip to question #4)

If yes, please indicate the following:

1. Degree / certificate: _________________

2. Major / area of study: _________________

3. From which institution or school: _________________

4. Date awarded: MM / YR

4. During the past year, did you apply to any degree or certificate program? Certificate programs are those that require completion of multiple units over extended months or years. Do not include one-time workshops.

No (skip to question #5)

Yes

I choose not to answer (skip to question #5)

If yes, please indicate the following:

1. Degree / certificate the program awards: _________________

2. Major / area of study: _________________

3. Institution: _________________

4. Date applied: MM / YR

5. Status of application:

Accepted and will attend

Accepted and will not attend

Waitlisted

Pending

Not accepted

5. During the past year, did you receive any scholarships or grants for education expenses that you do not need to repay?

No (skip to question #6)

Yes

I choose not to answer (skip to question #6)

If yes, please indicate the following:

1. Name of scholarship/grant: ______________________________

(Please enter “Don’t know” if you are not sure of the name.)

2. Amount (total value including value of any fee/tuition waivers):

Less than $1,000

$1,000-4,999

$5,000-9,999

$10,000 or more

3. Period of the award: MM/YYYY to MM/YYYY

4. Was this award based on:

Need

Merit

Need and Merit

Other (specify): ________________

6. Do you have any education debt?

No (skip to question #7)

Yes

I choose not to answer (skip to question #7)

If yes, please indicate the following:

1. Total amount that you owe: $ __ __ __, __ ___ ___

Less than $5,000

$5,000-9,999

$10,000-19,999

$20,000 or more

I don’t know how much I owe

1. How much you borrowed during the past year: $ __ __ __, __ __ __

Less than $1,000

$1,000-4,999

$5,000-9,999

$10,000 or more

7. Please attach your most recent academic vita (such as a CV)

7. Do you have any concern about your ability to finance your college education?

None (I am confident that I will have sufficient funds)

Some (but I probably will have enough funds)

Major (not sure I will have enough funds to complete college)

8. Plea se tell us which of the following activities you participated in since last time during summer 2016 or the 2016-17 school year. Check all that apply.

Other tTuition or stipend program

Other sSummer program (e.g., Summer Research Experience)

Academic advising and support beyond that provided to all students at your institution (e.g., specialized tutoring, STEM advising)

Mentoring (A mentor provides guidance, assistance, and encouragement on professional and academic issues.)

Research training (e.g., workshops, training, field experience, conferences)

Other cCareer advancement programs (e.g., networking, professional exposure, GRE Prep, field trips, career panels, applications)

9. In the past year, have you participated in a pre-professional or departmental club?

No

Yes

10. To allow us to follow your professional accomplishments, please provide any of the following identifiers that you may have:

1. LinkedIn ID _______________________

I do not have one

2. ORCID ID _________________

I do not have one

3. NIH eRA Commons ID ___________________

I do not have one

1. Mentoring

This next section concerns your experiences with mentoring in a variety of contexts.

A mentor is someone who provides guidance, assistance, and encouragement on professional and academic issues. A mentor can be either someone who is more experienced (or senior) than you or someone who is at an education or professional level similar to you (a “peer”).

A mentee is someone who receives guidance or assistance from a mentor. A mentee can be someone less experienced (or junior) than you or someone who is your peer.

A mentoring relationship can be formal (with a set schedule and perhaps arranged by your institution) or informal.

11. First, we would like to ask you about a mentor who is senior to you. Do you have a faculty member or someone else who is more senior than you whom you consider a mentor?

No (Skip to question #17)

Yes

I choose not to answer (skip to question #17)

1. How many different mentors do you regularly work with? ______

2. For the mentor you work with most closely (your primary mentor), please provide the following information:

Position: ____________________________

Institution/ Company: __________________________

Discipline: ___________________________

3. Which of the following does your primary mentor help you with? (choose all that apply)

Research, in general (e.g., guidance related to finding literature, research techniques, and selecting a research topic)

Research, sSpecialized research issues (e.g., just on statistics or instrumentation)

Educational choices and strategies (e.g., guidance in selecting coursework, further educational opportunities)

Career planning (e.g., giving advice, helping find opportunities)

Emotional support (e.g., listening to personal concerns)

Other (specify): ________________________________

4. How do you usually communicate with your primary mentor?

In-person

Phone/Skype

Email/Text

Other (specify): ______________

5. How often do you usually communicate with your primary mentor about your research?

Weekly or more often

Monthly

Several time a year

Annually or less

6. How did you find this mentor? (Note: Your local BUILD program is called <local campus name>)

Through your local campus BUILD

They were assigned in some other way by your department or campus

You were matched / linked through the National Research Mentoring Network (NRMN)

Matched / linked through some other formal program

You sought out your mentor independently

Other (specify): ______________

12. Please rate how skilled you feel your primary mentor was in the following areas:
			Not at all Extremely
	a. Active listening		1	2	3	4	5	6	7	N/A
	b. Providing constructive feedback		1	2	3	4	5	6	7	N/A
	c. Establishing a relationship based on trust		1	2	3	4	5	6	7	N/A
	d. Identifying and accommodating different communication styles		1	2	3	4	5	6	7	N/A
	e. Employing strategies to improve communication		1	2	3	4	5	6	7	N/A
	f. Coordinating effectively with other mentors with whom you work with		1	2	3	4	5	6	7	N/A
	g. Working with you to set clear expectations of the mentoring relationship		1	2	3	4	5	6	7	N/A
	h. Aligning his/her expectations with your own		1	2	3	4	5	6	7	N/A
	i. Considering how personal and professional differences may impact expectations		1	2	3	4	5	6	7	N/A
	j. Working with you to set research goals		1	2	3	4	5	6	7	N/A
	k. Helping you develop strategies to meet goals		1	2	3	4	5	6	7	N/A
	l. Accurately estimating your level of scientific knowledge		1	2	3	4	5	6	7	N/A
	m. Accurately estimating your ability to conduct research		1	2	3	4	5	6	7	N/A
	n. Employing strategies to enhance your understanding of the research		1	2	3	4	5	6	7	N/A
	o. Motivating you		1	2	3	4	5	6	7	N/A
	p. Building your confidence		1	2	3	4	5	6	7	N/A
	q. Stimulating your creativity		1	2	3	4	5	6	7	N/A
	r. Acknowledging your professional contributions		1	2	3	4	5	6	7	N/A
	s. Negotiating a path to professional independence with you		1	2	3	4	5	6	7	N/A
	t. Taking into account the biases and prejudices s/he brings to your mentor/mentee relationship		1	2	3	4	5	6	7	N/A
	u. Working effectively with mentees whose personal background is different from his/her own (age, race, gender, class, region, culture, religion, family composition etc.)		1	2	3	4	5	6	7	N/A
	v. Helping you network effectively		1	2	3	4	5	6	7	N/A
	w. Helping you set career goals		1	2	3	4	5	6	7	N/A
	x. Helping you balance work with your personal life		1	2	3	4	5	6	7	N/A
	y. Understanding his/her impact as a role model for you		1	2	3	4	5	6	7	N/A
	z. Helping you acquire resources		1	2	3	4	5	6	7	N/A

13. Please respond to the following statements about your primary mentor.

	My mentor did not do this	My mentor tried to do this but was ineffective	My mentor did this sometimes and was effective	My mentor did this frequently, and was effective
My mentor gave me an overview of how my research fit into an overall research project.	1	2	3	4
My mentor helped me develop my research skills.	1	2	3	4
My mentor showed interest in my research project.	1	2	3	4
My mentor was available to me when I had problems or questions about my research.	1	2	3	4
My mentor offered constructive feedback when necessary.	1	2	3	4
My mentor and I developed a relationship based on trust.	1	2	3	4
My mentor understood how I learn best.	1	2	3	4
My mentor created an environment that allowed me to achieve my goals.	1	2	3	4
My mentor seemed so busy that I was afraid to interrupt her/him.	1	2	3	4
My mentor had an effective mentoring style.	1	2	3	4
My mentor acted as a positive role model.	1	2	3	4
My mentor showed interest in me as a person.	1	2	3	4
My mentor fostered my independence.	1	2	3	4
My mentor fostered confidence in my skills.	1	2	3	4
My mentor appreciated my contributions.	1	2	3	4
My mentor encouraged me to be creative.	1	2	3	4
My mentor made me enthusiastic about my project.	1	2	3	4
My mentor helped me feel curious about my project.	1	2	3	4
My mentor treated me as a colleague.	1	2	3	4
My mentor helped me decide on a career path.	1	2	3	4
My mentor communicated his/her expectations of me.	1	2	3	4
My mentor respected my goals.	1	2	3	4
My mentor allowed me to take ownership in my research.	1	2	3	4
My mentor created an environment where I felt safe to make mistakes.	1	2	3	4
My mentor made me feel included in the lab.	1	2	3	4
My mentor regularly assessed skills and knowledge that I gained in the lab.	1	2	3	4

134. In your mentoring relationship, how important is it to you that your primary mentor does the following:

	Not Important	Somewhat Important	Very Important
Is willing to discuss diversity	1	2	3
Considers their own cultural background, as well as yours	1	2	3
Values and respects cultural differences	1	2	3

145. In your mentoring relationship, how skilled is your primary mentor in the following:

	Not Skilled	Somewhat Skilled	Very Skilled
Discussing diversity	1	2	3
Considerings their own cultural background, as well as yours	1	2	3
Valuinges and respectings cultural differences	1	2	3

156a. How would you rate the overall quality of the mentoring you received from your primary mentor?

Very Low Average Very High
1	2	3	4	5	6	7

156b. How satisfied are you with the mentoring you are receiving from your primary mentor?

Not at all						Extremely
1	2	3	4	5	6	7

167. To what extent do you feel your primary mentor is meeting your expectations?

Very Low Average Very High
1	2	3	4	5	6	7

PEER MENTORS

In addition to having mentors who are senior to themselves, many people also have mentors that are at a similar educational or professional level as themselves (a peer). For the next set of items, please consider any of your peer mentors.

178. Do you have someone at a similar educational or professional level as you (i.e., a peer) whom you consider an academic/career mentor?

No (skip to question #18)

Yes

I choose not to answer (skip to question #18)

1. How many different peer mentors do you have? _________

2. Which of the following do your peer mentors help you with? (Choose all that apply)

Research issues

Social and emotional needs (e.g., sharing concerns about school)

Tangible help (e.g., advice about faculty and classes, help with writing)

Networking assistance (e.g., helping you meet other people in your field)

Career planning (e.g., giving advice, helping find opportunities)

Other (specify): _______________________________

3. How do you usually communicate with your primary peer mentor?

In-person

Phone/Skype

Email/Text

Other (specify): ______________

4. How often do you usually communicate with your primary peer mentor?

Weekly

Monthly

Several times a year

Annually or less

5. How did you find this mentor?

Through < local campus name for BUILD >

They were assigned in some other way by your department or campus

You were matched through the National Research Mentoring Network (NRMN)

Matched through some other formal program

You sought out your mentor independently

Other (specify): ______________

SERVING AS A MENTOR [SKIP FOR FRESHMEN]

Now we would like to ask you about any mentoring that you do. This first set of items asks about mentoring YOU may do with those you are JUNIOR to you.

189. Do you have anyone who you currently mentor about academic issues who is junior to you?

No (skip to question #23)

Yes

I choose not to answer (skip to question #23)

1. How many different people do you regularly mentor currently? ______

2. At what education level are the people you mentor? (Choose all that apply)

College students

High school students

Middle or elementary school students

3. Which of the following do you help your mentees with? (Choose all that apply)

Research issues

Social and emotional needs (e.g., sharing concerns about school)

Tangible help (e.g., advise about faculty and classes, help with writing)

Networking assistance (e.g., helping you them meet other people in your field)

Career planning (e.g., giving advice, helping find opportunities)

Other (specify): ___________________________

4. How do you usually communicate with your mentees?

In-person

Phone/Skype

Email/Text

Other (specify): ______________

5. On average, how often do you usually communicate with your mentees?

Weekly or more often

Monthly

Several times a year

Annually or less

6. How did you first connect with your mentees? (Choose all that apply; Note: Your local BUILD program is called <local campus name>)

Through your local BUILD program

They were assigned in some other way by your department or campus

Matched / linked through some other formal program

They sought you out independently

Other (specify): _________________

1920. Please rate how skilled you feel you are in each of the following areas when mentoring those junior to you:

	Not at all Extremely
a. Active listening	1	2	3	4	5	6	7	N/A
b. Providing constructive feedback	1	2	3	4	5	6	7	N/A
c. Establishing a relationship based on trust	1	2	3	4	5	6	7	N/A
d. Identifying and accommodating different communication styles	1	2	3	4	5	6	7	N/A
e. Employing strategies to improve communication with mentees	1	2	3	4	5	6	7	N/A
f. Coordinating effectively with your mentees’ other mentors	1	2	3	4	5	6	7	N/A
g. Working with mentees to set clear expectations of the mentoring relationship	1	2	3	4	5	6	7	N/A
h. Aligning your expectations with your mentees’	1	2	3	4	5	6	7	N/A
i. Considering how personal and professional differences may impact expectations	1	2	3	4	5	6	7	N/A
j. Working with mentees to set research goals	1	2	3	4	5	6	7	N/A
k. Helping mentees develop strategies to meet goals	1	2	3	4	5	6	7	N/A
l. Accurately estimating your mentees’ level of scientific knowledge	1	2	3	4	5	6	7	N/A
m. Accurately estimating your mentees’ ability to conduct research	1	2	3	4	5	6	7	N/A
n. Employing strategies to enhance your mentees’ knowledge and abilities	1	2	3	4	5	6	7	N/A
o. Motivating your mentees’	1	2	3	4	5	6	7	N/A
p. Building your mentees’ confidence	1	2	3	4	5	6	7	N/A
q. Stimulating your mentees’ creativity	1	2	3	4	5	6	7	N/A
r. Acknowledging your mentees’ professional contributions	1	2	3	4	5	6	7	N/A
s. Negotiating a path to professional independence with your mentees	1	2	3	4	5	6	7	N/A
t. Taking into account the biases and prejudices you bring to the mentor/mentee relationship	1	2	3	4	5	6	7	N/A
u. Working effectively with mentees whose personal background is different from your own (age, race, gender, class, region, culture, religion, family composition etc.)	1	2	3	4	5	6	7	N/A
v. Helping your mentees network effectively	1	2	3	4	5	6	7	N/A
w. Helping your mentees set career goals	1	2	3	4	5	6	7	N/A
x. Helping your mentees balance work with their personal life	1	2	3	4	5	6	7	N/A
y. Understanding your impact as a role model before your their research experience	1	2	3	4	5	6	7	N/A
z. Helping your mentees acquire resources	1	2	3	4	5	6	7	N/A

201. In your mentoring relationship, how important is it to you that YOU do the following:

	Not Important	Somewhat Important	Very Important
Be willing to discuss diversity issues	1	2	3
Consider your mentees’ their own cultural background and your own	1	2	3
Value and respect cultural differences	1	2	3

212. In your mentoring relationship, how skilled are YOU in the following:

	Not Skilled	Somewhat Skilled	Very Skilled
Discussing diversity	1	2	3
Considering your mentees’ their own cultural background, as well as yours	1	2	3
Valuing and respecting cultural differences	1	2	3

223. How satisfied are you with the mentoring you are providing to your mentees?

Not at all						Extremely
1	2	3	4	5	6	7

PEER MENTEES [SKIP FOR FRESHMEN]

These next items focus on people you mentor who are peers to you (at a similar educational and professional level). For the next set of items, please consider your peer mentees.

234. Do you have anyone who you currently mentor on academic/career issues who is at a similar level to yours (a peer)?

No (skip to question #24)

Yes

I choose not to answer (skip to question #24)

a. How many different people do you regularly mentor currently? ______

b. Which of the following do you help your mentees with? (Choose all that apply)

Research issues

Social and emotional needs (e.g., sharing concerns about school)

Tangible help (e.g., advise about faculty and classes, help with writing)

Networking assistance (e.g., helping themyou meet other people in your field)

Career planning (e.g., giving advice, helping find opportunities)

Other (specify): ___________________________

c. How do usually communicate with your peer mentees?

In-person

Phone/Skype

Email/Text

Other (specify): ______________

d. On average, how often do you usually communicate with your peer mentees?

Weekly or more often

Monthly

Several times a year

Annually or less

e. How did you first connect with your mentees? (Choose all that apply)

Through < local campus program for BUILD >

They were assigned in some other way by your department or campus

You were matched through the National Research Mentoring Network (NRMN)

Matched through some other formal program

They sought you out independently

Other (specify): _________________

C. Career Interests and Attitudes

2437. Indicate the importance to you personally of each of the following:

	Essential	Very Important	Somewhat Important	Not Important
Obtaining recognition from colleagues for contributions to my special field.	1	2	3	4
Making a theoretical contribution to science.	1	2	3	4
Becoming an authority in my field.	1	2	3	4

2438. Indicate to what extent the following statements are true of you:

	Strongly ADisagree	ADisagree	Neutral	DisaAgree	Strongly DisaAgree
I have a strong sense of belonging to the community of scientists	5	4	3	2	1
I derive great personal satisfaction from working on a team that is doing important research	5	4	3	2	1
I have come to think of myself as a ‘scientist’	5	4	3	2	1
I feel like I belong in the field of science	5	4	3	2	1

2639. Indicate to what extent you are confident that you can complete the following tasks:

	AbsolutelyNot at all confident	VeryA little confident	Somewhat Confident	A littleVery Confident	Not at all Absolutely Confident
Use technical science skills (use of tools, instruments, and/or techniques)	5	4	3	2	1
Generate a research question	5	4	3	2	1
Determine how to collect appropriate data	5	4	3	2	1
Explain the results of a study	5	4	3	2	1
Use scientific literature to guide research	5	4	3	2	1
Integrate results from multiple studies	5	4	3	2	1

2740. Rate yourself on each of the following traits as compared with the average person your age. We want the most accurate estimate of how you see yourself. (Mark one in each row)

	Highest 10%	Above Average	Average	Below Average	Lowest 10%
Academic ability
Drive to achieve
Mathematical ability
Self-confidence (intellectual)

2841. Will you pursue a science-related research career?

Definitely yes

Possibly yes

Uncertain

Possibly no

Definitely no

I choose not to answer

	Frequently	Occasionally	Not at all
29. How often have you studied with other students?	1	2	3
30. Since entering this college, indicate how often you:
Tutored another student	1	2	3
Discussed course content with students outside of class	1	2	3
Received advice/counseling from another student	1	2	3
Worked with classmates on group projects	1	2	3

3142. Since we last contacted you, During the past year (Summer 2016 or this academic year (2016-17)), have you participated in any training to improve your skills as a mentor or as a mentee?

No (skip to question #32)

Yes

I choose not to answer (skip to question #32)

1. Type of training (Select all that apply)

In-person

On-line that occurs in scheduled, real-time (synchronous)

On-line or other virtual that you can take at any time that provides feedback or interaction with others (asynchronous)

Self-study (by any means, but no interaction or feedback)

2. Approximately how many hours was your training over the past year?

_____hours

3243. Have you completed formal training/workshops related to your career or research (minimum of at least 4 hours duration)?

No (skip to question #33)

Yes

I choose not to answer (skip to question #33)

If yes, please indicate the focus of the training:

	Yes	No
On NIH funding?
On other funding?
On biomedical career development (e.g., training in leadership, teaching, mentoring, publishing, gaining tenure, etc.)?
On other biomedical research related topics?

D. Research and Grants

337. Please attach your most recent academic vita (such as a CV)

The next set of items ask about grants and publications. If you have a document that lists these (such as a resume or CV), you can upload that document and skip some of the items below. Otherwise, we will ask you to provide information about each grant and publication.

Upload now I do not want to upload now I do not have a document to upload

3424. Have you had any opportunity to conduct your own scientific research or to participate in scientific research directed by others in the past year?

No (skip to question # 38)

Yes

I choose not to answer (skip to question # 38)

3525. Please check all research activities you participated in last year (Choose all that apply)

Hands-on research activities with laboratory equipment in a class

Worked in a laboratory in a college/university

Worked on research in a non-academic location

Designed your own research experience or project

Conducted research that had an unknown outcome Literature review, synthesis of existing knowledge, and/or conceptual

Conducted research that advanced knowledge (even if it was a very small advancement Analysis of existing (secondary) data

Analysis of data you collect (primary analysis)

Other (Specify: ______________)

None of the above

For each item checked above, please indicate the following:

35a. What was the research for?

A class or degree requirement

Part of a paid job (e.g., research assistant), internship, or training program

Related to your ownrole as an independent researcher

35b. What was your role?

Project Lead on my own project

Working on someone else’s student-led project

Working on a faculty member-led project

Other (Specify): _________________________________

3626. Since you started college, have you applied for or received funding to support your own research? Please do not include fellowships or scholarships that primarily pay for tuition, fees, or living expenses. Also, please do not include service projects unless they include a research component.

No (skip to question #38)

Yes

37. [If Yes to #36]

Below is a list of all research funding support you have provided to us in the past.

Have you applied for any additional funding to support your own research that is not on the list (either as the lead investigator, with a faculty advisor as the lead, or for a other paid position) OR has the status of previous submissions changed?

No

Yes

Please complete or update information for each grant or proposal:

1. Funding Agency Type:

Your university

Federal agency (e.g., NIH, NSF)

Nonfederal governmental

Nonprofit (e.g., foundations)

For-profit

Other (specify): ____________

2. [If NIH or Other Federal] Full grant number if available

____________________________________

3. [If Nonfederal, Nonprofit, For-Profit, Other]

Agency/Foundation/Company Name: __________________

4. Role:

Principal Investigator

Co-Principal Investigator

Investigator

Other (specify): _____________

5. Submission status:

Submitted (first time for this proposal)

Re-submitted with revisions

Not funded

NIH Impact score (if applicable): ______

Funded

NIH Impact score (if applicable): ______

f. Project Title: __________________

g. Amount (total across all years):

Less than $50,000

$50,000-$99,999

$100,000-$249,999

$250,000-$499,999

$500,000 or more

h. Start Date (e.g., 07/08/2015)

___ / ___ / ___

i. End Date (e.g., 07/08/2016)

___ / ___ / ___

dj. What was the main purpose of the funding?

Research

Training of others (e.g., students, peers, workforce)

Your career development

Other (specify): _____________________

28. Have you conducted research that is not funded by the grants listed above?

No

Yes

1. What type of research was this?

Literature review, synthesis of existing knowledge, and/or conceptual

Analysis of existing (secondary) data

Analysis of data you collect (primary analysis)

b. What was the research for?

A class or degree requirement

Part of a paid job (e.g. research assistant), internship, or training program

Related to your role as an independent researcher

c. What was your role?

Project Lead on my own project

Working on someone else’s student-led project

Working on a faculty member-led project

Other (Specify): __________________________________

38. The next set of items ask about publications. If you have a list of these and did not upload already, you can upload it now.

Upload now I do not want to upload now I do not have a document to upload

3929. Do you have any scientific publications accepted, in-press, or published (including as a co-author)?

No (skip to question #40)

Yes

I choose not to answer (skip to question #40)

Below is a list of publications you have provided to us in the past.

[From database, the publication citation will display. Need to have “Change Status” capability for each on the list, as well as the ability to add new items].

Do you have any peer-reviewed publications that you have had accepted to add to this list?

No (skip to question #30)

Yes

If yes, please answer the following questions:

1. Publication Type:

Journal article

Chapter in a book

Book

Other, specify: ____________

2. List all Authors (Last FM, comma separated): ______, ______, ______

Complete items c-j if journal article selected

c. PMID #: ________________(if provided, skip to question #40)

d. Title: __________________

e. Journal Name: __________________

f. Year Published (or indicate “in press” or “epub ahead”): ________

g. Volume: ______

h. Issue: ______

i. Page Numbers: ______

j. DOI or URL for epubs: ____________________

Complete the applicable information below depending on publication type:

k. [if Book or Chapter] Book/Anthology Publication Title: __________________

l. [if Chapter] Chapter Title : __________________

m. [If Chapter] Editors: __________________

n. Year Published: ______

o. [If Book or Chapter] Edition: ______

p. [If Book or Chapter] Publisher: ________________

q. City: ________________

r. State: __________

s. [If Book or Chapter] Page Numbers: ______

t. DOI or URL for epubs: ____________________

4031. Have you presented at a scientific conference in the last year (including posters)?

No

Yes

32. [FIRST TIME ADMINISTRATION]

Have you ever participated in technology transfer activities (including issued patents, completed licenses, and drug, device, or diagnostic approvals)?

[RETURN RESPONDENTS]

Below is a list of technology transfer activities (including issued patents, completed licenses, and drug, device, or diagnostic approvals you have provided to us in the past.

[From database, the technology transfer activities will display. Need to have “Change Status” capability for each on the list, as well as the ability to add new items].

Please review the list. Are there any to add to this list?

No (skip to question #33)

Yes

1. Please enter a title and brief description for each Technology Activity:

New patent issued

License completed

Drug, device, or diagnostic received regulatory approval

Result of basic research commercialized

Other (specify): _____________________

2. Please provide a brief description: _____________________________________

4133. Have you received any honors or awards in the past year?

No (skip to question #42)

Yes

If yes, please provide the name/ title of the honors or awards you’ve received: ________________________________________________________________

________________________________________________________________

4234. Have you held office in any pre-professional or profession organization in the past year?

No (skip to question #43)

Yes

If yes, please list any offices you have held in pre-professional or professional organizations in the past year: ________________________________________________________________

________________________________________________________________

35. Have you provided service to any federal agencies (e.g. reviewer for NIH/NSF/CDC or similar proposals, member of federal agency advisory council, etc.) in the past year?

No (skip to question #36)

Yes

If yes, please list any service to federal agencies you have performed in the past year: _________________________________________________________________

_________________________________________________________________

36. Have you provided service to any non-federal agencies such as state agencies or foundations in the past year?

No (skip to question #37)

Yes

If yes, please list any service to non-federal agencies you have performed in the past year:

______________________________________________________________________

______________________________________________________________________

ITEMS 43-47 WILL BE COMPLETED ONLY BY FRESHMEN STUDENTS (SELECTED YFCY ITEMS FOR HALLMARKS)

43. Since entering this college, how often have you interacted with the following people (e.g., by phone, e-mail, text, or in person):

	Daily	2 or 3 times per week	Once a week	1 or 2 times per month	1 of 2 times per term	Never
Faculty during office hours	6	5	4	3	2	1
Faculty outside of class or office hours	6	5	4	3	2	1
Academic advisors/counselors	6	5	4	3	2	1
Graduate students/teaching assistants	6	5	4	3	2	1

44. Since entering this college, how often have you felt:

	Frequently	Occasionally	Not at all
Lonely or homesick	3	2	1
Isolated from campus life	3	2	1
Unsafe on this campus	3	2	1
Worried about your health	3	2	1
That your courses inspired you to think in new ways	3	2	1
That your job responsibilities interfered with your schoolwork	3	2	1
That your family responsibilities interfered with your schoolwork	3	2	1
Family support to succeed	3	2	1
That faculty provided me with feedback that helped me assess my progress in class	3	2	1
That my contributions were valued in class	3	2	1
That faculty encouraged me to ask questions and participate in discussions	3	2	1

45. Since entering this college, how has it been to:

	Very Easy	Somewhat Easy	Somewhat Difficult	Very Difficult
Understand what your professors expect of you academically	4	3	2	1
Develop effective study skills	4	3	2	1
Adjust to the academic demands of college	4	3	2	1
Manage your time effectively	4	3	2	1
Develop close friendships with other students	4	3	2	1

46. Please indicate the extent to which you agree or disagree with the following statements:

	Strongly Agree	Agree	Disagree	Strongly Disagree
I see myself as part of the campus community	4	3	2	1
Faculty showed concern about my progress	4	3	2	1
I have been able to find a balance between academics and extracurricular activities	4	3	2	1
Faculty empower me to learn here	4	3	2	1
If asked, I would recommend this college to others	4	3	2	1
I feel valued at this institution	4	3	2	1
Faculty believe in my potential to succeed academically	4	3	2	1
My college experiences have exposed me to diverse opinions, cultures, and values	4	3	2	1
Faculty encouraged me to meet with them outside of class	4	3	2	1
I feel a sense of belonging to this campus	4	3	2	1
At least one faculty member has taken an interest in my development	4	3	2	1
I feel I am a member of this college	4	3	2	1

47. Please rate your satisfaction with your college in each area:

	Very Satisfied	Satisfied	Neutral	Dissatisfied	Very Dissatisfied	Can’t Rate / No Experience
Amount of contact with faculty	6	5	4	3	2	1
Ability to find a faculty or staff mentor	6	5	4	3	2	1
Overall sense of community among students	6	5	4	3	2	1

Finally, we just need a bit of information about you.

485. Please indicate “Yes” or “No” for each of the following:

	Yes	No
Are you deaf or do you have serious difficulty hearing?
Are you blind or do you have serious difficulty seeing, even when wearing glasses?
Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?
Do you have serious difficulty walking or climbing stairs?
Do you have difficulty dressing or bathing?
Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor’s office or shopping?

496. Are you Hispanic, Latino/a, or Spanish Origin?

No Yes

I choose not to answer

5047. What is your race? Check all that apply

White

Black or African American

American Indian or Alaska Native

Asian Indian

Chinese

Filipino

Japanese

Vietnamese

Other Asian

Native Hawaiian

Guamanian or Chamorro

Samoan

Other Pacific Islander

IF CV UPLOAD DEFERRED:

You indicated earlier that you would like to upload a document outlining your publications and grants. Please do so here.

List of majors to for pull-down menu (provided by Higher Education Research Institute:

ARTS AND HUMANITIES

01 Art, fine and applied

02 English (language and literature)

03 History

04 Journalism/Communication

05 Classical and Modern

Languages and Literature

06 Media/Film Studies

07 Music

08 Philosophy

09 Theatre/Drama

10 Theology/Religion

11 Other Arts and Humanities

BIOLOGICAL & LIFE

SCIENCES

12 Biology (general)

13 Animal Biology (zoology)

14 Ecology & Evolutionary

Biology

15 Marine Biology

16 Microbiology

17 Molecular, Cellular, &

Developmental Biology

18 Neurobiology/Neuroscience

19 Plant Biology (botany)

20 Agriculture/Natural Resources

21 Biochemistry/Biophysics

22 Environmental Science

23 Other Biological Science

BUSINESS

24 Accounting

25 Business Admin. (general)

26 Entrepreneurship

27 Finance

28 Hospitality/Tourism

29 Human Resources Management

30 International Business

31 Marketing

32 Management

33 Computer/Management

Information Systems

34 Real Estate

35 Other Business

EDUCATION

36 Elementary Education

37 Music/Art Education

38 Physical Education/Recreation

39 Secondary Education

40 Special Education

41 Other Education

ENGINEERING

42 Aerospace/Aeronautical/

Astronautical Engineering

43 Biological/Agricultural

Engineering

44 Biomedical Engineering

45 Chemical Engineering

46 Civil Engineering

47 Computer Engineering

48 Electrical/Electronic

Communications Engineering

49 Engineering Science/

Engineering Physics

50 Environmental/Environmental

Health Engineering

51 Industrial/Manufacturing

Engineering

52 Materials Engineering

53 Mechanical Engineering

54 Other Engineering

HEALTH PROFESSIONS

55 Clinical Laboratory Science

56 Health Care Administration/

Studies

57 Health Technology

58 Kinesiology

59 Nursing

60 Pharmacy

61 Therapy (occupational,

physical, speech)

62 Other Health Profession

MATH AND COMPUTER

SCIENCE

63 Computer Science

64 Mathematics/Statistics

65 Other Math and Computer

Science

PHYSICAL SCIENCE

66 Astronomy & Astrophysics

67 Atmospheric Sciences

68 Chemistry

69 Earth & Planetary Sciences

70 Marine Sciences

71 Physics

72 Other Physical Science

SOCIAL SCIENCE

73 Anthropology

74 Economics

75 Ethnic/Cultural Studies

76 Geography

77 Political Science (gov’t.,

international relations)

78 Psychology

79 Public Policy

80 Social Work

81 Sociology

82 Women’s/Gender Studies

83 Other Social Science

OTHER MAJORS

84 Architecture/Urban Planning

85 Criminal Justice

86 Library Science

87 Security & Protective

Services

88 Military Sciences/

Technology/Operations

89 OTHER

90 UNDECIDED