Form 0920-1163 CUPS Alumni Assessment Survey

Data Collection for CDC Fellowship Programs

CDC CUPS Alumni Assessment Final 20200504

CDC Undergraduate Public Health Scholars (CUPS) Program Assessment – Alumni Survey

OMB: 0920-1163

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0920-1163 can be found here:

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Form Approved OMB No. 0920-XXX

Expiration Date XX/XX/XXXX

CDC CUPS Assessment – Alumni Survey

Pilot Draft: 1/8/2020

Introduction

Form Approved OMB No. 0920-XXX/ Expiration Date XX/XX/XXXX

Thank you for taking the time to participate in the CDC Undergraduate Public Health Scholars (CUPS) Alumni survey. The purpose of this survey is to learn about your academic and career progression, accomplishments, and perceptions of the CUPS program.

All information that you provide will be kept secure and confidential. This survey is voluntary and will have no negative effect on you if you decide not to participate. The results of this survey will be analyzed and reported as aggregates. For example, 50% of alumni have completed graduate training, or 75% of alumni have pursued public health as a career. Findings from this survey will be used to inform and potentially make the case for future programming. Your participation is greatly appreciated.

This survey should take you less than 25 minutes to complete. If you have any questions or concerns, please contact [XXXXX] at [phone #] or [email address].

[Separate link for each grantee]

[Grantees will provide student cohort year information]

Public reporting burden of 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 CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74 Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX).

The Privacy Act applies to this information collection. The requested information is used toward assessment and continuous quality improvement of CDC fellowship activities and services. CDC will treat data/information in a secure manner and will not disclose, unless otherwise compelled by law.

Demographics

What was your age when you participated in the CUPS program? XX years old

Where is your primary state of residence? [Dropdown of state names for selection]

Which of the following best characterize the area you grew up in before college?

Urban
Suburban
Rural

Race & Ethnicity

Which of the following Hispanic, Latino/a, or Spanish origin are you? (Select all that apply)

Not of Hispanic, Latino/a, or Spanish origin
Mexican, Mexican American, Chicano/a
Puerto Rican
Cuban
Another Hispanic, Latino/a or Spanish origin

What is your race? (Select all that apply)

White
Black or African American
American Indian
Alaska Native
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islanders

SeXual Orientation/Gender Identity

What sex were you assigned at birth, on your original birth certificate?

Male
Female

How do you describe yourself? (check one)

Male
Female
Transgender
Do not identify as female, male, or transgender

Do you consider yourself to be:

Heterosexual or straight
Gay or lesbian
Bisexual
Other (Please specify): __________________

Primary language

Do you speak a language other than English at home?

If yes, please specify: _________________

Family Background

Are you the first generation in your family to attend college?

What is the highest school completed by either of your parents?

Less than high school
High school or equivalent diploma
Some college or associate’s degree
Bachelor’s degree
Master’s, professional, or doctoral degree
Unknown

Disability

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 difficulties doing errands alone, such as visiting a doctor’s office or shopping?

Disposition

Select the best option that describes your current status: (select all that apply)

I’m furthering my education at an academic institution (e.g., college, graduate school, certificate program).
I’m employed.
I’m not employed.
I’m participating in a training or service program, such as an internship or fellowship (e.g., AmeriCorps, Peace Corps, Public Health Informatics Fellowship, Public Health Associate Program).
I’m taking a “gap year.” For purposes of this survey, this is a period of time, 9 months or longer after graduating from university, in which you intentionally take a break before entering graduate school or starting your professional career.
Other (please explain) ___________________________________________________________________

Education

What was the focus (i.e., major and/or minor) of your undergraduate education? (select all that apply)

Biological sciences (including biology, biochemistry, or other natural sciences)
Social sciences (for example, sociology, psychology)
Public health (for example, population health, community health, or global health)
Other(s) (please specify) _____________________________________

Have you completed undergraduate education?

Name of academic institution (please specify): _____________________________________

Go to Question 21

Date of your graduation: XX/XX/XXXX

Degree(s) received:

Bachelor of Arts (BA)
Bachelor of Science (BS)
Other (please specify) ________________

If No, do you expect to graduate?

Go to Question 21

Name of academic institution (please specify): _____________________________________

Expected date of graduation: XX/XX/XXXX

Degree(s) to receive:

Bachelor of Arts (BA)

Skip to Question 25
Bachelor of Science (BS)
Other (please specify) ________________

Please share the reason: _____________________________________________________

_________________________________________________________________________

After receiving your undergraduate degree, did you or will you enroll in an academic institution for an advanced degree(s)?

Yes  Go to Question 22

Skip to Question 22
No

If No, are you planning to pursue

an advanced degree program(s)? By pursue, we mean start looking into programs, take entrance

exams or prepare for them, apply for programs, etc.

Yes, starting in the next year.
Yes, starting in the next 2-4 years.
Yes, starting in the next 5-10 years.

Skip to

Question 25
Yes, starting in more than 10 years.
No

If No, what are your reason(s) for not pursuing an advanced degree? (Select all that apply)

Financial reasons (i.e., tuition cost)
Family commitment (e.g., need to care for family members)
Health reasons
Personal reasons
Academic reasons (See next page)

(Continue from Question 21)

Not interested
Other: (please specify) _____________________________________

Which of the following best describes the foci of your education after your undergraduate degree?

(Select all that apply)

	Date Started	Date Completed (or expected)
Public health (including population health) Master of Public health (MPH)	XX/XX/XXXX	XX/XX/XXXX
Doctorate of Public Health (DrPH)	XX/XX/XXXX	XX/XX/XXXX
Master of Science (MSPH)	XX/XX/XXXX	XX/XX/XXXX
Doctor of Philosophy (PhD)	XX/XX/XXXX	XX/XX/XXXX
Doctor of Science (ScD)	XX/XX/XXXX	XX/XX/XXXX
Other (please specify) _____________________	XX/XX/XXXX	XX/XX/XXXX
Health-related fields (including medicine, pharmacy, or nursing) Doctor of Medicine (MD)	XX/XX/XXXX	XX/XX/XXXX
Doctor of Osteopathic Medicine (DO)	XX/XX/XXXX	XX/XX/XXXX
Bachelor of Science in Nursing (BSN)	XX/XX/XXXX	XX/XX/XXXX
Doctorate of Nursing Practice (DNP or PhD)	XX/XX/XXXX	XX/XX/XXXX
Master of Physician Assistant (MSPA)	XX/XX/XXXX	XX/XX/XXXX
Doctor of Veterinary Medicine (DVM)	XX/XX/XXXX	XX/XX/XXXX
Doctor of Dental Surgery or Dental Medicine (DDS or DMD)	XX/XX/XXXX	XX/XX/XXXX
Doctor of Pharmacy (PharmD) Other (please specify) ______________________	XX/XX/XXXX XX/XX/XXXX	XX/XX/XXXX XX/XX/XXXX
Biomedical sciences (including biology, biochemistry, or other natural sciences) Master of Science (MS)	XX/XX/XXXX	XX/XX/XXXX
Doctor of Philosophy (PhD)	XX/XX/XXXX	XX/XX/XXXX
Doctor of Science (ScD)	XX/XX/XXXX	XX/XX/XXXX
Other (please specify) ______________________	XX/XX/XXXX	XX/XX/XXXX
Other Juris Doctor (JD)	XX/XX/XXXX	XX/XX/XXXX
Doctor of Education (EdD)	XX/XX/XXXX	XX/XX/XXXX
Master of Social Work (MSW) Master of Business Administration (MBA)	XX/XX/XXXX XX/XX/XXXX	XX/XX/XXXX XX/XX/XXXX
Master of Public Administration (MPA)	XX/XX/XXXX	XX/XX/XXXX
Other (please specify field) ______________________ Degree(s) sought or received: Bachelor of Arts (BA)	XX/XX/XXXX	XX/XX/XXXX
Bachelor of Science (BS)	XX/XX/XXXX	XX/XX/XXXX
Master of Arts (MA) Other (please specify)	XX/XX/XXXX XX/XX/XXXX	XX/XX/XXXX XX/XX/XXXX

Do you plan to pursue an advanced degree program(s) beyond what you indicated in Question 22?

No, I consider my education to be complete after that.  Go to Question 24
Yes, in the next 2-4 years.
Yes, in the next 5-10 years.
Yes, in more than 10 years.

If yes, which of the following best describes the foci of your academic goal in this pursuit?

(Select all that apply)

Public health (including population health)

Master of Public health (MPH)
Doctorate of Public Health (DrPH)
Master of Science (MSPH)
Doctor of Philosophy (PhD)
Doctor of Science (ScD)
Other (please specify) ______________________

Health-related fields (including medicine, pharmacy, or nursing)

Doctor of Medicine (MD)
Doctor of Osteopathic Medicine (DO)
Bachelor of Science in Nursing (BSN)
Doctorate of Nursing Practice (DNP or PhD)
Master of Physician Assistant (MSPA)
Doctor of Veterinary Medicine (DVM)
Doctor of Dental Surgery or Dental Medicine (DDS or DMD)
Doctor of Pharmacy (PharmD)
Other (please specify) ______________________

Biomedical sciences (including biology, biochemistry, or other natural sciences)

Master of Science (MS)
Doctor of Philosophy (PhD)
Doctor of Science (ScD)
Other (please specify) ______________________

Other

Juris Doctor (JD)
Doctor of Education (EdD)
Master of Social Work (MSW)
Master of Business Administration (MBA)
Master of Public Administration (MPA)
Other (please specify field) ______________________

Degree(s) sought or received:

Bachelor of Arts (BA)
Bachelor of Science (BS)
Master of Arts (MA)
Other (please specify) ______________________

Since receiving your undergraduate degree, did you take a “gap year?” This is a period of time, 9 months or longer after graduating from university, in which you intentionally take a break before entering graduate school or starting your professional career. (select all that apply)
- No
- Yes, before I entered graduate school
- Yes, before I started my professional career
- Yes, I am currently taking a “gap year.”

If Yes, what was/will be the length of your “gap year?” (select one)

< 1 year
1 year
≤ 2 years but > 1 year
Other (please specify): _____________________________

What was/is the purpose or your main reason(s) for taking a “gap year?” (select all that apply)

To save money to further education
To further explore career options and opportunities
To gain additional work experiences
To apply for schools and/or jobs
Other (pleases specify): _______________________________

Please elaborate on your reason(s) [optional]: _______________________________________________________________________

_______________________________________________________________________

What did/are you do during this time? (select all that apply)

Traveled and/or lived aboard
Volunteered
Internship or experiential learning opportunities
Took classes
Worked (please specify industry): ______________________________

Other (please specify): ________________________________

Employment

Are you currently employed?

Yes Start date of employment: XX/XX/XXXX
No

If No, what was the Start date of your last employment: XX/XX/XXXX

End date of your last employment: XX/XX/XXXX

Are you currently or have you ever been employed in a career position?
- Yes Start date of most recent or current career position: XX/XX/XXXX

No  Go to Question 33

If Yes, are you currently employed in this position?

Yes
No End date of most recent career position: XX/XX/XXXX

Which of the following best describes the industry of your current career position (or most recent one if you are not currently in a career position)?

Public health (including population health)
Biomedical sciences (including biology, biochemistry, or other natural sciences)
Health-related fields (including medicine, pharmacy, nursing)
Other (please specify) ________________________________

Which of the following best describes your employment in the career position?

I work at the international level
I work at the national level
I work at the state level
I work at the county/city level
I work at the tribal level
I work at the territorial level

Which of the following best describes your type of employment in the career position?

International development agency (e.g., Doctors without Borders, Care International)
Public sector/government (e.g., CDC, health departments)

Academic institution or university (Please specify): ____________________________
Other non-profit organization (Please specify): ______________________________________
For-profit organization (Please specify): ______________________________________

Contractor to an international or government agency
Other (please specify): ______________________________________

If applicable, please indicate which of the following international, public sector or government agency you work for or are a contractor for (in the career position):

World Health Organization (WHO)
United States Agency for International Development (USAID)
Center for Disease Control and Prevention (CDC)
Indian Health Service (IHS)
Military (including US Public Health Service/Commissioned Corps): _____________________
State government agency (Please specify) : _____________________
City/County government agency (Please specify): _____________________
Territorial or tribal agency Please specify): ________________________
Other (Please specify): _______________________
Not applicable (I do not work for and am not a contractor for an international, public sector or government agency)

Area(s) of your work in your career position (including, but not limited to biomedical sciences, public health, or health-related fields) ? (Select all that apply)

Infectious diseases
Chronic diseases
Injury prevention
Environmental health
Maternal, child, and family health
Reproductive Health
Provision of clinical care
Public health emergency preparedness and response
Global migration and quarantine
Immunization
Health equity
Laboratory sciences
Health communication
Information technology
Mental health
Education
Law
Business or commercial trade
Fine arts
Other (please specify) __________________________

Have you had a career change in your life?

Yes Approximate date of career change: XX/XXXX
No

If yes, please describe: ___________________________________________________________________

______________________________________________________________________________________

Training or service program

Since completing CUPS, did you join any training or service program such as an internship or fellowship (e.g., AmeriCorps, Peace Corps, CDC Public Health Informatics Fellowship, CDC Public Health Associate Program) after CUPS?

If yes, what is the name of the program A? ___________________________________

Which of the following best describe the industry of this training or service program?

Public health (including population health)
Biomedical sciences (including biology, biochemistry, or other natural sciences)
Health-related fields (including medicine, pharmacy, nursing)
Other (please specify) __________________________________________

Date started: XX/XX/XXXX

Date of completion: XX/XX/XXXX

If not expected to complete, please share reason for not completing: __________________________________________________________

Name of the program B? ___________________________________

Which of the following best describe the industry of this training or service program?

Public health (including population health)
Biomedical sciences (including biology, biochemistry, or other natural sciences)
Health-related fields (including medicine, pharmacy, or nursing)
Other (please specify) __________________________________________

Date started: XX/XX/XXXX

Date of completion: XX/XX/XXXX

If not expected to complete, please share reason for not completing: __________________________________________________________

Name of the program C? ___________________________________

Which of the following best describe the industry of this training or service program?

Public health (including population health)
Biomedical sciences (including biology, biochemistry, or other natural sciences)
Health-related fields (including medicine, pharmacy, nursing)
Other (please specify) __________________________________________

Date started: XX/XX/XXXX

Date of completion: XX/XX/XXXX

If not expected to complete, please share reason for not completing: __________________________________________________________

Effect of CUPS

Before joining the CUPS program, I

Had little or no exposure to the field of public health
Had some exposure to the field of public health
Had a lot of exposure to the field of public health

Before joining the CUPS program, I

Was not interested in pursuing a degree in biomedical sciences (e.g., biology, biochemistry, or other natural sciences) or health-related fields (e.g., MD, DO, RN, PA, DDS, Social work, etc.)
Was interested in pursuing a degree in biomedical sciences or health-related fields (please specify degree(s) and field(s)): _____________________

Before joining the CUPS program, I

Was not interested in pursuing a degree in public health
Was interested in pursuing a degree in public health
Had an undergraduate degree (i.e., major or minor) in a public health-related field (e.g., community health, global health)

My interest in public health had increased as a result of CUPS.

Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree

My interest in social determinants of health, health disparities, and factors associated with health equity has increased as the result of CUPS.

Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree

I would recommend CUPS to others considering a career in public health.

Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree

How influential has the CUPS program been to your career path (including but not limited to public health, area(s) of concentration or expertise, or agencies/organizations)?

Extremely influential
Very influential
Somewhat influential
Slightly influential
Not at all influential

____________________________________________________________________________________________________________________________________________________________________________

______________________________________________________________________________________

Was your CUPS mentor(s) of a similar racial-ethnic background as you?

Yes
No
Don’t know

How influential have CUPS mentor(s) been to your career path (including but not limited to public health, area(s) of concentration or expertise, or agencies/organizations)?

Extremely influential
Very influential
Somewhat influential
Slightly influential
Not at all influential

Please explain your response: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What was the most influential part of your CUPS experience on your career? Please explain: _____________________________________________________________________________________________

_____________________________________________________________________________________________

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Contribution and commitment to public Health and Health Equity

I have contributed to efforts in health equity in my current role.

Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree

I plan to contribute to efforts in public health in my future work.

Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree

Please share how you intend to do this: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

I plan to contribute to efforts in health equity in my future work.

Strongly agree
agree
Neither agree nor disagree
Disagree
Strongly disagree

I would mentor others, including students who are interested in pursuing public health or minority health as their career?

Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree

Thank you so much for your participation!

We may be interested in learning more about your education and career interest or choices.

Would you be willing to talk with us further?

Yes
No

If Yes, please provide your contact information:

Name: ________________________

Email: _________________________

Phone: ________________________

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