Form 1 HERI Freshman Survey (On-line Version)

OMB #0925-XXXX
EXP. XX/XXXX

Attachment 8a:
HERI Freshman Survey (On-line Version)

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COOPERATIVE INSTITUTIONAL RESEARCH PROGRAM (CIRP) FRESHMAN
SURVEY INFORMATION SHEET
University of California, Los Angeles
Purpose of the Study
You are asked to complete this survey as part of a national study conducted by the Higher
Education Research Institute (HERI) at the University of California, Los Angeles. This study
is designed to determine what happens to students when they attend college. Since 1966, over
15 million students at over 1,900 colleges and universities have participated in this research.
The data gathered are used in studies designed to better understand student learning and
development and to help improve the quality of college education.
Procedures
To participate in this study, please complete and submit the following survey. Most
respondents complete this questionnaire in about 45 minutes, although individual progress will
vary by how quickly you move through the questions.
You may decide not to complete the survey for any reason at any time without consequence of
any kind. The Higher Education Research Institute does not offer payment for participation. Your
participation and responses to the questionnaire indicate your consent to participate in the
study. We ask for your name and address so that the researchers at UCLA can contact you at
some later date for follow-up study.
Potential Benefits to Subjects and/or Society
You may have the opportunity to reflect on your prior academic experiences and your
expectations for college as you complete the survey, which may enhance self-understanding.
Your responses to the survey also will be directly beneficial to your college or university, and
may benefit future generations of college students as well.
Potential Risks and Discomforts
There could be survey items that you are uncomfortable answering or to which you would simply
prefer not to respond. Your participation in this study is strictly voluntary, and you will be under
no obligation whatsoever to answer any questions that you are not inclined to answer. You may
choose not to answer any specific questions you do not want to answer and still remain in the
study.
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Information Protection
Please note that your responses will be used for research purposes only and will be protected. Any
information that is obtained in connection with this study and that can be identified with you will be
protected and secured to the extent permitted by law. Your identified responses will be returned to
your institution for institutional assessment purposes. Before receiving any responses your school is
required to certify in advance that the data will only be used for research purposes and will not be
used to investigate specific individuals. Names and addresses will not be returned to your institution,
however Student ID Numbers will be included in the final data file to allow your institution to merge
responses with other campus data.
Identification of investigators
If you have any questions or concerns about the research, please contact the Managing Director of
HERI, Dr. Kevin Eagan at this address:
Higher Education Research Institute
UCLA Graduate School of Education and Information Studies Box 951521
Los Angeles, CA 90095-1521
Email: [email protected]
Phone: 310-825-1925
Rights of Research Subjects
You may withdraw your consent at any time and discontinue participation without penalty. You are not
waiving any legal claims, rights or remedies because of your participation in this research study. If you
have questions regarding your rights as a research subject, contact the UCLA Office for Protection of
Research Subjects, 11000 Kinross Avenue, Suite 102, Box 951694, Los Angeles, CA 90095-1694, (310)
825-7122.

Public reporting burden for this collection of information is estimated to average 45 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-xxxx*). Do not return the completed form to this address.

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Do you consent to participate in the 2016 CIRP Freshman Survey?
Yes, please take me to the survey
No, I wish to opt out

Welcome to the 2016 CIRP Freshman Survey
Welcome to the 2016 CIRP Freshman Survey. This survey is a partnership between your institution
and the Higher Education Research Institute at the University of California, Los Angeles.

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Thank you for your participation. Your opinion and feedback matter!
Please click "next" to access the survey. To review your response to a previous question, click the "back"
button.

Default Question Block

Please provide the following information:
First Name

Last Name
Address
City

Zip

Email
Student ID
Date of Birth (MM/DD/YYYY)

Block 2

Please type in the two-digit code associated with your school or college:

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Your sex:
Male
Female

Is English your primary language?
Yes
No
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In what year did you graduate from high school? (Mark one)
2016
2015
2014
2013 or earlier
Did not graduate but passed G.E.D. test
Never completed high school

Are you enrolled (or enrolling as a: (Mark one)
Full-time student
Part-time student

How many miles is this college from your permanent home?
5 or less
6 to 10
11 to 50
51 to 100
101 to 500
Over 500

What was your average grade in high school? (Mark one)

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A or A+
AB+
B
BC+
C
D

What were your scores on the SAT I and/or ACT?

SAT Reading and Writing
SAT Mathematics
ACT Composite

Where do you plan to live during the fall term? (Mark one)
With my family or other relatives
Other private home, apartment, or room
College residence hall
Fraternity or sorority house
Other campus student housing
Other

From what high school did you graduate?
Name of high school:
City:
State:

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Are you:
(Mark all that apply)
White/Caucasian
African American/Black
American Indian/Alaska Native
East Asian (e.g., Chinese, Japanese, Korean, Taiwanese)
Filipino

Southeast Asian (e.g., Cambodian, Vietnamese, Hmong)
South Asian (e.g., Indian, Pakistani, Nepalese, Sri Lankan)
Other Asian
Native Hawaiian/Pacific Islander
Mexican American/Chicano
Puerto Rican
Other Latino
Other

Prior to this term, have you ever taken courses for credit at this institution?
Yes
No

Since leaving high school, have you ever taken courses, whether for credit or not for
credit, at any other institution (university, 4- or 2-year college, technical, vocational, or
business school)?
Yes
No

To how many colleges other than this one did you apply for admission this year?
None

5

1

6

2

7-8

3

9-10

4

11 or more

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Were you accepted by your first choice college?
Yes
No

Is this college your: (Mark one)
First choice
Second choice
Third choice
Less than third choice

Citizenship status: (Mark one)
U.S. citizen
Permanent resident (green card)
International student (i.e, F-1, J-1, or M-1 visa)
None of the above

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Please mark which of the following courses you have completed: (Mark Yes or No for each
item)
Yes

No

Algebra II
Pre-Calculus & Trigonometry
Probability & Statistics
Calculus
AP Probability & Statistics
AP Calculus
AP Computer Science A

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How many weeks this summer did you participate in a bridge program at this
institution?
Zero
One to two
Three to four
Five to six
Seven or more

During high school (grades 9-12) how many years did you study each of the following
subjects? (Mark one for each item)
None

1/2

1

2

3

4

5 or more

Mathematics
Foreign Language
Physical Science
Biological Science
History / Am. Gov't
Computer Science
Art and/or Music

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How many Advanced Placement/International Baccalaureate courses did you take in
high school? (Mark one in each row)
Not offered
at my high
school

None

10-14

AP Courses
IB Courses

Please refer to the same Parent/Guardian throughout this survey.
Please mark the sex of your parent(s) or guardian(s).
Male

Female

Parent/Guaridan 1
Parent/Guaridan 2

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At any time since you turned 13, were you in foster care or were you a dependent of the
court?
Yes
No
I don't know

Do you consider yourself: (Mark Yes or No for each item)

Pre-Law

Please indicate your intended major.

Please indicate your intended career.

Please indicate the career of Parent/Guardian 1

Please indicate the career of Parent/Guardian 2

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Current employment status: (Mark one in each row)

Employed
Parent/Guardian 1
Parent/Guardian 2

How much of your first year's educational expenses (room, board, tuition, and fees) do
you expect to cover from each of the sources listed below? (Mark one answer for each possible
source)
$10,000Family resources (parents,
relatives, spouse, etc.)
My own resources (savings from
work, work-study, other income)
Aid which need not be repaid
(grants, scholarships, military
funding, etc.)
Aid which must be repaid (loans,
etc.)

Did you receive any of the following forms of financial aid? (Mark Yes or No for each item)

Military grants
Pell Grant
Need-based grants or scholarships
Merit-based grants or scholarships
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What is your best estimate of your parents'/guardians' total income last year? Consider
income from all sources before taxes. (Mark one)
Less than $10,000
$10,000-14,999
$15,000-19,999
$20,000-24,999
$25,000-29,999
$30,000-39,999
$40,000-49,999
$50,000-59,999
$60,000-74,999
$75,000-99,999
$100,000-149,999
$150,000-199,999
$200,000-249,999
$250,000 or more

Do you have any concern about your ability to finance your college education? (Mark one)
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)

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Current religious preference: (Mark one in each column)
Parent/Guardian 1

Parent/Guardian 2

Agnostic
Atheist

Baptist
Buddhist
Church of Christ
Eastern Orthodox
Hindu
Jewish
LDS (Mormon)

Lutheran
Methodist
Muslim
Presbyterian
Quaker
Roman Catholic
Seventh-day Adventist
United Church of Christ/
Congregational
Other Christian
Other Religion
None

What is the highest academic degree you intend to obtain? (Mark one in each column)
Highest Planned

Highest Planned at This College

None
Vocational certificate
Associate (A.A. or
equivalent)
Bachelor's degree (B.A.,
B.S., etc.)
Master's degree (M.A., M.S.,
etc.)
Ph.D. or Ed.D.
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M.D., D.O., D.D.S., D.V.M.

J.D. (Law)
B.D. or M.Div. (Divinity)
Other

In the past year, how often have you: (Mark one for each item)
Not at all
Attended a religious service
Been bored in class
Demonstrated for a cause (e.g., boycott, rally, protest)
Tutored with other students
Studied with other students
Consumed beer
Consumed wine or liquor
Felt overwhelmed by all you had to do
Felt depressed
Performed volunteer work
Asked a teacher for advice after class
Voted in a student election
Socialized with someone of another racial/ethnic group
Been late to class
Discussed religion

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Skipped school/class
Publicly communicated your opinion about a cause
(e.g., blog, email, petition)
Helped raise money for a cause or campaign
Fallen asleep in class
Failed to complete homework on time
Felt anxious

How would you rate yourself in the following areas:
(Mark one in each row)
A Major

A Major
Weakness

Ability to see the world from someone else's
perspective
Tolerance of others with different beliefs
Openness to having my own views challenged
Ability to discuss and negotiate controversial
issues
Ability to work cooperatively with diverse people
Critical thinking skills

Ability to manage your time effectively

What is the highest level of formal education obtained by your parents/guardians? (Mark
one in each column)
Parent/Guardian 1

Parent/Guardian 2

Junior high/Middle school
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or less

Some high school
High school graduate
Postsecondary school other
than college
Some college
College degree
Some graduate school
Graduate degree

How often in the past year did you:
(Mark one in each row)
Not at All
Ask questions in class
Support your opinions with a logical argument
Seek solutions to problems and explain them to others
Evaluate the quality or reliability of information you received
Take a risk because you felt you had more to gain
Seek alternative solutions to a problem
Look up scientific research articles and resources
Explore topics on your own, even though it was not required for
a class
Accept mistakes as part of the learning process
Analyze multiple sources of information before coming to a
conclusion
Take on a challenge that scares you

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How confident are you that you can: (Mark one in each row)
Absolutely

Very

Moderately

Somewhat

Not at all

Use technical science skills (use of tools,
instruments, and/or techniques)
Generate a research question
Determine how to collect appropriate data
Explain the results of a study
Use scientific literature to guide research
Integrate results from multiple studies
Ask relevant questions
Identify what is known and not known about a
problem
Understand scientific concepts
See connections between different areas of
science and mathematics

How would you characterize your political views?
Far left
Liberal
Middle-of-the-road
Conservative
Far right

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In deciding to go to college, how important to you was each of the following reasons?
(Mark one answer for each possible reason)
Very Important

Somewhat
Important

Not Important

To get a better job
To gain a general education and
appreciation of ideas
To make me a more cultured person
To be able to make more money
To learn more about things that interest
me
To get training for a specific career

To prepare myself for graduate or
professional school
To please my family

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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

Below

Lowest 10%

Academic ability
Artistic ability
Compassion
Creativity
Drive to achieve
Emotional health
Leadership ability
Mathematical ability
Physical health
Public speaking ability
Risk-taking
Self-confidence
(intellectual)
Self-confidence (social)

Spirituality
Understanding of others
Writing ability

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Mark one in each row:
Agree

Agree

Disagree

Disagree

Wealthy people should pay a larger share of taxes
than they do now
Addressing global climate change should be a
federal priority
The federal government should have stricter
gun control laws
Affirmative action in college admissions should
be abolished
Sexual activity that occurs without the presence of
explicity, affirmative consent (i.e., "yes means yes") is
considered sexualty assault
There is little that a person can do to be better at
math - you are either "good" or "bad" at math
Intelligence is something that can be improved by
studying or working harder

Below are some reasons that might have influenced your decision to attend this
particular college. How important was each reason in your decision to come here? (Mark
one answer for each possible reason)

Very Important

Not Important

My parents/relatives wanted me to come here
My teacher advised me

This college has a very good academic reputation
This college has a good reputation for its social
and extracurriculur activities
I was offered financial assistance
The cost of attending this college
High school counselor advised me
Private college counselor advised me

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I wanted to live near home

Not offered aid by first choice
Could not afford first choice
This college's graduates gain admission to top
graduate/professional schools
This college's graduates get good jobs
I was attracted by the religious affiliation/orientation
of the college
I wanted to go to a school about the size of this college
Rankings in national magazines

I was admitted through an Early Action or Early
Decision program
A visit to this campus
This college's graduates make a difference in the
world

During your last year in high school, how much time did you spend during a typical week
doing the following activities?
(Mark one for each item)
Less
than 1

1-2 hrs

3-5 hrs

6-10
hrs

hrs

Over 20
hrs

Studying/homework
Socializing with friends in person
Online social networking
(Facebook, Twitter, etc)

Partying
Student clubs/groups
Exercise or sports
Working for pay
Household/childcare duties

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Military status: (Mark one)
None
ROTC, cadet, or midshipman at a service academy
In Active Duty, Reserves, or National Guard
A discharged veteran NOT serving in Active Duty, Reserves, or National Guard

How many years do you expect it will take you to graduate from this college?
1
2
3
4
5
6+
I do not plan to graduate from this college.

What is your sexual orientation?
Heterosexual/Straight
Gay
Lesbian
Bisexual
Queer
Other

Do you identify as transgender?
Yes
No

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Do you have any of the following disabilities or medical
conditions? :(Mark Yes or No for each item)
Yes

No

Learning disability (dyslexia, etc.)
Attention deficity hyperactivity disorder (ADHD)
Autism spectrum disorder
Physical disability (speech, sight, mobility,
hearing, etc.)
Chronic illness (cancer, diabetes, autoimmune
disorders, etc.)
Psychological disorder (depression, etc).
Other

Will you pursue a science-related research career?

Definitely yes
Probably yes
Uncertain
Probably no
Definitely no

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Indicate the importance to you personally of each of the following:
(Mark one in each row)
Very

Not

Essential
Becoming accomplished in one of the performing arts
(acting, dancing, etc.)
Becoming an authority in my field
Obtaining recognition from my colleagues for
contributions to my special field
Influencing the political structure
Influencing social values
Raising a family
Being very well off financially
Helping others who are in difficulty
Making a theoretical contribution to science
Writing original works (poems, novels, etc.)

Creating artistic works (painting, sculpture, etc.)
Becoming successful in a business of my own
Becoming involved in programs to clean up the
environment
Developing a meaningful philosophy of life
Participating in a community action program
Helping to promote racial understanding
Keeping up to date with political affairs
Becoming a community leader
Improving my understanding of other countries
and cultures
Integrating spirituality into my life

To what extent are the following statements true of you: (Mark one in each row)
Strongly
I have a strong sense of belonging to a
community of scientists
I derive great personal satisfaction from
working on a team that is doing important
research
I think of myself as a scientist
I feel like I belong in the field of science

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What is your best guess as to the chances that you will:
Very Good
Chance

Some
Chance

Very Little

No Chance

Change major field
Change career choice
Participate in student government
Get a job to help pay for college expenses
Join a social fraternity or sorority
Transfer to another college before graduating
Participate in volunteer or community service work
Seek personal counseling
Participate in student clubs/groups
Participate in a study abroad program
Work on a professor's research project
Get tutoring help in specific courses
Take courses from more than one college
simultaneously
Take a leave of absence from this college
temporarily
Take a course exclusively online
Vote in a local, state, or national election

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