Form 1 CIRP HERI Freshman Survey

Evaluation of the Enhancing Diversity of the NIH-funded Workforce Program (NIGMS)

Attachment 12_CIRP HERI Freshman Survey

2019 CIRP HERI Freshman Survey

OMB: 0925-0747

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0925-0747 can be found here:

2023-05-15 - Revision of a currently approved collection

Document [pdf]

Download: pdf | pdf

OMB #0925-0747
EXP. 11/2019

Attachment 12: CIRP
HERI Freshman
Survey

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 (0925-0747). Do not return the completed form
to this address.

THE CIRP FRESHMAN SURVEY INFORMATION SHEET
PURPOSE OF THE STUDY
You are asked to complete this survey as part of the Enhance Diversity Study, a national study on student experiences and
career choices. Your school is part of this study, conducted by the Diversity Program Consortium (Co-Principal Investigator:
Keith Norris, MD, PhD, Teresa Seeman, PhD, and Steven P. Wallace, PhD) in partnership with 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 attached survey. Most respondents complete this questionnaire
in about 25 minutes, although individual progress will vary by how quickly you move through the questions.
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 (for information on
item details, visit http://stembuild.umbc.edu/DPC_Survey_Details/). You are also giving the UCLA team permission to
share the information you provide on the survey with your institution for their review of local programs and to allow UCLA
to contact you every year or so for follow-up surveys to understand your career choices after you leave your school. You
may decide not to complete the survey for any reason at any time without consequence of any kind.
POTENTIAL BENEFITS TO SUBJECTS AND/OR SOCIETY
You will receive a $5 Amazon card by email if you complete the survey. 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 selfunderstanding. 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.
CONFIDENTIALITY
Please note that your responses will be used for research purposes only and will be strictly confidential. Any information that is
obtained in connection with this study and that can be identified with you will remain confidential. Your identified responses will
be returned to your institution for institutional assessment purposes. Your responses will also be shared with members of the
Diversity Program Consortium to understand how well students are prepared for and succeeding in biomedical research careers.
Information about you is protected by a federal Certificate of Confidentiality. This means that we cannot be forced to release
information about you for any legal proceeding, even if a court of law asks.
The Certificate allows us to use information about you for purposes of this research, or to disclose it for other research when allowed
by law. The Certificate requires other researchers to also protect information we share with them.
There are limits to this protection. The Certificate does not protect your information when:
•
You or your family voluntarily release information about yourselves.

Protocol ID:IRB#15-001776

UCLA IRB Approved Approval Date: 7/15/2019 Through: 7/14/2020 Committee: North General IRB

•
You consent to release of information (for example, the uses described in this form, or if you sign release forms for
employment, insurance or medical care).
•
A federal agency audits or evaluates research that it funds.

IDENTIFICATION OF INVESTIGATORS
If you have any questions or concerns about the research, please contact Dr. Keith Norris, Dr. Teresa Seeman, or Dr.
Steven P. Wallace, Co-Principal Investigators of the Diversity Program Consortium Coordination and Evaluation Center
or the
Diversity Program Consortium Coordination and Evaluation Center
UCLA School of Medicine
1100 Glendon Avenue, Suite 710
Los Angeles, CA 90024
Email: [email protected] Phone: 310-267-5114
If you have any questions about the survey or your gift card, please contact Karina Ramirez at:
Email: [email protected] Phone: 310-267-0845

To reach the Managing Director of HERI and Director of CIRP, 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.
UCLA Office of the Human Research Protection Program (OHRPP): If you have questions about your rights as a
research subject, or you have concerns or suggestions and you want to talk to someone other than the researchers, you may
contact the UCLA OHRPP by phone: (310) 206-2040; by email: [email protected] or by mail: Box 951406,
Los Angeles, CA 90095-1406.

Protocol ID:IRB#15-001776

UCLA IRB Approved Approval Date: 7/15/2019 Through: 7/14/2020 Committee: North General IRB

I do not plan to graduate from this college.

47. Will you pursue a science-related research career?
(Mark one)

`
`
`

`
`

Definitely yes
Probably yes
Uncertain

Probably no
Definitely no

48. Is English your primary language?
` Yes
` No
49. Do you have any of the following disabilities or medical
conditions? (Mark Yes or No for each item)
Learning disability (dyslexia, etc.)....................
Attention deficit 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.................................................................

N No Chance
L Very Little Chance

52. What is your best guess as to
the chances that you will:
(Mark one for each item)

Yes

`
`
`

S Some Chance
V Very Good Chance

Change major field......................................................................
Change career choice.................................................................
Participate in student government..............................................
Get a job to help pay for college expenses................................
Join a fraternity or sorority..........................................................
Participate in student protests or demonstrations.....................
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...................................

VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN

The remaining ovals are provided for questions specifically designed by your college rather than the Higher Education Research
Institute. If your college has chosen to use the ovals, please observe carefully the supplemental directions given to you.
53.
54.
55.
56.

ABCDE
ABCDE
ABCDE
ABCDE

57.
58.
59.
60.

ABCDE
ABCDE
ABCDE
ABCDE

61.
62.
63.
64.

ABCDE
ABCDE
ABCDE
ABCDE

65.
66.
67.
68.

ABCDE
ABCDE
ABCDE
ABCDE

69.
70.
71.
72.

ABCDE
ABCDE
ABCDE
ABCDE

THANK YOU!
© Prepared by the Higher Education Research Institute,
University of California, Los Angeles, California 90095-1521

a~aa

Group Code

2. What is your current gender identity?
` Man/Trans Man
` Woman/Trans Woman
` Gender queer/Gender non-conforming
` Identity not listed above

3. What is your sexual orientation?
` Heterosexual/Straight ` Queer
` Gay
` Pansexual
` Lesbian
` Asexual
` Bisexual
` Not listed
above
4. In what year did you graduate from
high school? (Mark one)
2019
` Did not graduate but
passed G.E.D. test
2018
2017
` Never completed
high school
2016 or earlier

5. Are you enrolling: (Mark one)

Full-time

Part-time

6. How many miles is this college from
your permanent home? (Mark one)

`
`

5 or less
6-10

`
`

11-50
51-100

`
`

101-500
Over 500

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

`
`
`

A or A+
A–
B+

`
`
`

B
B–
C+

`
`

C
D

8. Prior to this term, have you ever taken
courses for credit at this institution?

Yes

9. Since leaving high school, have you ever
taken courses, whether for credit or not
for credit, at any other institution?

`
Data Recognition Corp.-6G9144-18411-54321

11. From what kind of high school did you
graduate? (Mark one)

1. Do you identify as transgender?
` Yes
` No

`
`
`
`

Yes

ACT Composite........................

aaaa

`
`
`
`
`
`

18. Please mark which of the following courses you
have completed:
YN Pre-calculus/Trigonometry
YN Probability & Statistics
YN Calculus
YN AP Probability & Statistics
YN AP Calculus

Public school (not charter or magnet)
Public charter school
Public magnet school
Private religious/parochial school
Private independent college-prep school
19. During high school (grades 9-12) how many years
Home school
did you study each of the following subjects? (Mark
one for each item)
12. Are you: (Mark all that apply)
` White/Caucasian
Mathematics.................... ```````
` African American/Black
Foreign Language........... ```````
` American Indian/Alaska Native
Physical Science............. ```````
` East Asian (e.g., Chinese, Japanese,
Biological Science........... ```````
Korean, Taiwanese)
History/Am. Gov’t............ ```````
` Filipina/o/x
Computer Science.......... ```````
Southeast
Asian
(e.g.,
Cambodian,
`
Vietnamese, Hmong)
Arts and/or Music............ ```````
` South Asian (e.g., Indian, Pakistani,
20. On how many AP exams did you score a 3 or higher?
Nepalese, Sri Lankan)
` None
` 5-6
` Other Asian
1-2
`
` 7-8
` Native Hawaiian/Pacific Islander
3-4
`
` 9 or more
` Mexican American/Chicana/o/x
` Puerto Rican
21. Which years did you take physics in high school?
(Mark all that apply)
` South American
` Other Latina/o/x
` 9th
` 11th ` Did not take physics
10th
` Other
`
` 12th
13. Did you participate in a bridge program
at this institution this summer?

Yes

14. To how many colleges other than this one
did you apply for admission this year?
` None ` 3 ` 6
` 11 or
more
4
7-8
1

`
`

9-10

16. Is this college your: (Mark one)

`
`

First choice
Second choice

`
`

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

Male

Parent/Guardian 1............................
Parent/Guardian 2............................

`
`

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

15. Were you accepted by your first choice
college? ` Yes
` No

5 or
more

CORRECT MARK INCORRECT MARKS

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

SAT Mathematics................

`
`
`

SAT Critical Reading...........

17. Citizenship status: (Mark one)

MARKING DIRECTIONS
• Use a black or blue pen.
• Fill in your response completely.
Mark out any answer you wish to
change with an “X”.

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

EMAIL (print letters carefully):

1/2

46. How many years do you expect it will take you to
graduate from this college?

EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN

COUNTRY,
if NOT USA:

None

None
ROTC, cadet, or midshipman at a service academy
In the Reserves or National Guard
On Active Duty
A discharged veteran NOT serving on Active Duty,
in Reserves, or in National Guard

EVSN
EVSN

ZIP:

Year

Day
(01-31)

AT PE
IO RT
N Y
R O
ES F
EA TH
R E
C H
H IG
IN H
S T ER
IT
U
TE

`
`
`
`
`

STUDENT ID# (as instructed):

V Very Important
E 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..............................................

STATE:

45. Military Status: (Mark one)

CITY:

````````

N Not Important
S Somewhat Important

When were you born?

Month
(01-12)

ADDRESS:

````````
````````
````````

54321
54321
54321

````````
````````

51. Please indicate the importance to you
personally of each of the following:
(Mark one for each item)

54321

24. Below is a list of different undergraduate major fields grouped
into general categories. (Fill in appropriate three-digit code on
your survey)

NAME:

Over
20

16-20

11-15

6-10

````````
````````
````````

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....................

PLEASE PRINT IN ALL CAPS YOUR NAME AND PERMANENT/HOME ADDRESS (one letter or number per box).
FIRST
MI
LAST

SERIAL #

Studying/homework...................
Socializing with friends in person..
Using social media.....................
Watching TV/online video
content (e.g., Amazon, Hulu,
Netflix, YouTube)......................
Partying......................................
Participating in student clubs/
groups......................................
Exercising/sports........................
Working (for pay)........................
Performing household/childcare
duties........................................

2019 CIRP Freshman Survey

50. To what extent are the following
1 Strongly Disagree
statements true of you:
2 Disagree Somewhat
(Mark one in each row)
3 Neutral

4 Agree Somewhat
5 Strongly Agree

3-5

Hours per week:

Less
than
1 hou
r
1-2

None

44. During your last year in high school, how much time
did you spend during a typical week:

Pre-Med............................................
Pre-Law............................................

`. `
` `

24. Please indicate your intended major using the
codes provided on the
attached fold out.
Less than third choice

ARTS AND HUMANITIES
001 Art, fine and applied
002 Classical and Modern

Languages and Literature
003 English (language and literature)
004 History
005 Journalism/Communication
006 Media/Film Studies
007 Music
008 Philosophy
009 Theatre/Drama
010 Theology/Religion
011 Other Arts and Humanities
BIOLOGICAL & LIFE
SCIENCES
112 Agriculture/Natural Resources
113 Animal Biology (zoology)
114 Biochemistry/Biophysics
115 Biology (general)
116 Ecology & Evolutionary
Biology
117 Environmental Science
118 Marine Biology
119 Microbiology
120 Molecular, Cellular, &

Developmental Biology
121 Neurobiology/Neuroscience
122 Plant Biology (botany)
123 Other Biological Science
BUSINESS
224 Accounting
225 Business Admin. (general)
226 Computer/Management

Information Systems
227 Entrepreneurship
228 Finance
229 Hospitality/Tourism
230 Human Resources Management
231 International Business
232 Management
233 Marketing
234 Real Estate
235 Other Business
EDUCATION
336 Elementary Education
337 Music/Art Education
338 Physical Education/Recreation
339 Secondary Education
340 Special Education
341 Other Education

HEALTH PROFESSIONS
555 Clinical Laboratory Science
556 Health Care Administration/
Studies
557 Health Technology
558 Kinesiology
559 Nursing
560 Pharmacy
561 Therapy (occupational,

physical, speech)
562 Other Health Profession
MATH AND COMPUTER
SCIENCE
663 Computer Science
664 Mathematics/Statistics
665 Other Math and Computer
Science
PHYSICAL SCIENCE
766 Astronomy & Astrophysics
767 Atmospheric Sciences
768 Chemistry
769 Earth & Planetary Sciences
770 Marine Sciences
771 Physics
772 Other Physical Science
SOCIAL SCIENCE
873 Anthropology
874 Economics
875 Ethnic/Cultural Studies
876 Geography
877 Political Science (gov’t.,

international relations)
878 Psychology
879 Public Policy
880 Social Work
881 Sociology
882 Women’s/Gender Studies
883 Other Social Science
OTHER MAJORS
984 Architecture/Urban Planning
985 Criminal Justice
986 Library Science
987 Security & Protective
Services
988 Military Sciences/
Technology/Operations
989 OTHER
990 UNDECIDED

ENGINEERING
442 Aerospace/Aeronautical/

Astronautical Engineering
443 Biological/Agricultural
Engineering
444 Biomedical Engineering
445 Chemical Engineering
446 Civil Engineering
447 Computer Engineering
448 Electrical/Electronic/

Communications Engineering
449 Engineering Science/

Engineering Physics
450 Environmental/Environmental

Health Engineering
451 Industrial/Manufacturing
Engineering
452 Materials Engineering
453 Mechanical Engineering
454 Other Engineering

Third choice

Turn over for Question 25

USE OF THIS SURVEY WITHOUT
PERMISSION IS PROHIBITED

Military grants...................................
Work-study.......................................
Pell Grant..........................................

Need-based grants or scholarships..
Merit-based grants or scholarships..

`.
`
`
`
`

`
`
`
`
`

`
`
`
`
`
`

$100,000-$124,999
$125,000-$149,999
$150,000-$199,999
$200,000-$249,999
$250,000-$499,999
$500,000 or higher

30. In your lifetime, have you been homeless for at
least one month?

`
`

Yes
No

34. In the past year, how often
have you: (Mark one for each
item)
Attended a religious service.......
Been bored in class...................
Demonstrated for a cause (e.g.,
boycott, rally, protest).............
Tutored another student.............
Studied with other students.......
Consumed beer..........................
Consumed wine or liquor...........

` ... `
` ... `
` ... `
` ... `
` ...
. `
` ... `
` ... `
` ... `
` ... `
` ... `

FON
FON
FON
FON
FON
FON
FON

FON

35. How would you rate
yourself in the following
areas:
(Mark one for each item)

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..........

`````
`````

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

Junior high/Middle
school or less...............
Some high school..........

Parent/
Guardian 2

` ........... `
` ........... `
High school graduate/GED. ` ........... `
Postsecondary school
other than college........
Some college.................
College degree...............
Some graduate school...
Graduate degree............

` ...........
` ...........

`
`
` ........... `
` ........... `
` ........... `

USE OF THIS SURVEY WITHOUT
PERMISSION IS PROHIBITED

FON
FON
FON

hat
Not at
All

Modera

tely

FON
FON

AVMSN
AVMSN
AVMSN
AVMSN
AVMSN
AVMSN
AVMSN
AVMSN
AVMSN
AVMSN

39. How would you characterize your political
views? (Mark one)

`
`
`

Far left
Liberal
Middle-of-the-road

`
`

Conservative
Far right

40. In deciding to go to college, how
important to you was each of the
following reasons? (Mark one
answer for each possible reason)
To be able 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....................................

VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN

42. Mark one in each row:

Below
Averag
e
Lowes
t 10%

Highes
t 10%
Above
Averag
e
Averag
e

Freque
ntly
Occas
ionally
Not at
All

FON
FON

Somew

Use technical science skills (use
of tools, instruments, and/or
techniques)....................................
Generate an answerable 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..

Very

Freque
ntly
Occas
ionally
Not at
All

FON
FON
FON

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

FON

41. 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)
Academic ability.......................................
Artistic ability............................................
Compassion.............................................
Computer programming skills..................
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............................................

`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````

1 Strongly Disagree
2 Disagree Somewhat

3 Agree Somewhat
4 Strongly Agree

Racial discrimination is no longer a major problem in America.........................
Abortion should be legal.....................................................................................
Colleges have the right to ban extreme speakers from campus........................
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...........................
The federal government should raise taxes to reduce the deficit......................
Gays and lesbians should have the legal right to adopt a child........................
The U.S. government should create a clear path to citizenship for
undocumented immigrants...............................................................................
My political views closely resemble those of my parent(s)/guardian(s)..............

4321
4321
4321
4321
4321
4321
4321
4321
4321
4321
4321

43. 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)
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 extracurricular activities......
I was offered financial assistance............................................................................
The cost of attending this college............................................................................
High school counselor advised me..........................................................................
Private college counselor advised me.....................................................................
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 this 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........................................
Communication with a professor.............................................................................
The academic reputation of my intended major......................................................

Ver
Impyo
rta
Som nt
Impoewhat
rtant
Not
Impo
rtant

Yes

FON
FON

FON

hat Im
portan
t
Not Im
portan
t

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

33. What is the highest academic
degree that you intend to
obtain?
(Mark one in each column)

Y12
Y12
Y12
Y12

FON

ant

Family 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.).......................... ``````

29. What is your best estimate of your parents’/
guardians’ total income last year? Consider
income from all sources before taxes. (Mark one)

Carefully detach this section after
answering Questions 24 and 25

FON
FON
FON
FON

Absolu

9,999
$10,000$14,999
$15,000+

$6,000-$

5,999

$3,000-$

27. 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)

`
`
`
`
`
`

FON

A Majo
r Stren
gth
Somew
hat Str
ong
Averag
e
Somew
hat We
ak
A Majo
r Weak
ness

````
````

Parent/Guardian 1...................
Parent/Guardian 2...................

Highest Plann
at This Collegeed

Retired

Seasonal
ly
Employed
Unemploy
ed

Employed

26. Current employment status:
(Mark one in each row)

Less than $15,000
$15,000-$24,999
$25,000-$29,999
$30,000-$59,999
$60,000-$74,999
$75,000-$99,999

Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12

FON
FON
FON

FON

Very Im
port

35 Protective Services
(e.g., Homeland Security,
Law Enforcement, Firefighter)

Agnostic.....................................
Atheist........................................
Baptist........................................
Buddhist.....................................
Church of Christ.........................
Eastern Orthodox.......................
Episcopalian...............................
Hindu..........................................
Jewish........................................
LDS (Mormon)............................
Lutheran.....................................
Methodist...................................
Muslim........................................
Presbyterian...............................
Quaker........................................
Roman Catholic..........................
Seventh-day Adventist...............
United Church of Christ/
Congregational...........................
Other Christian...........................
Other religion(s)/belief(s).............
None...........................................

Felt overwhelmed by all I
had to do.............................
Felt depressed.......................
Performed volunteer work.....
Asked a teacher for advice
after class............................
Socialized with someone of
another racial/ethnic group..
Been late to class..................
Discussed politics.................
Skipped school/class............
Publicly communicated my
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...........................
Written computer code.........
Felt hungry but did not eat
because I didn’t have
enough money for food......

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 feel you have
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..........

Somew

33 Military
34 Postal Worker

Parent/Guardian 2 career

nally
Not at
All

67 UNDECIDED

64 CLERGY
65 HOMEMAKER/STAY AT
HOME PARENT
66 OTHER

32. Current religious preference:
(Mark one in each column)

Occas
io

GOVERNMENT
32 Federal/State/Local
Government Official

58 Custodian/Janitor/Housekeeper
59 Food Service (e.g., Chef/Cook,
Server)
60 Hair Stylist/Aesthetician/
Manicurist
61 Interior Designer
62 Skilled Trades (e.g., Plumber,
Electrician, Construction)
63 Social/Non-Profit Services

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

Highest Plann
ed

SERVICE INDUSTRY

Some (but I probably will have enough
funds)

ntly

22 College Administrator/Staff
23 College Faculty
24 Early Childcare Provider
25 Elementary School Teacher
26 K-12 Administrator
27 Librarian
28 Secondary School Teacher in a
non-STEM subject
29 Secondary School Teacher in
Science, Technology,
Engineering, or Math (STEM)
30 Teacher’s Assistant/
Paraprofessional
31 Other K-12 Professional

Freque

EDUCATION

SCIENCE AND ENGINEERING
55 Engineer
56 Research Scientist (e.g., Biologist,
Chemist, Physicist)
57 Urban Planner/Architect

Parent/Guardian 1 career

None

20 Journalist
21 Public Relations/Media
Relations

LAW
53 Lawyer/Judge
54 Paralegal

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

$1-$2,99

COMMUNICATIONS
19 Advertising

INFORMATION TECHNOLOGY
50 Computer Programmer/Developer
51 Computer/Systems Analyst
52 Web Designer

37. How often in the past year
did you:
(Mark one for each item)

34. Continued. In the past year,
how often have you: (Mark
one for each item)

AT PE
IO RT
N Y
R O
ES F
EA TH
R E
C H
H IG
IN H
S T ER
IT
U
TE

BUSINESS
08 Accountant
09 Administrative Assistant
10 Business Manager/Executive
11 Business Owner/Entrepreneur
12 Finance (e.g., Actuary,
Banking, Loan Officer, Planner)
13 Human Resources
14 Management Consultant
15 Real Estate Agent/Realtor/
Appraiser/Developer
16 Retail Sales
17 Sales/Marketing
18 Sports Management

Your intended career

AGRICULTURE
06 Farmer or Forester
07 Natural Resource
Specialist/Environmentalist

HEALTHCARE/MEDICINE
36 Clinical Psychologist
37 Dentist/Orthodontist
38 Dietician/Nutritionist
39 Home Health Care Worker
40 Medical/Dental Assistant
(e.g., Hygienist, Lab Tech,
Nursing Asst.)
41 Medical Doctor/Surgeon
42 Mental Health Professional
43 Optometrist
44 Pharmacist
45 Physician Assistant
46 Registered Nurse
47 Social Worker
48 Therapist (e.g., Physical,
Occupational, Speech)
49 Veterinarian

ARTS
01 Actor or Entertainer
02 Artist
03 Graphic Designer
04 Musician
05 Writer/Producer/Director

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

Yours
Parent/
Guardia
Parent/ n 1
Guardia
n2

25. Please indicate your intended career
as well as the careers of your parents/
guardians, using the codes provided
on the attached fold out. (Your intended
career, Parent/Guardian 1 career, Parent/
Guardian 2 career)

25. Below is a list of different careers grouped into general
categories. (Fill in appropriate two-digit codes on your survey)

VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN

Carefully detach this section after
answering Questions 24 and 25

`
`
`
`
`
`

Less than $15,000
$15,000-$24,999
$25,000-$29,999
$30,000-$59,999
$60,000-$74,999
$75,000-$99,999

`
`
`
`
`
`

$100,000-$124,999
$125,000-$149,999
$150,000-$199,999
$200,000-$249,999
$250,000-$499,999
$500,000 or higher

30. In your lifetime, have you been homeless for at
least one month?

`
`

Yes
No

` ... `
` ... `

FON
FON
FON
FON
FON
FON
FON

Critical thinking skills...
Ability to manage your
time effectively..........

`````

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

Junior high/Middle
school or less...............
Some high school..........

Parent/
Guardian 2

` ...........
` ...........

`
`
` ........... `
` ........... `
` ........... `

Far left
Liberal
Middle-of-the-road

Below
Averag
e
Lowes
t 10%

`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````

hat
Not at
All

Modera

tely

FON
FON

AVMSN
AVMSN
AVMSN
AVMSN
AVMSN
AVMSN
AVMSN
AVMSN
AVMSN
AVMSN

`
`

Conservative
Far right

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

To be able 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....................................

VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN

42. Mark one in each row:

1 Strongly Disagree
2 Disagree Somewhat

3 Agree Somewhat
4 Strongly Agree

4321
4321
4321
4321
4321
4321
4321
4321
4321
4321
4321

Ver
Impyo
rta
Som nt
Impoewhat
rtant
Not
Impo
rtant

FON

39. How would you characterize your political
views? (Mark one)

`
`
`

Highes
t 10%
Above
Averag
e
Averag
e

Freque
ntly
Occas
ionally
Not at
All

FON

Somew

tely

Very

Freque
ntly
Occas
ionally
Not at
All

`````

Absolu

Yours
Parent/
Guardia
Parent/ n 1
Guardia
n2

` ... `
` ... `
` ... `
` ... `
` ...
. `
` ... `
` ... `
` ... `

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

FON

hat Im
portan
t
Not Im
portan
t

29. What is your best estimate of your parents’/
guardians’ total income last year? Consider
income from all sources before taxes. (Mark one)

35. How would you rate
yourself in the following
areas:
(Mark one for each item)

FON
FON

ant

`
`
`
`
`

FON

Very Im
port

Need-based grants or scholarships..
Merit-based grants or scholarships..

`.
`
`
`
`

FON
FON
FON

FON

Somew

Military grants...................................
Work-study.......................................
Pell Grant..........................................

FON
FON

FON

AT PE
IO RT
N Y
R O
ES F
EA TH
R E
C H
H IG
IN H
S T ER
IT
U
TE

Yes

FON

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

33. What is the highest academic
degree that you intend to
obtain?
(Mark one in each column)

Y12
Y12
Y12
Y12

FON
FON
FON
FON

FON

$6,000-$

9,999
$10,000$14,999
$15,000+

27. 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)

FON
FON
FON

A Majo
r Stren
gth
Somew
hat Str
ong
Averag
e
Somew
hat We
ak
A Majo
r Weak
ness

Retired

Seasonal
ly
Employed
Unemploy
ed

Employed

````
````

35 Protective Services
(e.g., Homeland Security,
Law Enforcement, Firefighter)

Parent/Guardian 1...................
Parent/Guardian 2...................

Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12

37. How often in the past year
did you:
(Mark one for each item)

34. Continued. In the past year,
how often have you: (Mark
one for each item)

33 Military
34 Postal Worker

26. Current employment status:
(Mark one in each row)

Highest Plann
at This Collegeed

67 UNDECIDED

64 CLERGY
65 HOMEMAKER/STAY AT
HOME PARENT
66 OTHER

Parent/Guardian 2 career

nally
Not at
All

GOVERNMENT
32 Federal/State/Local
Government Official

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

Occas
io

SERVICE INDUSTRY

Some (but I probably will have enough
funds)

Highest Plann
ed

ntly

EDUCATION

SCIENCE AND ENGINEERING
55 Engineer
56 Research Scientist (e.g., Biologist,
Chemist, Physicist)
57 Urban Planner/Architect

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

32. Current religious preference:
(Mark one in each column)

5,999

20 Journalist
21 Public Relations/Media
Relations

LAW
53 Lawyer/Judge
54 Paralegal

Parent/Guardian 1 career

$3,000-$

COMMUNICATIONS
19 Advertising

INFORMATION TECHNOLOGY
50 Computer Programmer/Developer
51 Computer/Systems Analyst
52 Web Designer

Your intended career

None

AGRICULTURE
06 Farmer or Forester
07 Natural Resource
Specialist/Environmentalist

$1-$2,99

ARTS
01 Actor or Entertainer
02 Artist
03 Graphic Designer
04 Musician
05 Writer/Producer/Director

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

Freque

25. Below is a list of different careers grouped into general
categories. (Fill in appropriate two-digit codes on your survey)

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 extracurricular activities......
I was offered financial assistance............................................................................
The cost of attending this college............................................................................
High school counselor advised me..........................................................................
Private college counselor advised me.....................................................................
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 this 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........................................
Communication with a professor.............................................................................
The academic reputation of my intended major......................................................

VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN

USE OF THIS SURVEY WITHOUT
PERMISSION IS PROHIBITED

I do not plan to graduate from this college.

47. Will you pursue a science-related research career?
(Mark one)

`
`
`

`
`

Definitely yes
Probably yes
Uncertain

Probably no
Definitely no

48. Is English your primary language?
` Yes
` No

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

Learning disability (dyslexia, etc.)....................
Attention deficit 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.................................................................

N No Chance
L Very Little Chance

52. What is your best guess as to
the chances that you will:
(Mark one for each item)

Yes

`
`
`

S Some Chance
V Very Good Chance

VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN

ABCDE
ABCDE
ABCDE
ABCDE

57.
58.
59.
60.

ABCDE
ABCDE
ABCDE
ABCDE

61.
62.
63.
64.

ABCDE
ABCDE
ABCDE
ABCDE

65.
66.
67.
68.

ABCDE
ABCDE
ABCDE
ABCDE

69.
70.
71.
72.

ABCDE
ABCDE
ABCDE
ABCDE

THANK YOU!
© Prepared by the Higher Education Research Institute,
University of California, Los Angeles, California 90095-1521

MARKING DIRECTIONS
• Use a black or blue pen.
• Fill in your response completely.
Mark out any answer you wish to
change with an “X”.

USE OF THIS SURVEY WITHOUT
PERMISSION IS PROHIBITED

10. What were your scores on the SAT
and/or ACT?
SAT Critical Reading...........
SAT Mathematics................

CORRECT MARK INCORRECT MARKS

a~aa
A

11. From what kind of high school did you
graduate? (Mark one)

1. Do you identify as transgender?
` Yes
` No
2. What is your current gender identity?
` Man/Trans Man
` Woman/Trans Woman
` Gender queer/Gender non-conforming
` Identity not listed above
3. What is your sexual orientation?
` Heterosexual/Straight ` Queer
` Gay
` Pansexual
` Lesbian
` Asexual
` Bisexual
` Not listed
above
4. In what year did you graduate from
high school? (Mark one)

`
`
`
`

2019
` Did not graduate but
passed G.E.D. test
2018
2017
` Never completed
high school
2016 or earlier

5. Are you enrolling: (Mark one)

Full-time

Part-time

6. How many miles is this college from
your permanent home? (Mark one)

`
`

5 or less
6-10

`
`

11-50
51-100

`
`

101-500
Over 500

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

`
`
`

A or A+
A–
B+

`
`
`

B
B–
C+

`
`

C
D

8. Prior to this term, have you ever taken
courses for credit at this institution?

Yes

9. Since leaving high school, have you ever
taken courses, whether for credit or not
for credit, at any other institution?
Yes

ACT Composite........................

aaaa

Group Code

`
Data Recognition Corp.-6G9144-18411-54321

EMAIL (print letters carefully):

`
`
`
`
`
`

17. 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

18. Please mark which of the following courses you
have completed:
YN Pre-calculus/Trigonometry
YN Probability & Statistics
YN Calculus
YN AP Probability & Statistics
YN AP Calculus

Yes

14. To how many colleges other than this one
did you apply for admission this year?
` None ` 3 ` 6
` 11 or
more
4
7-8
1

`
`

9-10

16. Is this college your: (Mark one)

`
`

First choice
Second choice

`
`

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

Male

Parent/Guardian 1............................
Parent/Guardian 2............................

`
`

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

15. Were you accepted by your first choice
college? ` Yes
` No

5 or
more

EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN

COUNTRY,
if NOT USA:

EVSN
EVSN

ZIP:

STUDENT ID# (as instructed):

V Very Important
E Essential

STATE:

None
ROTC, cadet, or midshipman at a service academy
In the Reserves or National Guard
On Active Duty
A discharged veteran NOT serving on Active Duty,
in Reserves, or in National Guard

CITY:

Year

Day
(01-31)

````````

46. How many years do you expect it will take you to
graduate from this college?

N Not Important
S Somewhat Important

Month
(01-12)

ADDRESS:

1/2

````````
````````
````````

45. Military Status: (Mark one)

`
`
`
`
`

54321
54321
54321

When were you born?

None

````````
````````

51. Please indicate the importance to you
personally of each of the following:
(Mark one for each item)

54321

24. Below is a list of different undergraduate major fields grouped
into general categories. (Fill in appropriate three-digit code on
your survey)

NAME:

SERIAL #

Over
20

16-20

11-15

6-10

````````
````````
````````

PLEASE PRINT IN ALL CAPS YOUR NAME AND PERMANENT/HOME ADDRESS (one letter or number per box).
FIRST
MI
LAST

AT PE
IO RT
N Y
R O
ES F
EA TH
R E
C H
H IG
IN H
S T ER
IT
U
TE

2019 CIRP Freshman Survey

50. To what extent are the following
1 Strongly Disagree
statements true of you:
2 Disagree Somewhat
(Mark one in each row)
3 Neutral

4 Agree Somewhat
5 Strongly Agree

3-5

Hours per week:

Less
than
1 hou
r
1-2

None

44. During your last year in high school, how much time
did you spend during a typical week:

Pre-Med............................................
Pre-Law............................................

`. `
` `

24. Please indicate your intended major using the
codes provided on the
attached fold out.
Less than third choice

ARTS AND HUMANITIES
001 Art, fine and applied
002 Classical and Modern

Developmental Biology
121 Neurobiology/Neuroscience
122 Plant Biology (botany)
123 Other Biological Science
BUSINESS
224 Accounting
225 Business Admin. (general)
226 Computer/Management

HEALTH PROFESSIONS
555 Clinical Laboratory Science
556 Health Care Administration/
Studies
557 Health Technology
558 Kinesiology
559 Nursing
560 Pharmacy
561 Therapy (occupational,

ENGINEERING
442 Aerospace/Aeronautical/

Astronautical Engineering
443 Biological/Agricultural
Engineering
444 Biomedical Engineering
445 Chemical Engineering
446 Civil Engineering
447 Computer Engineering
448 Electrical/Electronic/

Communications Engineering
449 Engineering Science/

Engineering Physics
450 Environmental/Environmental

Health Engineering
451 Industrial/Manufacturing
Engineering
452 Materials Engineering
453 Mechanical Engineering
454 Other Engineering

Third choice

Turn over for Question 25

I do not plan to graduate from this college.

47. Will you pursue a science-related research career?
(Mark one)

`
`
`

`
`

Definitely yes
Probably yes
Uncertain

Probably no
Definitely no

N No Chance
L Very Little Chance

52. What is your best guess as to
the chances that you will:
(Mark one for each item)

Yes

`
`
`

S Some Chance
V Very Good Chance

VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN
VSLN

ABCDE
ABCDE
ABCDE
ABCDE

57.
58.
59.
60.

ABCDE
ABCDE
ABCDE
ABCDE

61.
62.
63.
64.

ABCDE
ABCDE
ABCDE
ABCDE

65.
66.
67.
68.

ABCDE
ABCDE
ABCDE
ABCDE

69.
70.
71.
72.

ABCDE
ABCDE
ABCDE
ABCDE

THANK YOU!
© Prepared by the Higher Education Research Institute,
University of California, Los Angeles, California 90095-1521

a~aa
A

5. Are you enrolling: (Mark one)

Full-time

Part-time

6. How many miles is this college from
your permanent home? (Mark one)

`
`

5 or less
6-10

`
`

11-50
51-100

`
`

101-500
Over 500

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

`
`
`

A or A+
A–
B+

`
`
`

B
B–
C+

`
`

C
D

8. Prior to this term, have you ever taken
courses for credit at this institution?

Yes

9. Since leaving high school, have you ever
taken courses, whether for credit or not
for credit, at any other institution?

`
Data Recognition Corp.-6G9144-18411-54321

11. From what kind of high school did you
graduate? (Mark one)

Group Code

`
`
`
`

Yes

ACT Composite........................

aaaa
`
`
`
`
`
`

18. Please mark which of the following courses you
have completed:
YN Pre-calculus/Trigonometry
YN Probability & Statistics
YN Calculus
YN AP Probability & Statistics
YN AP Calculus

CORRECT MARK INCORRECT MARKS

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

13. Did you participate in a bridge program
at this institution this summer?

Yes

14. To how many colleges other than this one
did you apply for admission this year?
` None ` 3 ` 6
` 11 or
more
4
7-8
1

`
`

9-10

15. Were you accepted by your first choice
college? ` Yes
` No
16. Is this college your: (Mark one)

`
`

First choice
Second choice

`
`

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

Male

Parent/Guardian 1............................
Parent/Guardian 2............................

`
`

23. Do you consider yourself: (Mark Yes or No for
each item)
Pre-Med............................................
Pre-Law............................................

ARTS AND HUMANITIES
001 Art, fine and applied
002 Classical and Modern

Developmental Biology
121 Neurobiology/Neuroscience
122 Plant Biology (botany)
123 Other Biological Science

HEALTH PROFESSIONS
555 Clinical Laboratory Science
556 Health Care Administration/
Studies
557 Health Technology
558 Kinesiology
559 Nursing
560 Pharmacy
561 Therapy (occupational,

AT PE
IO RT
N Y
R O
ES F
EA TH
R E
C H
H IG

SAT Mathematics................

`
`
`

SAT Critical Reading...........

17. Citizenship status: (Mark one)

MARKING DIRECTIONS
• Use a black or blue pen.
• Fill in your response completely.
Mark out any answer you wish to
change with an “X”.

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

EMAIL (print letters carefully):

46. How many years do you expect it will take you to
graduate from this college?

EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN
EVSN

COUNTRY,
if NOT USA:

None
ROTC, cadet, or midshipman at a service academy
In the Reserves or National Guard
On Active Duty
A discharged veteran NOT serving on Active Duty,
in Reserves, or in National Guard

STUDENT ID# (as instructed):

ZIP:

`
`
`
`
`

EVSN
EVSN

STATE:

Year

Day
(01-31)

45. Military Status: (Mark one)

CITY:

V Very Important
E Essential

Month
(01-12)

ADDRESS:

1/2

````````

N Not Important
S Somewhat Important

NAME:

None

````````
````````
````````

54321
54321
54321

When were you born?

````````
````````

51. Please indicate the importance to you
personally of each of the following:
(Mark one for each item)

54321

24. Below is a list of different undergraduate major fields grouped
into general categories. (Fill in appropriate three-digit code on
your survey)

Over
20

16-20

11-15

6-10

````````
````````
````````

PLEASE PRINT IN ALL CAPS YOUR NAME AND PERMANENT/HOME ADDRESS (one letter or number per box).
FIRST
MI
LAST

SERIAL #

2019 CIRP Freshman Survey

50. To what extent are the following
1 Strongly Disagree
statements true of you:
2 Disagree Somewhat
(Mark one in each row)
3 Neutral

4 Agree Somewhat
5 Strongly Agree

3-5

Hours per week:

Less
than
1 hou
r
1-2

None

44. During your last year in high school, how much time
did you spend during a typical week:

Yes

`. `
` `

24. Please indicate your intended major using the
codes provided on the
attached fold out.
Less than third choice

BUSINESS
224 Accounting
225 Business Admin. (general)
226 Computer/Management

SOCIAL SCIENCE
873 Anthropology
874 Economics
875 Ethnic/Cultural Studies
876 Geography
877 Political Science (gov’t.,

international relations)
878 Psychology
879 Public Policy
880 Social Work
881 Sociology
882 Women’s/Gender Studies
883 Other Social Science

OTHER MAJORS
984 Architecture/Urban Planning
985 Criminal Justice
986 Library Science
987 Security & Protective
Services
988 Military Sciences/
Technology/Operations

989 OTHER

990 UNDECIDED

ENGINEERING
442 Aerospace/Aeronautical/

Astronautical Engineering
443 Biological/Agricultural
Engineering
444 Biomedical Engineering
445 Chemical Engineering
446 Civil Engineering
447 Computer Engineering
448 Electrical/Electronic/

Communications Engineering
449 Engineering Science/

Engineering Physics
450 Environmental/Environmental

Health Engineering
451 Industrial/Manufacturing
Engineering
452 Materials Engineering
453 Mechanical Engineering
454 Other Engineering

Third choice

Turn over for Question 25

USE OF THIS SURVEY WITHOUT
PERMISSION IS PROHIBITED

29. What is your best estimate of your parents’/
guardians’ total income last year? Consider
income from all sources before taxes. (Mark one)

Carefully detach this section after
answering Questions 24 and 25

`
`
`
`
`
`

$100,000-$124,999
$125,000-$149,999
$150,000-$199,999
$200,000-$249,999
$250,000-$499,999
$500,000 or higher

30. In your lifetime, have you been homeless for at
least one month?

`
`

USE OF THIS SURVEY WITHOUT
PERMISSION IS PROHIBITED

Less than $15,000
$15,000-$24,999
$25,000-$29,999
$30,000-$59,999
$60,000-$74,999
$75,000-$99,999

Yes
No

None...........................................
Vocational certificate..................
Associate (A.A. or equivalent)....
Bachelor’s (B.A., B.S., B.D., etc.)..
Master’s (M.A., M.S., M.B.A., etc.)..
J.D. (Law)...................................
M.D., D.D.S., D.V.M., etc. (Medical)..
Ph.D............................................
Professional Doctorate (Ed.D.,
Psy.D., etc.)..............................
Other...........................................
34. In the past year, how often
have you: (Mark one for each
item)
Attended a religious service.......
Been bored in class...................
Demonstrated for a cause (e.g.,
boycott, rally, protest).............
Tutored another student.............
Studied with other students.......
Consumed beer..........................
Consumed wine or liquor...........

` ... `
` ... `

FON
FON
FON
FON
FON
FON
FON

35. How would you rate
yourself in the following
areas:
(Mark one for each item)

`````
`````

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

Junior high/Middle
school or less...............
Some high school..........

Parent/
Guardian 2

` ...........
` ...........

`
`
` ........... `
` ........... `
` ........... `

FON
FON
FON

hat
Not at
All

Modera

tely

FON
FON

AVMSN
AVMSN
AVMSN
AVMSN
AVMSN
AVMSN
AVMSN
AVMSN
AVMSN
AVMSN

39. How would you characterize your political
views? (Mark one)

`
`
`

Far left
Liberal
Middle-of-the-road

`
`

Conservative
Far right

VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN

42. Mark one in each row:

Below
Averag
e
Lowes
t 10%

Highes
t 10%
Above
Averag
e
Averag
e

Freque
ntly
Occas
ionally
Not at
All

FON
FON

Somew

Freque
ntly
Occas
ionally
Not at
All

FON

tely

Yours
Parent/
Guardia
Parent/ n 1
Guardia
n2

` ... `
` ... `
` ... `
` ... `
` ...
. `
` ... `
` ... `
` ... `

FON
FON
FON

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

FON

`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````

1 Strongly Disagree
2 Disagree Somewhat

3 Agree Somewhat
4 Strongly Agree

4321
4321
4321
4321
4321
4321
4321
4321
4321
4321
4321

Ver
Impyo
rta
Som nt
Impoewhat
rtant
Not
Impo
rtant

`
`
`
`
`

FON
FON

FON

hat Im
portan
t
Not Im
portan
t

Need-based grants or scholarships..
Merit-based grants or scholarships..

`.
`
`
`
`

FON

ant

Military grants...................................
Work-study.......................................
Pell Grant..........................................

Yes

FON
FON
FON
FON

Very

9,999
$10,000$14,999
$15,000+

$6,000-$

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

33. What is the highest academic
degree that you intend to
obtain?
(Mark one in each column)

Y12
Y12
Y12
Y12

FON

Absolu

Seasonal
ly
Employed
Unemploy
ed

Employed

FON
FON
FON

FON

Very Im
port

35 Protective Services
(e.g., Homeland Security,
Law Enforcement, Firefighter)

27. 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)

Somew

33 Military
34 Postal Worker

````
````

Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12
Y12

37. How often in the past year
did you:
(Mark one for each item)

34. Continued. In the past year,
how often have you: (Mark
one for each item)

A Majo
r Stren
gth
Somew
hat Str
ong
Averag
e
Somew
hat We
ak
A Majo
r Weak
ness

67 UNDECIDED

64 CLERGY
65 HOMEMAKER/STAY AT
HOME PARENT
66 OTHER

Parent/Guardian 1...................
Parent/Guardian 2...................

Highest Plann
at This Collegeed

GOVERNMENT
32 Federal/State/Local
Government Official

26. Current employment status:
(Mark one in each row)

Retired

Parent/Guardian 2 career

nally
Not at
All

SERVICE INDUSTRY

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

Occas
io

Some (but I probably will have enough
funds)

Highest Plann
ed

EDUCATION

SCIENCE AND ENGINEERING
55 Engineer
56 Research Scientist (e.g., Biologist,
Chemist, Physicist)
57 Urban Planner/Architect

32. Current religious preference:
(Mark one in each column)

None

20 Journalist
21 Public Relations/Media
Relations

LAW
53 Lawyer/Judge
54 Paralegal

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

ntly

Parent/Guardian 1 career

$1-$2,99

COMMUNICATIONS
19 Advertising

INFORMATION TECHNOLOGY
50 Computer Programmer/Developer
51 Computer/Systems Analyst
52 Web Designer

ER
O T
N Y
R O
ES F
EA TH
R E
C H
H IG
IN H
S T ER
IT
U
TE

Your intended career

5,999

AGRICULTURE
06 Farmer or Forester
07 Natural Resource
Specialist/Environmentalist

$3,000-$

ARTS
01 Actor or Entertainer
02 Artist
03 Graphic Designer
04 Musician
05 Writer/Producer/Director

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

Freque

25. Below is a list of different careers grouped into general
categories. (Fill in appropriate two-digit codes on your survey)

VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN
VSN

File Type	application/pdf
Author	DPurnell
File Modified	2019-11-20
File Created	2016-01-09