Form 3 STEP-UP Participant survey form

STEP-UP Participant Survey
OMB# 0925-0748
Expiration date: XX/XX/XXXX

Page 1 of 33

*Note to NIH Project Clearance Branch/OMB:
Survey logic and branching results in length of
instrument and presumed repeated education
section (up to 10 education degrees can be listed).
Participants will only see questions that apply, so the
survey skips to next relevant section/question.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Office of Minority Health Research
Coordination (OMHRC) would like to know about STEP-UP participants educational and professional achievements. As
a former STEP-UP program participant, we are asking you to complete this brief questionnaire about your education
and employment history. Your responses will help us assess the outcomes of the STEP-UP program.
Your participation in this questionnaire is completely voluntary and your survey responses will be kept secure to the
extent permitted by law.
Burden Disclosure: Public reporting burden for this collection of information is estimated to average 5 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# 0925-0748. Do not return the completed form to this address.
Protecting your privacy is very important to us. We will keep your survey responses anonymous. Names and other
personal identifiers will not appear in any report and we will not report individual information, such as education and
professional achievements. Groups of records that contain information about an individual and are designed to be
retrieved by the individual’s name or other personal identifier linked to the individual are covered by the Privacy Act
of 1974, as amended (5 U.S.C. Section 552a). All of the information that you share with us will be kept private under
the Privacy Act. All findings from the survey will be presented in aggregate.
NIDDK will retain data collected through this survey long enough to achieve the specified objective for which they
were collected. The data generated from these activities falls under the National Archives and Records
Administration (NARA) General Records Schedule (GRS) 20-item IC 'Electronic Records,' and will be handled per the
requirements of that schedule (http://www.archives.gov/records-mgmt/grs/grs20.html ).

If you have questions about this privacy policy, please e-mail them to [email protected].

By selecting "I consent", you are indicating that you
consent to participate in this survey.

05/08/2020 2:11pm

I consent
I do not consent

projectredcap.org

Page 2 of 33

Contact Information
Is this still the best email address to use to
contact you?
Please provide an updated email address.

05/08/2020 2:11pm

Yes
No

__________________________________

projectredcap.org

Page 3 of 33

Education Please provide information on any degrees that you are currently enrolled in or
have completed. If you have taken the survey previously, your answers will show below.
Please update any of the information that has changed.
Degree

Other degree, please describe:

Associate's degree or equivalent
Bachelor's degree or equivalent
Master's degree or equivalent
Doctoral degree or equivalent
Medical degree
Other degree

__________________________________

Associate's degree type

Associate of Science (A.S.)
Associate of Arts (A.A.)
Other
Undecided

Bachelor's degree type

Bachelor of Arts (B.A.)
Bachelor of Science (B.S.)
Bachelor of Science in Nursing (B.S.N.)
Other
Undecided

Master's degree type

Master of Arts (M.A.)
Master of Public Health (M.P.H)
Master of Science (M.S.) in biomedical science
field
Master of Science (M.S.) in another science or
engineering field
Master of Science in Nursing (M.S.N)
Master of Fine Arts (M.F.A)
Master of Business Administration (M.B.A)
Other
Undecided

Doctoral degree type

Doctor of Philosophy (Ph.D.)
Doctor of Science (D.Sc.)
Doctor of Education (E.D.)
Doctor of Veterinary Medicine (D.V.M.)
Juris Doctor (J.D.)
Other
Undecided

Doctoral degree type Ph.D., please describe:

Doctoral degree type D.Sc., please describe:

Medical degree type

05/08/2020 2:11pm

__________________________________

__________________________________
Doctor of Medicine (M.D.)
Doctor of Dentistry (D.D.S)
Doctor of Optometry (O.D.)
Doctor of Pharmacy (Pharm.D.)
Other
Undecided

projectredcap.org

Page 4 of 33

Other degree type, please describe:

Major 1 (if applicable)

Other degree major, please describe:

05/08/2020 2:11pm

__________________________________
Anthropology
Archaeology
Biochemistry
Bioinformatics
Biology
Biomedical Science
Business
Chemistry
Computer/Information Technology Science
Earth and Planetary Sciences
Economics
Education
Engineering
Foreign Language
Forensic Science
Genetics
Government / Political Science
Health Care Profession (e.g. Nursing)
History
Math
Microbiology
Molecular Cell Biology
Neurobiology or Neuroscience
Philosophy
Physics
Physiology
Pre-Med
Pre-Vet
Psychology
Sociology
Other
Undecided

__________________________________

projectredcap.org

Page 5 of 33

Major 2 (if applicable)

Other degree major, please describe:

Institution

Anthropology
Archaeology
Biochemistry
Bioinformatics
Biology
Biomedical Science
Business
Chemistry
Computer/Information Technology Science
Earth and Planetary Sciences
Economics
Education
Engineering
Foreign Language
Forensic Science
Genetics
Government / Political Science
Health Care Profession (e.g. Nursing)
History
Math
Microbiology
Molecular Cell Biology
Neurobiology or Neuroscience
Philosophy
Physics
Physiology
Pre-Med
Pre-Vet
Psychology
Sociology
Other
Undecided

__________________________________

__________________________________

Degree status

Currently enrolled
Completed
No longer pursuing

Month degree completed

January
February
March
April
May
June
July
August
September
October
November
December

Year degree completed

Do you have any additional degrees to add?

05/08/2020 2:11pm

__________________________________
Yes
No

projectredcap.org

Page 6 of 33

Degree

Other degree, please describe:

Associate's degree or equivalent
Bachelor's degree or equivalent
Master's degree or equivalent
Doctoral degree or equivalent
Medical degree
Other degree

__________________________________

Associate's degree type

Associate of Science (A.S.)
Associate of Arts (A.A.)
Other
Undecided

Bachelor's degree type

Bachelor of Arts (B.A.)
Bachelor of Science (B.S.)
Bachelor of Science in Nursing (B.S.N.)
Other
Undecided

Master's degree type

Master of Arts (M.A.)
Master of Public Health (M.P.H)
Master of Science (M.S.) in biomedical science
field
Master of Science (M.S.) in another science or
engineering field
Master of Science in Nursing (M.S.N)
Master of Fine Arts (M.F.A)
Master of Business Administration (M.B.A)
Other
Undecided

Doctoral degree type

Doctor of Philosophy (Ph.D.)
Doctor of Science (D.Sc.)
Doctor of Education (E.D.)
Doctor of Veterinary Medicine (D.V.M.)
Juris Doctor (J.D.)
Other
Undecided

Doctoral degree type Ph.D., please describe:

Doctoral degree type D.Sc., please describe:

Medical degree type

Other degree type, please describe:

05/08/2020 2:11pm

__________________________________

__________________________________
Doctor of Medicine (M.D.)
Doctor of Dentistry (D.D.S)
Doctor of Optometry (O.D.)
Doctor of Pharmacy (Pharm.D.)
Other
Undecided

__________________________________

projectredcap.org

Page 7 of 33

Major 1 (if applicable)

Other degree major, please describe:

05/08/2020 2:11pm

Anthropology
Archaeology
Biochemistry
Bioinformatics
Biology
Biomedical Science
Business
Chemistry
Computer/Information Technology Science
Earth and Planetary Sciences
Economics
Education
Engineering
Foreign Language
Forensic Science
Genetics
Government / Political Science
Health Care Profession (e.g. Nursing)
History
Math
Microbiology
Molecular Cell Biology
Neurobiology or Neuroscience
Philosophy
Physics
Physiology
Pre-Med
Pre-Vet
Psychology
Sociology
Other
Undecided

__________________________________

projectredcap.org

Page 8 of 33

Major 2 (if applicable)

Other degree major, please describe:

Institution

Anthropology
Archaeology
Biochemistry
Bioinformatics
Biology
Biomedical Science
Business
Chemistry
Computer/Information Technology Science
Earth and Planetary Sciences
Economics
Education
Engineering
Foreign Language
Forensic Science
Genetics
Government / Political Science
Health Care Profession (e.g. Nursing)
History
Math
Microbiology
Molecular Cell Biology
Neurobiology or Neuroscience
Philosophy
Physics
Physiology
Pre-Med
Pre-Vet
Psychology
Sociology
Other
Undecided

__________________________________

__________________________________

Degree status

Currently enrolled
Completed
No longer pursuing

Month degree completed

January
February
March
April
May
June
July
August
September
October
November
December

Year degree completed

Do you have any additional degrees to add?

05/08/2020 2:11pm

__________________________________
Yes
No

projectredcap.org

Page 9 of 33

Degree

Other degree, please describe:

Associate's degree or equivalent
Bachelor's degree or equivalent
Master's degree or equivalent
Doctoral degree or equivalent
Medical degree
Other degree

__________________________________

Associate's degree type

Associate of Science (A.S.)
Associate of Arts (A.A.)
Other
Undecided

Bachelor's degree type

Bachelor of Arts (B.A.)
Bachelor of Science (B.S.)
Bachelor of Science in Nursing (B.S.N.)
Other
Undecided

Master's degree type

Master of Arts (M.A.)
Master of Public Health (M.P.H)
Master of Science (M.S.) in biomedical science
field
Master of Science (M.S.) in another science or
engineering field
Master of Science in Nursing (M.S.N)
Master of Fine Arts (M.F.A)
Master of Business Administration (M.B.A)
Other
Undecided

Doctoral degree type

Doctor of Philosophy (Ph.D.)
Doctor of Science (D.Sc.)
Doctor of Education (E.D.)
Doctor of Veterinary Medicine (D.V.M.)
Juris Doctor (J.D.)
Other
Undecided

Doctoral degree type Ph.D., please describe:

Doctoral degree type D.Sc., please describe:

Medical degree type

Other degree type, please describe:

05/08/2020 2:11pm

__________________________________

__________________________________
Doctor of Medicine (M.D.)
Doctor of Dentistry (D.D.S)
Doctor of Optometry (O.D.)
Doctor of Pharmacy (Pharm.D.)
Other
Undecided

__________________________________

projectredcap.org

Page 10 of 33

Major 1 (if applicable)

Other degree major, please describe:

05/08/2020 2:11pm

Anthropology
Archaeology
Biochemistry
Bioinformatics
Biology
Biomedical Science
Business
Chemistry
Computer/Information Technology Science
Earth and Planetary Sciences
Economics
Education
Engineering
Foreign Language
Forensic Science
Genetics
Government / Political Science
Health Care Profession (e.g. Nursing)
History
Math
Microbiology
Molecular Cell Biology
Neurobiology or Neuroscience
Philosophy
Physics
Physiology
Pre-Med
Pre-Vet
Psychology
Sociology
Other
Undecided

__________________________________

projectredcap.org

Page 11 of 33

Major 2 (if applicable)

Other degree major, please describe:

Institution

Anthropology
Archaeology
Biochemistry
Bioinformatics
Biology
Biomedical Science
Business
Chemistry
Computer/Information Technology Science
Earth and Planetary Sciences
Economics
Education
Engineering
Foreign Language
Forensic Science
Genetics
Government / Political Science
Health Care Profession (e.g. Nursing)
History
Math
Microbiology
Molecular Cell Biology
Neurobiology or Neuroscience
Philosophy
Physics
Physiology
Pre-Med
Pre-Vet
Psychology
Sociology
Other
Undecided

__________________________________

__________________________________

Degree status

Currently enrolled
Completed
No longer pursuing

Month degree completed

January
February
March
April
May
June
July
August
September
October
November
December

Year degree completed

Do you have any additional degrees to add?

05/08/2020 2:11pm

__________________________________
Yes
No

projectredcap.org

Page 12 of 33

Degree

Other degree, please describe:

Associate's degree or equivalent
Bachelor's degree or equivalent
Master's degree or equivalent
Doctoral degree or equivalent
Medical degree
Other degree

__________________________________

Associate's degree type

Associate of Science (A.S.)
Associate of Arts (A.A.)
Other
Undecided

Bachelor's degree type

Bachelor of Arts (B.A.)
Bachelor of Science (B.S.)
Bachelor of Science in Nursing (B.S.N.)
Other
Undecided

Master's degree type

Master of Arts (M.A.)
Master of Public Health (M.P.H)
Master of Science (M.S.) in biomedical science
field
Master of Science (M.S.) in another science or
engineering field
Master of Science in Nursing (M.S.N)
Master of Fine Arts (M.F.A)
Master of Business Administration (M.B.A)
Other
Undecided

Doctoral degree type

Doctor of Philosophy (Ph.D.)
Doctor of Science (D.Sc.)
Doctor of Education (E.D.)
Doctor of Veterinary Medicine (D.V.M.)
Juris Doctor (J.D.)
Other
Undecided

Doctoral degree type Ph.D., please describe:

Doctoral degree type D.Sc., please describe:

Medical degree type

Other degree type, please describe:

05/08/2020 2:11pm

__________________________________

__________________________________
Doctor of Medicine (M.D.)
Doctor of Dentistry (D.D.S)
Doctor of Optometry (O.D.)
Doctor of Pharmacy (Pharm.D.)
Other
Undecided

__________________________________

projectredcap.org

Page 13 of 33

Major 1 (if applicable)

Other degree major, please describe:

05/08/2020 2:11pm

Anthropology
Archaeology
Biochemistry
Bioinformatics
Biology
Biomedical Science
Business
Chemistry
Computer/Information Technology Science
Earth and Planetary Sciences
Economics
Education
Engineering
Foreign Language
Forensic Science
Genetics
Government / Political Science
Health Care Profession (e.g. Nursing)
History
Math
Microbiology
Molecular Cell Biology
Neurobiology or Neuroscience
Philosophy
Physics
Physiology
Pre-Med
Pre-Vet
Psychology
Sociology
Other
Undecided

__________________________________

projectredcap.org

Page 14 of 33

Major 2 (if applicable)

Other degree major, please describe:

Institution

Anthropology
Archaeology
Biochemistry
Bioinformatics
Biology
Biomedical Science
Business
Chemistry
Computer/Information Technology Science
Earth and Planetary Sciences
Economics
Education
Engineering
Foreign Language
Forensic Science
Genetics
Government / Political Science
Health Care Profession (e.g. Nursing)
History
Math
Microbiology
Molecular Cell Biology
Neurobiology or Neuroscience
Philosophy
Physics
Physiology
Pre-Med
Pre-Vet
Psychology
Sociology
Other
Undecided

__________________________________

__________________________________

Degree status

Currently enrolled
Completed
No longer pursuing

Month degree completed

January
February
March
April
May
June
July
August
September
October
November
December

Year degree completed

Do you have any additional degrees to add?

05/08/2020 2:11pm

__________________________________
Yes
No

projectredcap.org

Page 15 of 33

Degree

Other degree, please describe:

Associate's degree or equivalent
Bachelor's degree or equivalent
Master's degree or equivalent
Doctoral degree or equivalent
Medical degree
Other degree

__________________________________

Associate's degree type

Associate of Science (A.S.)
Associate of Arts (A.A.)
Other
Undecided

Bachelor's degree type

Bachelor of Arts (B.A.)
Bachelor of Science (B.S.)
Bachelor of Science in Nursing (B.S.N.)
Other
Undecided

Master's degree type

Master of Arts (M.A.)
Master of Public Health (M.P.H)
Master of Science (M.S.) in biomedical science
field
Master of Science (M.S.) in another science or
engineering field
Master of Science in Nursing (M.S.N)
Master of Fine Arts (M.F.A)
Master of Business Administration (M.B.A)
Other
Undecided

Doctoral degree type

Doctor of Philosophy (Ph.D.)
Doctor of Science (D.Sc.)
Doctor of Education (E.D.)
Doctor of Veterinary Medicine (D.V.M.)
Juris Doctor (J.D.)
Other
Undecided

Doctoral degree type Ph.D., please describe:

Doctoral degree type D.Sc., please describe:

Medical degree type

Other degree type, please describe:

05/08/2020 2:11pm

__________________________________

__________________________________
Doctor of Medicine (M.D.)
Doctor of Dentistry (D.D.S)
Doctor of Optometry (O.D.)
Doctor of Pharmacy (Pharm.D.)
Other
Undecided

__________________________________

projectredcap.org

Page 16 of 33

Major 1 (if applicable)

Other degree major, please describe:

05/08/2020 2:11pm

Anthropology
Archaeology
Biochemistry
Bioinformatics
Biology
Biomedical Science
Business
Chemistry
Computer/Information Technology Science
Earth and Planetary Sciences
Economics
Education
Engineering
Foreign Language
Forensic Science
Genetics
Government / Political Science
Health Care Profession (e.g. Nursing)
History
Math
Microbiology
Molecular Cell Biology
Neurobiology or Neuroscience
Philosophy
Physics
Physiology
Pre-Med
Pre-Vet
Psychology
Sociology
Other
Undecided

__________________________________

projectredcap.org

Page 17 of 33

Major 2 (if applicable)

Other degree major, please describe:

Institution

Anthropology
Archaeology
Biochemistry
Bioinformatics
Biology
Biomedical Science
Business
Chemistry
Computer/Information Technology Science
Earth and Planetary Sciences
Economics
Education
Engineering
Foreign Language
Forensic Science
Genetics
Government / Political Science
Health Care Profession (e.g. Nursing)
History
Math
Microbiology
Molecular Cell Biology
Neurobiology or Neuroscience
Philosophy
Physics
Physiology
Pre-Med
Pre-Vet
Psychology
Sociology
Other
Undecided

__________________________________

__________________________________

Degree status

Currently enrolled
Completed
No longer pursuing

Month degree completed

January
February
March
April
May
June
July
August
September
October
November
December

Year degree completed

Do you have any additional degrees to add?

05/08/2020 2:11pm

__________________________________
Yes
No

projectredcap.org

Page 18 of 33

Degree

Other degree, please describe:

Associate's degree or equivalent
Bachelor's degree or equivalent
Master's degree or equivalent
Doctoral degree or equivalent
Medical degree
Other degree

__________________________________

Associate's degree type

Associate of Science (A.S.)
Associate of Arts (A.A.)
Other
Undecided

Bachelor's degree type

Bachelor of Arts (B.A.)
Bachelor of Science (B.S.)
Bachelor of Science in Nursing (B.S.N.)
Other
Undecided

Master's degree type

Master of Arts (M.A.)
Master of Public Health (M.P.H)
Master of Science (M.S.) in biomedical science
field
Master of Science (M.S.) in another science or
engineering field
Master of Science in Nursing (M.S.N)
Master of Fine Arts (M.F.A)
Master of Business Administration (M.B.A)
Other
Undecided

Doctoral degree type

Doctor of Philosophy (Ph.D.)
Doctor of Science (D.Sc.)
Doctor of Education (E.D.)
Doctor of Veterinary Medicine (D.V.M.)
Juris Doctor (J.D.)
Other
Undecided

Doctoral degree type Ph.D., please describe:

Doctoral degree type D.Sc., please describe:

Medical degree type

Other degree type, please describe:

05/08/2020 2:11pm

__________________________________

__________________________________
Doctor of Medicine (M.D.)
Doctor of Dentistry (D.D.S)
Doctor of Optometry (O.D.)
Doctor of Pharmacy (Pharm.D.)
Other
Undecided

__________________________________

projectredcap.org

Page 19 of 33

Major 1 (if applicable)

Other degree major, please describe:

05/08/2020 2:11pm

Anthropology
Archaeology
Biochemistry
Bioinformatics
Biology
Biomedical Science
Business
Chemistry
Computer/Information Technology Science
Earth and Planetary Sciences
Economics
Education
Engineering
Foreign Language
Forensic Science
Genetics
Government / Political Science
Health Care Profession (e.g. Nursing)
History
Math
Microbiology
Molecular Cell Biology
Neurobiology or Neuroscience
Philosophy
Physics
Physiology
Pre-Med
Pre-Vet
Psychology
Sociology
Other
Undecided

__________________________________

projectredcap.org

Page 20 of 33

Major 2 (if applicable)

Other degree major, please describe:

Institution

Anthropology
Archaeology
Biochemistry
Bioinformatics
Biology
Biomedical Science
Business
Chemistry
Computer/Information Technology Science
Earth and Planetary Sciences
Economics
Education
Engineering
Foreign Language
Forensic Science
Genetics
Government / Political Science
Health Care Profession (e.g. Nursing)
History
Math
Microbiology
Molecular Cell Biology
Neurobiology or Neuroscience
Philosophy
Physics
Physiology
Pre-Med
Pre-Vet
Psychology
Sociology
Other
Undecided

__________________________________

__________________________________

Degree status

Currently enrolled
Completed
No longer pursuing

Month degree completed

January
February
March
April
May
June
July
August
September
October
November
December

Year degree completed

Do you have any additional degrees to add?

05/08/2020 2:11pm

__________________________________
Yes
No

projectredcap.org

Page 21 of 33

Degree

Other degree, please describe:

Associate's degree or equivalent
Bachelor's degree or equivalent
Master's degree or equivalent
Doctoral degree or equivalent
Medical degree
Other degree

__________________________________

Associate's degree type

Associate of Science (A.S.)
Associate of Arts (A.A.)
Other
Undecided

Bachelor's degree type

Bachelor of Arts (B.A.)
Bachelor of Science (B.S.)
Bachelor of Science in Nursing (B.S.N.)
Other
Undecided

Master's degree type

Master of Arts (M.A.)
Master of Public Health (M.P.H)
Master of Science (M.S.) in biomedical science
field
Master of Science (M.S.) in another science or
engineering field
Master of Science in Nursing (M.S.N)
Master of Fine Arts (M.F.A)
Master of Business Administration (M.B.A)
Other
Undecided

Doctoral degree type

Doctor of Philosophy (Ph.D.)
Doctor of Science (D.Sc.)
Doctor of Education (E.D.)
Doctor of Veterinary Medicine (D.V.M.)
Juris Doctor (J.D.)
Other
Undecided

Doctoral degree type Ph.D., please describe:

Doctoral degree type D.Sc., please describe:

Medical degree type

Other degree type, please describe:

05/08/2020 2:11pm

__________________________________

__________________________________
Doctor of Medicine (M.D.)
Doctor of Dentistry (D.D.S)
Doctor of Optometry (O.D.)
Doctor of Pharmacy (Pharm.D.)
Other
Undecided

__________________________________

projectredcap.org

Page 22 of 33

Major 1 (if applicable)

Other degree major, please describe:

05/08/2020 2:11pm

Anthropology
Archaeology
Biochemistry
Bioinformatics
Biology
Biomedical Science
Business
Chemistry
Computer/Information Technology Science
Earth and Planetary Sciences
Economics
Education
Engineering
Foreign Language
Forensic Science
Genetics
Government / Political Science
Health Care Profession (e.g. Nursing)
History
Math
Microbiology
Molecular Cell Biology
Neurobiology or Neuroscience
Philosophy
Physics
Physiology
Pre-Med
Pre-Vet
Psychology
Sociology
Other
Undecided

__________________________________

projectredcap.org

Page 23 of 33

Major 2 (if applicable)

Other degree major, please describe:

Institution

Anthropology
Archaeology
Biochemistry
Bioinformatics
Biology
Biomedical Science
Business
Chemistry
Computer/Information Technology Science
Earth and Planetary Sciences
Economics
Education
Engineering
Foreign Language
Forensic Science
Genetics
Government / Political Science
Health Care Profession (e.g. Nursing)
History
Math
Microbiology
Molecular Cell Biology
Neurobiology or Neuroscience
Philosophy
Physics
Physiology
Pre-Med
Pre-Vet
Psychology
Sociology
Other
Undecided

__________________________________

__________________________________

Degree status

Currently enrolled
Completed
No longer pursuing

Month degree completed

January
February
March
April
May
June
July
August
September
October
November
December

Year degree completed

Do you have any additional degrees to add?

05/08/2020 2:11pm

__________________________________
Yes
No

projectredcap.org

Page 24 of 33

Degree

Other degree, please describe:

Associate's degree or equivalent
Bachelor's degree or equivalent
Master's degree or equivalent
Doctoral degree or equivalent
Medical degree
Other degree

__________________________________

Associate's degree type

Associate of Science (A.S.)
Associate of Arts (A.A.)
Other
Undecided

Bachelor's degree type

Bachelor of Arts (B.A.)
Bachelor of Science (B.S.)
Bachelor of Science in Nursing (B.S.N.)
Other
Undecided

Master's degree type

Master of Arts (M.A.)
Master of Public Health (M.P.H)
Master of Science (M.S.) in biomedical science
field
Master of Science (M.S.) in another science or
engineering field
Master of Science in Nursing (M.S.N)
Master of Fine Arts (M.F.A)
Master of Business Administration (M.B.A)
Other
Undecided

Doctoral degree type

Doctor of Philosophy (Ph.D.)
Doctor of Science (D.Sc.)
Doctor of Education (E.D.)
Doctor of Veterinary Medicine (D.V.M.)
Juris Doctor (J.D.)
Other
Undecided

Doctoral degree type Ph.D., please describe:

Doctoral degree type D.Sc., please describe:

Medical degree type

Other degree type, please describe:

05/08/2020 2:11pm

__________________________________

__________________________________
Doctor of Medicine (M.D.)
Doctor of Dentistry (D.D.S)
Doctor of Optometry (O.D.)
Doctor of Pharmacy (Pharm.D.)
Other
Undecided

__________________________________

projectredcap.org

Page 25 of 33

Major 1 (if applicable)

Other degree major, please describe:

05/08/2020 2:11pm

Anthropology
Archaeology
Biochemistry
Bioinformatics
Biology
Biomedical Science
Business
Chemistry
Computer/Information Technology Science
Earth and Planetary Sciences
Economics
Education
Engineering
Foreign Language
Forensic Science
Genetics
Government / Political Science
Health Care Profession (e.g. Nursing)
History
Math
Microbiology
Molecular Cell Biology
Neurobiology or Neuroscience
Philosophy
Physics
Physiology
Pre-Med
Pre-Vet
Psychology
Sociology
Other
Undecided

__________________________________

projectredcap.org

Page 26 of 33

Major 2 (if applicable)

Other degree major, please describe:

Institution

Anthropology
Archaeology
Biochemistry
Bioinformatics
Biology
Biomedical Science
Business
Chemistry
Computer/Information Technology Science
Earth and Planetary Sciences
Economics
Education
Engineering
Foreign Language
Forensic Science
Genetics
Government / Political Science
Health Care Profession (e.g. Nursing)
History
Math
Microbiology
Molecular Cell Biology
Neurobiology or Neuroscience
Philosophy
Physics
Physiology
Pre-Med
Pre-Vet
Psychology
Sociology
Other
Undecided

__________________________________

__________________________________

Degree status

Currently enrolled
Completed
No longer pursuing

Month degree completed

January
February
March
April
May
June
July
August
September
October
November
December

Year degree completed

Do you have any additional degrees to add?

05/08/2020 2:11pm

__________________________________
Yes
No

projectredcap.org

Page 27 of 33

Degree

Other degree, please describe:

Associate's degree or equivalent
Bachelor's degree or equivalent
Master's degree or equivalent
Doctoral degree or equivalent
Medical degree
Other degree

__________________________________

Associate's degree type

Associate of Science (A.S.)
Associate of Arts (A.A.)
Other
Undecided

Bachelor's degree type

Bachelor of Arts (B.A.)
Bachelor of Science (B.S.)
Bachelor of Science in Nursing (B.S.N.)
Other
Undecided

Master's degree type

Master of Arts (M.A.)
Master of Public Health (M.P.H)
Master of Science (M.S.) in biomedical science
field
Master of Science (M.S.) in another science or
engineering field
Master of Science in Nursing (M.S.N)
Master of Fine Arts (M.F.A)
Master of Business Administration (M.B.A)
Other
Undecided

Doctoral degree type

Doctor of Philosophy (Ph.D.)
Doctor of Science (D.Sc.)
Doctor of Education (E.D.)
Doctor of Veterinary Medicine (D.V.M.)
Juris Doctor (J.D.)
Other
Undecided

Doctoral degree type Ph.D., please describe:

Doctoral degree type D.Sc., please describe:

Medical degree type

Other degree type, please describe:

05/08/2020 2:11pm

__________________________________

__________________________________
Doctor of Medicine (M.D.)
Doctor of Dentistry (D.D.S)
Doctor of Optometry (O.D.)
Doctor of Pharmacy (Pharm.D.)
Other
Undecided

__________________________________

projectredcap.org

Page 28 of 33

Major 1 (if applicable)

Other degree major, please describe:

05/08/2020 2:11pm

Anthropology
Archaeology
Biochemistry
Bioinformatics
Biology
Biomedical Science
Business
Chemistry
Computer/Information Technology Science
Earth and Planetary Sciences
Economics
Education
Engineering
Foreign Language
Forensic Science
Genetics
Government / Political Science
Health Care Profession (e.g. Nursing)
History
Math
Microbiology
Molecular Cell Biology
Neurobiology or Neuroscience
Philosophy
Physics
Physiology
Pre-Med
Pre-Vet
Psychology
Sociology
Other
Undecided

__________________________________

projectredcap.org

Page 29 of 33

Major 2 (if applicable)

Other degree major, please describe:

Institution

Anthropology
Archaeology
Biochemistry
Bioinformatics
Biology
Biomedical Science
Business
Chemistry
Computer/Information Technology Science
Earth and Planetary Sciences
Economics
Education
Engineering
Foreign Language
Forensic Science
Genetics
Government / Political Science
Health Care Profession (e.g. Nursing)
History
Math
Microbiology
Molecular Cell Biology
Neurobiology or Neuroscience
Philosophy
Physics
Physiology
Pre-Med
Pre-Vet
Psychology
Sociology
Other
Undecided

__________________________________

__________________________________

Degree status

Currently enrolled
Completed
No longer pursuing

Month degree completed

January
February
March
April
May
June
July
August
September
October
November
December

Year degree completed

Do you have any additional degrees to add?

05/08/2020 2:11pm

__________________________________
Yes
No

projectredcap.org

Page 30 of 33

Degree

Other degree, please describe:

Associate's degree or equivalent
Bachelor's degree or equivalent
Master's degree or equivalent
Doctoral degree or equivalent
Medical degree
Other degree

__________________________________

Associate's degree type

Associate of Science (A.S.)
Associate of Arts (A.A.)
Other
Undecided

Bachelor's degree type

Bachelor of Arts (B.A.)
Bachelor of Science (B.S.)
Bachelor of Science in Nursing (B.S.N.)
Other
Undecided

Master's degree type

Master of Arts (M.A.)
Master of Public Health (M.P.H)
Master of Science (M.S.) in biomedical science
field
Master of Science (M.S.) in another science or
engineering field
Master of Science in Nursing (M.S.N)
Master of Fine Arts (M.F.A)
Master of Business Administration (M.B.A)
Other
Undecided

Doctoral degree type

Doctor of Philosophy (Ph.D.)
Doctor of Science (D.Sc.)
Doctor of Education (E.D.)
Doctor of Veterinary Medicine (D.V.M.)
Juris Doctor (J.D.)
Other
Undecided

Doctoral degree type Ph.D., please describe:

Doctoral degree type D.Sc., please describe:

Medical degree type

Other degree type, please describe:

05/08/2020 2:11pm

__________________________________

__________________________________
Doctor of Medicine (M.D.)
Doctor of Dentistry (D.D.S)
Doctor of Optometry (O.D.)
Doctor of Pharmacy (Pharm.D.)
Other
Undecided

__________________________________

projectredcap.org

Page 31 of 33

Major 1 (if applicable)

Other degree major, please describe:

05/08/2020 2:11pm

Anthropology
Archaeology
Biochemistry
Bioinformatics
Biology
Biomedical Science
Business
Chemistry
Computer/Information Technology Science
Earth and Planetary Sciences
Economics
Education
Engineering
Foreign Language
Forensic Science
Genetics
Government / Political Science
Health Care Profession (e.g. Nursing)
History
Math
Microbiology
Molecular Cell Biology
Neurobiology or Neuroscience
Philosophy
Physics
Physiology
Pre-Med
Pre-Vet
Psychology
Sociology
Other
Undecided

__________________________________

projectredcap.org

Page 32 of 33

Major 2 (if applicable)

Other degree major, please describe:

Institution

Anthropology
Archaeology
Biochemistry
Bioinformatics
Biology
Biomedical Science
Business
Chemistry
Computer/Information Technology Science
Earth and Planetary Sciences
Economics
Education
Engineering
Foreign Language
Forensic Science
Genetics
Government / Political Science
Health Care Profession (e.g. Nursing)
History
Math
Microbiology
Molecular Cell Biology
Neurobiology or Neuroscience
Philosophy
Physics
Physiology
Pre-Med
Pre-Vet
Psychology
Sociology
Other
Undecided

__________________________________

__________________________________

Degree status

Currently enrolled
Completed
No longer pursuing

Month degree completed

January
February
March
April
May
June
July
August
September
October
November
December

Year degree completed

05/08/2020 2:11pm

__________________________________

projectredcap.org

Page 33 of 33

Employment
What is your current employment status?
(SELECT ALL THAT APPLY)

What is your current occupation?

Which of the following best describes the sector in
which you primarily work? Please select all that
apply.

Other, please describe:

Employed full-time
Employed part-time
Student full-time
Student part-time
Unemployed seeking employment
Unemployed not seeking employment
Stay-at-home parent, caretaker, or homemaker
Prefer not to answer

__________________________________
Academic setting (university or college)
Industry (for-profit company or business)
Government (federal, state, or local)
Non-profit organization
Other

__________________________________

Are you involved in research?

Yes
No

Have you ever received NIH research funding?

Yes
No

Please describe the funding you have received.

Is there anything else you would like to share about
your education and/or career, such as publications,
fellowships, or awards?

05/08/2020 2:11pm

__________________________________

__________________________________

projectredcap.org