Form 3 HiSTEP&HiSTEP2-Alumni

HISTEP & HISTEP2 ALUMNI
OMB Clearance Number: 0925-0299
Expiration Date: 30-Jun-2022

GENERAL INFORMATION
First Name (Given Name):*

Last Name (Family Name):*

Email Address:*

What year did you participate in HiSTEP?*

What year did you participate in HiSTEP 2.0?*

Alumni Database Report Date*

COLLEGE / UNIVERSITY APPLICATION INFORMATION
Are you planning on attending college in Fall 2017?*

What is your career goal once you graduate from college?

Are you conducting research during your academic school year (whether you are in high
school or in college)?

SCHOLARSHIP / FELLOWSHIP INFORMATION
Have you applied for any scholarships or fellowships?*

SUMMER PLANS
What did you do this past summer?

What are your plans for next summer?

Have you applied for any internships or programs?*

MEETINGS WITH COLLEGE ADVISOR
Have you met with the HiSTEP College Advisor?*

FINAL THOUGHTS
What was the most significant helpful item that you learned from HiSTEP?

Collection of this information is authorized by The Public Health Service Act, Section 410 (42 USC 285). Rights
of participants are protected by The Privacy Act of 1974. Participation is voluntary, and there are no penalties
for not participating or withdrawing from the study at any time. The information collected in this study will
be kept private to the extent provided by law. Names and other identifiers will not appear in any report of the
study. Information provided will be combined for all participants and reported as summaries.