Background Sheet

SURVEY OF EARNED DOCTORATES (SED)

Cognitive Interview Participant Background Sheet^

1. Contact Information

Name:	     
Address:	     
City, State, Zip:	     
Day phone:	     
Evening phone:	     
Email address:	     

2. When is the best day of the week and time of day to reach you by telephone?      

3. What is your date of birth?      

4. What is your doctoral field of study?      

5. From what university did you receive your doctoral degree?      

6. Are you: Male Female

7. Month and year you began your doctoral program:      

Month and year did you graduate:      

8. Is English your first language? Yes No

9. Are you currently a U.S. Citizen? Yes No

10. In what country or state to you intend to live after graduation (within the next year)?

In U.S.  State:      

Not in U.S.  Country:      

11. What is the status of your postgraduate plans (in the next year)? (Mark one)

Returning to, or continuing in, pre-doctoral employment

Have signed contract or made definite commitment for other work or study

Negotiating with one or more specific organizations

Seeking position but have no specific prospects

Do not plan to work or study

Other – specify:      

12. Have you completed a copy of the SED questionnaire? Yes No

13. Are you available during the weeks of XXX and XXX Monday through Friday, either during the day or evening? (Please fill in possible times)

          

 If you have questions, please contact Lekha at xx, 1-800-248-8649