2 HERI Freshman Survey (Paper Version)

Evaluation of the Enhancing Diversity of the NIH-funded Workforce Program for the National Institute of General Medical Sciences (NIGMS)

Attachment_08b_-_HERI_Freshman_Survey_(Paper_Version)

BUILD Student -Entrance Survey (Version A: HERI Freshman Survey Version B: HERI Freshman Survey for Non-Freshman Transfers

OMB: 0925-0747

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Attachment 8b:
HERI Freshman Survey (Paper Version)

CO
OOPERATIIVE INSTIITUTIONA
AL RESEA
ARCH PRO
OGRAM (C
CIRP) FRE
ESHMAN
SU
URVEY IN
NFORMAT
TION SHE
EET
Univ
versity off California
a, Los Ang
geles
Purp
pose of the
e Study
You aare asked to
o complete this survey as part of a national sttudy condu
ucted by thee Higher
Educcation Reseearch Institu
ute (HERI) at the Univ
versity of Caalifornia, Lo
os Angeles. This study is
desig
gned to deteermine wha
at happens to
t students when they attend colllege. Since1966, over 115
million studentss at over 1,9
900 collegess and universities havee participateed in this reesearch. The
data gathered arre used in studies desig
gned to bettter understtand studen
nt learning aand
development an
nd to help im
mprove the quality of college
c
educcation.
Proc
cedures
To paarticipate in
n this study
y, please com
mplete and submit thee following ssurvey. Most
respo
ondents com
mplete this questionna
aire in abou
ut 45 minuttes, althouggh individuaal progress will
vary by how quiickly you move
m
through
h the questiions.
You may decided not to complete the survey for any reason at any time without consequence of any kind.
The Higher Education Research Institute does not offer payment for participation. Your participation and
responses to the questionnaire indicate your consent to participate in the study. We ask for your name and
address so that the researchers at UCLA can contact you at some later data for follow-up study.
Pote
ential Benefits to Su
ubjects and
d/or Socie
ety
You may have the opportunity to reflect on your prior academic experiences and your expectations for
college as you complete the survey, which may enhance self-understanding. Your responses to the survey
also will be directly beneficial to your college or university, and may benefit future generations of college
students as well.
Pote
ential Risk
ks and Discomforts
Therre could be survey
s
item
ms that you are
a uncomffortable ansswering or tto which yo
ou would sim
mply
prefeer not to resspond. You
ur participattion in this study is strrictly volunttary, and yo
ou will be u
under
no ob
bligation wh
hatsoever to
t answer an
ny question
ns that you aare not incllined to ansswer. You m
may
choo
ose not to an
nswer any specific
s
questions you do
d not wantt to answerr and still reemain in the
studyy.
Information Protection
Please note that your responses will be used for research purposes only and will be protected.
Any information that is obtained in connection with this study and that can be identified with you will be
protected and secure to the extent permitted by law. Your identified responses will be returned to your
institution for institutional assessment purposes. Before receiving any responses your school
is required to certify in advance that the data are to be used for research purposes only and will not be used
to investigate specific individuals. Names and addresses will not be returned to your institution, however
Student ID numbers will be included in the final data file to allow your institution to merge responses with
other campus data.

Iden
ntification
n of investiigators
If you
u have any questions or
o concerns about the research,
r
pllease contacct the Manaaging Directtor of
HER
RI, Dr. Kevin
n Eagan at this
t addresss:
Hig
gher Educattion Researcch Institutee
UCLA Grad
duate Schoo
ol of Educattion and Infformation S
Studies Boxx 951521
Los Angelees, CA 9009
95-1521
Email: heri@ucla..edu
Phone:: 310-825-19
925
Righ
hts of Rese
earch Subjjects
You m
may withdrraw your consent at anyy time and discontinuee participattion withoutt penalty. Y
You are not
waiviing any lega
al claims, riights or rem
medies becau
use of your participation in this reesearch study. If you
have questions regarding
r
your
y
rights as
a a researcch subject, ccontact the U
UCLA Officce for Protecction of
Reseearch Subjeccts, 11000 Kinross
K
Aveenue, Suite 102,
1
Box 9551694, Los A
Angeles, CA
A 90095-169
94, (310)
825-7122.
g burden fo
or this collecction of info
formation iss estimated
d to averagee 45 minutees per
Public reporting
respo
onse, includ
ding the tim
me for revieewing instru
uctions, seaarching exissting data ssources, gatthering and
d
main
ntaining thee data needed, and com
mpleting an
nd reviewin
ng the collecction of info
ormation. A
An agency
may not conducct or sponso
or, and a peerson is nott required to
o respond tto, a collecttion of inforrmation unlless
it dissplays a currrently valid
d OMB conttrol numbeer. Send com
mments reggarding this burden esstimate or any
a
otherr aspect of this
t
collectiion of inforrmation, inccluding sugggestions fo
or reducing this burden
n, to: NIH,
Projeect Clearance Branch, 6705 Rock
kledge Drivee, MSC 7974
4, Bethesdaa, MD
2089
92-7974, AT
TTN: PRA (0925-xxxx
(
x*). Do not return the completed form to thiis address.

`

`

Yes

No

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

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

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

No

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

50. 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

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 social fraternity or sorority................................................
Transfer to another college before graduating............................
Participate in volunteer or community service work....................
Seek personal counseling...........................................................
Communicate regularly with your professors..............................
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.
54.
55.
56.
57.

ABCDE
ABCDE
ABCDE
ABCDE

58.
59.
60.
61.

62.
63.
64.
65.

ABCDE
ABCDE
ABCDE
ABCDE

ABCDE
ABCDE
ABCDE
ABCDE

66.
67.
68.
69.

ABCDE
ABCDE
ABCDE
ABCDE

70.
71.
72.
73.

ABCDE
ABCDE
ABCDE
ABCDE

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

4

Data Recognition Corp.-6G6144-15767-54321

9. From what high school did you graduate? 17. Please mark which of the following courses you
have completed:
Name of high school
YN Algebra II
YN Pre-calculus/Trigonometry
YN Probability & Statistics
City
State
YN Calculus
CORRECT MARK INCORRECT MARKS
YN AP Probability & Statistics
a~aa
aaaa
YN AP Calculus
10. Are you: (Mark all that apply)
A
B
YN AP Computer Science A
` White/Caucasian
Group Code
How many weeks this summer did you participate
18.
` African American/Black
in a bridge program at this institution?
` American Indian/Alaska Native
Your sex: ` Male
` Female
` 7+
` 0
` 3-4
` East Asian (e.g., Chinese, Japanese,
1-2
5-6
Korean, Taiwanese)
`
`
Is English your primary language?
Filipino
`
During
high
school
(grades 9-12) how many years
19.
Yes
No
`
`
Southeast Asian (e.g., Cambodian,
did you study each of the following subjects?
`
In what year did you graduate from
Vietnamese, Hmong)
(Mark one for each item)
high school? (Mark one)
South
Asian (e.g., Indian, Pakistani,
`
Nepalese, Sri Lankan)
` Did not graduate but
` 2016
Mathematics.................... ```````
passed G.E.D. test
2015
`
` Other Asian
Foreign Language........... ```````
` Never completed
` 2014
` Native Hawaiian/Pacific Islander
Physical Science............. ```````
high
school
` 2013 or earlier
` Mexican American/Chicano
Biological Science........... ```````
Are you enrolled (or enrolling) as a:
` Puerto Rican
History/Am. Gov’t............ ```````
(Mark one)
` Other Latino
` Full-time student
Computer Science........... ```````
` Other
` Part-time student
Arts and/or Music............ ```````
11. Prior to this term, have you ever taken
How many miles is this college from
20.
How many Advanced Placement/International
courses for credit at this institution?
your permanent home? (Mark one)
Baccalaureate courses did you take in high school?
` Yes
` No
(Mark one in each row)
` 5 or less ` 11-50 ` 101-500

3.

4.

5.

4

2.

5o
morre

1.

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

Over 500 12. Since leaving high school, have you ever
taken courses, whether for credit or not
6. What was your average grade in high
for credit, at any other institution
school? (Mark one)
(university, 4- or 2-year college, technical,
vocational, or business school)?
` C
` A or A+ ` B
AP Courses........................... ``````
` D
` A–
` B–
` Yes
` No
IB Courses............................. ``````
13. To how many colleges other than this one
` B+
` C+
21.
Please refer to the same Parent/Guardian
did you apply for admission this year?
7. What were your scores on the SAT I
throughout this survey. Please mark the sex of
` 11 or
` None ` 3 ` 6
and/or ACT?
your parent(s) or guardian(s).
more
Male Female
4 ` 7-8
1
`
`
SAT Reading and Writing....
5
9-10
2
Parent/Guardian
1............................
` `
`. `
`
Parent/Guardian 2............................ ` . `
14. Were you accepted by your first choice
SAT Mathematics................
college? ` Yes
` No
22. At any time since you turned 13, were you in foster
care or were you a dependent of the court?
15.
Is
this
college
your:
(Mark
one)
ACT Composite........................
` Yes ` No
` I don’t know
` First choice
` Third choice
8. Where do you plan to live during the fall
you consider yourself: (Mark Yes or No for
` Second choice ` Less than third choice 23. Do
term? (Mark one)
each item)
Yes
No
16. Citizenship status: (Mark one)
` With my family or other relatives
Pre-Med............................................ ` . `
Other
private
home,
apartment,
or
room
U.S.
citizen
`
`
Pre-Law............................................ ` . `
College residence hall
Permanent resident (green card)

`

`
`
`
`

6-10

`

51-100

`

Fraternity or sorority house
Other campus student housing
Other

`
`
`

International student (i.e., F-1, J-1, or
M-1 visa)
None of the above

15+

48. Do you identify as transgender?

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

EMAIL (print letters carefully):

3

Bisexual
Queer
Other

EVSN
EVSN

COUNTRY,
if NOT USA:

10-14

`
`
`

STUDENT ID# (as instructed):

ZIP:

2

Heterosexual/Straight
Gay
Lesbian

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:

5-9

6+

47. What is your sexual orientation?

`
`
`

CITY:

Year

Day
(01-31)

1

` 2 ` 3 ` 4 ` 5 `
` I do not plan to graduate from this college.

N Not Important
S Somewhat Important

Month
(01-12)

ADDRESS:

1-4

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

1

54321
54321
54321

NAME:

V Very Important
E Essential

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

`

54321

When were you born?

1/2

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

45. Military Status: (Mark one)

`
`
`
`
`

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

None

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

4 Agree Somewhat
5 Strongly Agree

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

Not o
my h ffered at
igh s
choo
None
l

Over
20

16-20

11-15

6-10

3-5

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

2016 CIRP Freshman Survey

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

SERIAL #

Studying/homework....................
Socializing with friends in person..
Online social networks
(Facebook, Twitter, etc.)...........
Partying......................................
Student clubs/groups..................
Exercise or sports......................
Working (for pay)........................
Household/childcare duties........

1-2

Hours per week:

Less

None

than

1 hou

r

44. During your last year in high school, how much time
did you spend during a typical week doing the
following activities?

ARTS AND HUMANITIES
01	Art, fine and applied
02	English (language and literature)
03	History
04	Journalism/Communication
05	Classical and Modern
	 Languages and Literature
06	Media/Film Studies
07	Music
08	Philosophy
09	Theatre/Drama
10	Theology/ Religion
11	Other Arts and Humanities
BIOLOGICAL & LIFE
SCIENCES
12	Biology (general)
13	Animal Biology (zoology)
14	Ecology & Evolutionary
	Biology
15	Marine Biology
16	Microbiology
17	Molecular, Cellular, &
	 Developmental Biology
18	Neurobiology/Neuroscience
19	Plant Biology (botany)
20	Agriculture/Natural Resources
21	Biochemistry/Biophysics
22	Environmental Science
23	Other Biological Science
BUSINESS
24	Accounting
25	 Business Admin. (general)
26	Entrepreneurship
27	Finance
28	Hospitality/Tourism
29	Human Resources Management
30	International Business
31	Marketing
32	Management
33	Computer/Management
	 Information Systems
34	Real Estate
35	Other Business
EDUCATION
36	Elementary Education
37	Music/Art Education
38	Physical Education/Recreation
39	Secondary Education
40	Special Education
41	Other Education

HEALTH PROFESSIONS
55	Clinical Laboratory Science	
56	 Health Care Administration/
	Studies	
57	 Health Technology
58	Kinesiology	
59	Nursing	
60	Pharmacy	
61	Therapy (occupational,
	 physical, speech)	
62	Other Health Profession
MATH AND COMPUTER
SCIENCE
63	Computer Science
64	Mathematics/Statistics	
65	Other Math and Computer
	Science	
PHYSICAL SCIENCE
66	 Astronomy & Astrophysics	
67	Atmospheric Sciences	
68	Chemistry	
69	Earth & Planetary Sciences	
70	Marine Sciences	
71	Physics	
72	Other Physical Science	
SOCIAL SCIENCE
73	Anthropology	
74	Economics	
75	Ethnic/Cultural Studies	
76	Geography	
77	Political Science (gov’t.,
	 international relations)
78	Psychology	
79	Public Policy	
80	 Social Work	
81	Sociology	
82	Women’s/Gender Studies	
83	Other Social Science
OTHER MAJORS
84	Architecture/Urban Planning
85	Criminal Justice	
86	Library Science	
87	Security & Protective
	Services	
88	Military Sciences/
	Technology/Operations	
89	OTHER
90	UNDECIDED	

ENGINEERING
42	Aerospace/Aeronautical/
	 Astronautical Engineering
43	Biological/Agricultural
	Engineering
44	Biomedical Engineering
45	Chemical Engineering
46	Civil Engineering
47	Computer Engineering
48	Electrical/ Electronic/
	 Communications Engineering
49	Engineering Science/
	 Engineering Physics
50	Environmental/Environmental
	 Health Engineering
51	Industrial/Manufacturing
	Engineering
52	Materials Engineering
53	Mechanical Engineering
54	Other Engineering

24. Please indicate your intended major using the
codes provided on the
attached fold out.

Turn over for Question 25

1

Carefully detach this section after
answering Questions 24 and 25

`
`
`
`
`

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

`
`
`
`
`
`

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. Please select how many individuals in your
household (including yourself) are dependent on
your parent(s)/guardian(s) for financial support.
(Mark one)

`

I am not dependent on
my parent(s)/guardian(s)

`
`

1
2

`
`
`
`

3
4
5
6 or more

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...........

2

...
...

`
`

FON
FON
FON
FON
FON
FON
FON

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

s

`````
`````

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

Parent/
Guardian 2

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

FON
FON
FON

Not at
All

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

Averag
e
Averag
e
Below
Averag
e
Lowes
t 10%

t 10%

Above

`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
1 Strongly Disagree
2 Disagree Somewhat

hat

Modera

tely

FON
FON

Highes

Not at
All

ntly

ionally

Oc c a s

Freque

FON
FON

Somew

tely
Very

Absolu

Not at
All

ntly

`
`
`
`
`
`
`
`

Oc c a s

Freque

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

e
Somew
hat We
ak
A Majo
r Weak
nes

Parent/
Guardia
Parent/ n 1
Guardia
n2

Yours

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

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

42. Mark one in each row:

3 Agree Somewhat
4 Strongly Agree

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.......................
Sexual activity that occurs without the presence of explicit, affirmative
consent (i.e., “yes means yes”) is considered sexual assault..........................
There is little that a person can do to be better at math – you are either
“good” or “bad” at math.....................................................................................
Intelligence is something that can be improved by studying or working harder..

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

VSN
VSN
3

Very
Impo
rta
Som nt
Impoewhat
rtant
Not
Impo
rtant

`.
`.
`
`
`

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

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

FON

hat Im
portan
t
Not Im
portan
t

Military grants...................................
Work-study.......................................
Pell Grant.........................................
Need-based grants or scholarships...
Merit-based grants or scholarships...

No

FON
FON

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

FON

t

Yes

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

FON
FON

FON

Very Im
portan

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

FON

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

``````

Y12
Y12
Y12
Y12

FON
FON
FON
FON
FON

Averag

``````

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

FON
FON

Streng
th
hat Str
ong

``````

FON
FON
FON

Somew

``````

Felt overwhelmed by all I
had to do.............................
Felt depressed.......................
Performed volunteer work.....
Asked a teacher for advice
after class............................
Voted in a student election....
Socialized with someone of
another racial/ethnic group...
Been late to class..................
Discussed religion.................
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...........................

A Majo
r

$15,000+

$14,999

9,999

$10,000-

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.).........................

5,999

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)

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

Not at
All

````
````

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............................
None...........................................

Highest Plann
at This Colle ed
ge

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

Retired

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

Employed
Seasonal
ly
Employed
Unemploy
ed

Parent/Guardian 2 career

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)
ionally

`

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

ionally

HEALTHCARE SUPPORT
36	Dietician/Nutritionist
37	 Home Health Worker
38	 Medical/Dental Assistant
	 (e.g., Hygienist, Lab Tech,
	 Nursing Asst.)
39	Registered Nurse
40	Therapist (e.g., Physical,
	 Occupational, Speech)

Some (but I probably will have enough
funds)

Occas

GOVERNMENT
32	Military
33	Federal/State/Local
	 Government Official
34	Protective Services
	 (e.g., Homeland Security,
	 Law Enforcement, Firefighter)
35	 Postal Worker

`

Highest Plann
ed

61	CLERGY
62	 HOMEMAKER/STAY AT
	 HOME PARENT
63	OTHER
64	UNDECIDED	

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

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

$6,000-$

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

`

ntly

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

SCIENCE AND ENGINEERING
52	Engineer
53	Research Scientist (e.g., Biologist,
	 Chemist, Physicist)
54	Urban Planner/Architect

Parent/Guardian 1 career

$3,000-$

COMMUNICATIONS
19	Journalist
20	Public Relations/Media
	Relations
21	Advertising

MEDICAL PRACTITIONERS
46	Clinical Psychologist
47	Dentist/Orthodontist
48	Medical Doctor/Surgeon
49	Optometrist
50	Pharmacist
51	Veterinarian

Your intended career

9

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

LAW
44	Lawyer/Judge
45	Paralegal

$1-$2,99

AGRICULTURE
06	Farmer or Forester
07	Natural Resource
	Specialist/Environmentalist

INFORMATION TECHNOLOGY
41	Computer Programmer/Developer
42	 Computer/Systems Analyst
43	Web Designer

None

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. 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

Carefully detach this section after
answering Questions 24 and 25

`
`
`
`
`

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

`
`
`
`
`
`

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. Please select how many individuals in your
household (including yourself) are dependent on
your parent(s)/guardian(s) for financial support.
(Mark one)

`

I am not dependent on
my parent(s)/guardian(s)

`
`

1
2

`
`
`
`

3
4
5
6 or more

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...........

2

...
...

`
`

FON
FON
FON
FON
FON
FON
FON

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

s

`````
`````

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

Parent/
Guardian 2

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

FON
FON
FON

Not at
All

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

Averag
e
Averag
e
Below
Averag
e
Lowes
t 10%

t 10%

Above

`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
1 Strongly Disagree
2 Disagree Somewhat

hat

Modera

tely

FON
FON

Highes

Not at
All

ntly

ionally

Oc c a s

Freque

FON
FON

Somew

tely
Very

Absolu

Not at
All

ntly

`
`
`
`
`
`
`
`

Oc c a s

Freque

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

e
Somew
hat We
ak
A Majo
r Weak
nes

Parent/
Guardia
Parent/ n 1
Guardia
n2

Yours

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

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

42. Mark one in each row:

3 Agree Somewhat
4 Strongly Agree

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.......................
Sexual activity that occurs without the presence of explicit, affirmative
consent (i.e., “yes means yes”) is considered sexual assault..........................
There is little that a person can do to be better at math – you are either
“good” or “bad” at math.....................................................................................
Intelligence is something that can be improved by studying or working harder..

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

VSN
VSN
3

Very
Impo
rta
Som nt
Impoewhat
rtant
Not
Impo
rtant

`.
`.
`
`
`

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

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

FON

hat Im
portan
t
Not Im
portan
t

Military grants...................................
Work-study.......................................
Pell Grant.........................................
Need-based grants or scholarships...
Merit-based grants or scholarships...

No

FON
FON

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

FON

t

Yes

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

FON
FON

FON

Very Im
portan

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

FON

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

``````

Y12
Y12
Y12
Y12

FON
FON
FON
FON
FON

Averag

``````

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

FON
FON

Streng
th
hat Str
ong

``````

FON
FON
FON

Somew

``````

Felt overwhelmed by all I
had to do.............................
Felt depressed.......................
Performed volunteer work.....
Asked a teacher for advice
after class............................
Voted in a student election....
Socialized with someone of
another racial/ethnic group...
Been late to class..................
Discussed religion.................
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...........................

A Majo
r

$15,000+

$14,999

9,999

$10,000-

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.).........................

5,999

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)

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

Not at
All

````
````

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............................
None...........................................

Highest Plann
at This Colle ed
ge

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

Retired

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

Employed
Seasonal
ly
Employed
Unemploy
ed

Parent/Guardian 2 career

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)
ionally

`

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

ionally

HEALTHCARE SUPPORT
36	Dietician/Nutritionist
37	 Home Health Worker
38	 Medical/Dental Assistant
	 (e.g., Hygienist, Lab Tech,
	 Nursing Asst.)
39	Registered Nurse
40	Therapist (e.g., Physical,
	 Occupational, Speech)

Some (but I probably will have enough
funds)

Occas

GOVERNMENT
32	Military
33	Federal/State/Local
	 Government Official
34	Protective Services
	 (e.g., Homeland Security,
	 Law Enforcement, Firefighter)
35	 Postal Worker

`

Highest Plann
ed

61	CLERGY
62	 HOMEMAKER/STAY AT
	 HOME PARENT
63	OTHER
64	UNDECIDED	

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

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

$6,000-$

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

`

ntly

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

SCIENCE AND ENGINEERING
52	Engineer
53	Research Scientist (e.g., Biologist,
	 Chemist, Physicist)
54	Urban Planner/Architect

Parent/Guardian 1 career

$3,000-$

COMMUNICATIONS
19	Journalist
20	Public Relations/Media
	Relations
21	Advertising

MEDICAL PRACTITIONERS
46	Clinical Psychologist
47	Dentist/Orthodontist
48	Medical Doctor/Surgeon
49	Optometrist
50	Pharmacist
51	Veterinarian

Your intended career

9

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

LAW
44	Lawyer/Judge
45	Paralegal

$1-$2,99

AGRICULTURE
06	Farmer or Forester
07	Natural Resource
	Specialist/Environmentalist

INFORMATION TECHNOLOGY
41	Computer Programmer/Developer
42	 Computer/Systems Analyst
43	Web Designer

None

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. 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

`

`

Yes

No

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

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

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

No

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

50. 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

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 social fraternity or sorority................................................
Transfer to another college before graduating............................
Participate in volunteer or community service work....................
Seek personal counseling...........................................................
Communicate regularly with your professors..............................
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.
54.
55.
56.
57.

ABCDE
ABCDE
ABCDE
ABCDE

58.
59.
60.
61.

62.
63.
64.
65.

ABCDE
ABCDE
ABCDE
ABCDE

ABCDE
ABCDE
ABCDE
ABCDE

66.
67.
68.
69.

ABCDE
ABCDE
ABCDE
ABCDE

70.
71.
72.
73.

ABCDE
ABCDE
ABCDE
ABCDE

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

4

Data Recognition Corp.-6G6144-15767-54321

9. From what high school did you graduate? 17. Please mark which of the following courses you
have completed:
Name of high school
YN Algebra II
YN Pre-calculus/Trigonometry
YN Probability & Statistics
City
State
YN Calculus
CORRECT MARK INCORRECT MARKS
YN AP Probability & Statistics
a~aa
aaaa
YN AP Calculus
10. Are you: (Mark all that apply)
A
B
YN AP Computer Science A
` White/Caucasian
Group Code
How many weeks this summer did you participate
18.
` African American/Black
in a bridge program at this institution?
` American Indian/Alaska Native
Your sex: ` Male
` Female
` 7+
` 0
` 3-4
` East Asian (e.g., Chinese, Japanese,
1-2
5-6
Korean, Taiwanese)
`
`
Is English your primary language?
Filipino
`
During
high
school
(grades 9-12) how many years
19.
Yes
No
`
`
Southeast Asian (e.g., Cambodian,
did you study each of the following subjects?
`
In what year did you graduate from
Vietnamese, Hmong)
(Mark one for each item)
high school? (Mark one)
South
Asian (e.g., Indian, Pakistani,
`
Nepalese, Sri Lankan)
` Did not graduate but
` 2016
Mathematics.................... ```````
passed G.E.D. test
2015
`
` Other Asian
Foreign Language........... ```````
` Never completed
` 2014
` Native Hawaiian/Pacific Islander
Physical Science............. ```````
high
school
` 2013 or earlier
` Mexican American/Chicano
Biological Science........... ```````
Are you enrolled (or enrolling) as a:
` Puerto Rican
History/Am. Gov’t............ ```````
(Mark one)
` Other Latino
` Full-time student
Computer Science........... ```````
` Other
` Part-time student
Arts and/or Music............ ```````
11. Prior to this term, have you ever taken
How many miles is this college from
20.
How many Advanced Placement/International
courses for credit at this institution?
your permanent home? (Mark one)
Baccalaureate courses did you take in high school?
` Yes
` No
(Mark one in each row)
` 5 or less ` 11-50 ` 101-500

3.

4.

5.

4

2.

5o
morre

1.

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

Over 500 12. Since leaving high school, have you ever
taken courses, whether for credit or not
6. What was your average grade in high
for credit, at any other institution
school? (Mark one)
(university, 4- or 2-year college, technical,
vocational, or business school)?
` C
` A or A+ ` B
AP Courses........................... ``````
` D
` A–
` B–
` Yes
` No
IB Courses............................. ``````
13. To how many colleges other than this one
` B+
` C+
21.
Please refer to the same Parent/Guardian
did you apply for admission this year?
7. What were your scores on the SAT I
throughout this survey. Please mark the sex of
` 11 or
` None ` 3 ` 6
and/or ACT?
your parent(s) or guardian(s).
more
Male Female
4 ` 7-8
1
`
`
SAT Reading and Writing....
5
9-10
2
Parent/Guardian
1............................
` `
`. `
`
Parent/Guardian 2............................ ` . `
14. Were you accepted by your first choice
SAT Mathematics................
college? ` Yes
` No
22. At any time since you turned 13, were you in foster
care or were you a dependent of the court?
15.
Is
this
college
your:
(Mark
one)
ACT Composite........................
` Yes ` No
` I don’t know
` First choice
` Third choice
8. Where do you plan to live during the fall
you consider yourself: (Mark Yes or No for
` Second choice ` Less than third choice 23. Do
term? (Mark one)
each item)
Yes
No
16. Citizenship status: (Mark one)
` With my family or other relatives
Pre-Med............................................ ` . `
Other
private
home,
apartment,
or
room
U.S.
citizen
`
`
Pre-Law............................................ ` . `
College residence hall
Permanent resident (green card)

`

`
`
`
`

6-10

`

51-100

`

Fraternity or sorority house
Other campus student housing
Other

`
`
`

International student (i.e., F-1, J-1, or
M-1 visa)
None of the above

15+

48. Do you identify as transgender?

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

EMAIL (print letters carefully):

3

Bisexual
Queer
Other

EVSN
EVSN

COUNTRY,
if NOT USA:

10-14

`
`
`

STUDENT ID# (as instructed):

ZIP:

2

Heterosexual/Straight
Gay
Lesbian

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:

5-9

6+

47. What is your sexual orientation?

`
`
`

CITY:

Year

Day
(01-31)

1

` 2 ` 3 ` 4 ` 5 `
` I do not plan to graduate from this college.

N Not Important
S Somewhat Important

Month
(01-12)

ADDRESS:

1-4

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

1

54321
54321
54321

NAME:

V Very Important
E Essential

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

`

54321

When were you born?

1/2

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

45. Military Status: (Mark one)

`
`
`
`
`

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

None

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

4 Agree Somewhat
5 Strongly Agree

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

Not o
my h ffered at
igh s
choo
None
l

Over
20

16-20

11-15

6-10

3-5

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

2016 CIRP Freshman Survey

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

SERIAL #

Studying/homework....................
Socializing with friends in person..
Online social networks
(Facebook, Twitter, etc.)...........
Partying......................................
Student clubs/groups..................
Exercise or sports......................
Working (for pay)........................
Household/childcare duties........

1-2

Hours per week:

Less

None

than

1 hou

r

44. During your last year in high school, how much time
did you spend during a typical week doing the
following activities?

ARTS AND HUMANITIES
01	Art, fine and applied
02	English (language and literature)
03	History
04	Journalism/Communication
05	Classical and Modern
	 Languages and Literature
06	Media/Film Studies
07	Music
08	Philosophy
09	Theatre/Drama
10	Theology/ Religion
11	Other Arts and Humanities
BIOLOGICAL & LIFE
SCIENCES
12	Biology (general)
13	Animal Biology (zoology)
14	Ecology & Evolutionary
	Biology
15	Marine Biology
16	Microbiology
17	Molecular, Cellular, &
	 Developmental Biology
18	Neurobiology/Neuroscience
19	Plant Biology (botany)
20	Agriculture/Natural Resources
21	Biochemistry/Biophysics
22	Environmental Science
23	Other Biological Science
BUSINESS
24	Accounting
25	 Business Admin. (general)
26	Entrepreneurship
27	Finance
28	Hospitality/Tourism
29	Human Resources Management
30	International Business
31	Marketing
32	Management
33	Computer/Management
	 Information Systems
34	Real Estate
35	Other Business
EDUCATION
36	Elementary Education
37	Music/Art Education
38	Physical Education/Recreation
39	Secondary Education
40	Special Education
41	Other Education

HEALTH PROFESSIONS
55	Clinical Laboratory Science	
56	 Health Care Administration/
	Studies	
57	 Health Technology
58	Kinesiology	
59	Nursing	
60	Pharmacy	
61	Therapy (occupational,
	 physical, speech)	
62	Other Health Profession
MATH AND COMPUTER
SCIENCE
63	Computer Science
64	Mathematics/Statistics	
65	Other Math and Computer
	Science	
PHYSICAL SCIENCE
66	 Astronomy & Astrophysics	
67	Atmospheric Sciences	
68	Chemistry	
69	Earth & Planetary Sciences	
70	Marine Sciences	
71	Physics	
72	Other Physical Science	
SOCIAL SCIENCE
73	Anthropology	
74	Economics	
75	Ethnic/Cultural Studies	
76	Geography	
77	Political Science (gov’t.,
	 international relations)
78	Psychology	
79	Public Policy	
80	 Social Work	
81	Sociology	
82	Women’s/Gender Studies	
83	Other Social Science
OTHER MAJORS
84	Architecture/Urban Planning
85	Criminal Justice	
86	Library Science	
87	Security & Protective
	Services	
88	Military Sciences/
	Technology/Operations	
89	OTHER
90	UNDECIDED	

ENGINEERING
42	Aerospace/Aeronautical/
	 Astronautical Engineering
43	Biological/Agricultural
	Engineering
44	Biomedical Engineering
45	Chemical Engineering
46	Civil Engineering
47	Computer Engineering
48	Electrical/ Electronic/
	 Communications Engineering
49	Engineering Science/
	 Engineering Physics
50	Environmental/Environmental
	 Health Engineering
51	Industrial/Manufacturing
	Engineering
52	Materials Engineering
53	Mechanical Engineering
54	Other Engineering

24. Please indicate your intended major using the
codes provided on the
attached fold out.

Turn over for Question 25

1

Bisexual
Queer
Other

48. Do you identify as transgender?

`

`

Yes

No

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

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

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

No

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

50. 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

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 social fraternity or sorority................................................
Transfer to another college before graduating............................
Participate in volunteer or community service work....................
Seek personal counseling...........................................................
Communicate regularly with your professors..............................
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.
54.
55.
56.
57.

ABCDE
ABCDE
ABCDE
ABCDE

58.
59.
60.
61.

ABCDE
ABCDE
ABCDE
ABCDE

62.
63.
64.
65.

ABCDE
ABCDE
ABCDE
ABCDE

66.
67.
68.
69.

ABCDE
ABCDE
ABCDE
ABCDE

70.
71.
72.
73.

ABCDE
ABCDE
ABCDE
ABCDE

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

4

Data Recognition Corp.-6G6144-15767-54321

4.

5.

6.

7.

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

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

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

15. Is this college your: (Mark one)

8. Where do you plan to live during the fall
term? (Mark one)

`
`
`
`
`
`

With my family or other relatives
Other private home, apartment, or room
College residence hall
Fraternity or sorority house
Other campus student housing
Other

`
`

First choice
Second choice

`
`

Third choice
Less than third choice

16. 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

1

4

3.

5o
morre

2.

3

1.

2

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

9. From what high school did you graduate? 17. Please mark which of the following courses you
have completed:
Name of high school
YN Algebra II
YN Pre-calculus/Trigonometry
YN Probability & Statistics
City
State
YN Calculus
CORRECT MARK INCORRECT MARKS
YN AP Probability & Statistics
a~aa
aaaa
YN AP Calculus
10. Are you: (Mark all that apply)
A
B
How many weeks this summer did you participate
18.
` White/Caucasian
in a bridge program at this institution?
Group Code
` African American/Black
` 7+
` 0
` 3-4
` American Indian/Alaska Native
Your sex: ` Male
1-2
5-6
` Female
`
`
` East Asian (e.g., Chinese, Japanese,
Korean, Taiwanese)
19. During high school (grades 9-12) how many years
Is English your primary language?
did you study each of the following subjects?
` Filipino
` Yes
` No
(Mark one for each item)
Southeast
Asian
(e.g.,
Cambodian,
`
In what year did you graduate from
Vietnamese, Hmong)
high school? (Mark one)
Mathematics.................... ```````
` South Asian (e.g., Indian, Pakistani,
Nepalese, Sri Lankan)
` Did not graduate but
` 2016
Foreign Language........... ```````
passed
G.E.D.
test
` 2015
` Other Asian
Physical Science............. ```````
` Never completed
` 2014
` Native Hawaiian/Pacific Islander
Biological Science........... ```````
high
school
` 2013 or earlier
` Mexican American/Chicano
History/Am. Gov’t............ ```````
Are you enrolled (or enrolling) as a:
` Puerto Rican
Computer Science........... ```````
(Mark one)
` Other Latino
` Full-time student
Arts and/or Music............ ```````
` Other
` Part-time student
20. How many Advanced Placement/International
11. Prior to this term, have you ever taken
Baccalaureate courses did you take in high school?
How many miles is this college from
courses for credit at this institution?
(Mark one in each row)
your permanent home? (Mark one)
` Yes
` No
` 5 or less ` 11-50 ` 101-500
` 6-10
` 51-100 ` Over 500 12. Since leaving high school, have you ever
taken courses, whether for credit or not
What was your average grade in high
for credit, at any other institution
school? (Mark one)
(university, 4- or 2-year college, technical,
AP Courses........................... ``````
vocational, or business school)?
` C
` A or A+ ` B
IB Courses............................. ``````
` D
` A–
` B–
` Yes
` No
21. Please refer to the same Parent/Guardian
13. To how many colleges other than this one
` B+
` C+
throughout this survey. Please mark the sex of
did you apply for admission this year?
your parent(s) or guardian(s).
What were your scores on the SAT I
Male Female
` 11 or
` None ` 3 ` 6
and/or ACT?
more
4
7-8
1
Parent/Guardian
1............................
` `
`. `
`
SAT Reading and Writing....
5
9-10
2
Parent/Guardian
2............................
` `
`. `
`

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

15+

`
`
`

EVSN
EVSN

ZIP:

EMAIL (print letters carefully):

10-14

Heterosexual/Straight
Gay
Lesbian

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:

STUDENT ID# (as instructed):

5-9

6+

47. What is your sexual orientation?

`
`
`

CITY:

Year

Day
(01-31)

1

` 2 ` 3 ` 4 ` 5 `
` Do not plan to graduate from this college

N Not Important
S Somewhat Important

Month
(01-12)

ADDRESS:

1-4

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

1

54321
54321
54321

NAME:

V Very Important
E Essential

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

`

54321

When were you born?

1/2

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

45. Military Status: (Mark one)

`
`
`
`
`

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

None

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

4 Agree Somewhat
5 Agree Strongly

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

Not o
my h ffered at
igh s
choo
None
l

Over
20

16-20

11-15

6-10

3-5

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

2016 CIRP Freshman Survey

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

SERIAL #

Studying/homework....................
Socializing with friends in person..
Online social networks
(Facebook, Twitter, etc.)...........
Partying......................................
Student clubs/groups..................
Exercise or sports......................
Working (for pay)........................
Household/childcare duties........

1-2

Hours per week:

Less

None

than

1 hou

r

44. During your last year in high school, how much time
did you spend during a typical week doing the
following activities?

22. At any time since you turned 13, were you in foster
care or were you a dependent of the court?

`
`
`

Yes
No
I don’t know

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

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

No

`. `
`. `

24. Please indicate your intended major using the
codes provided on the
attached fold out.

ARTS AND HUMANITIES
01	Art, fine and applied
02	English (language and literature)
03	History
04	Journalism/Communication
05	Classical and Modern
	 Languages and Literature
06	Media/Film Studies
07	Music
08	Philosophy
09	Theatre/Drama
10	Theology/ Religion
11	Other Arts and Humanities
BIOLOGICAL & LIFE
SCIENCES
12	Biology (general)
13	Animal Biology (zoology)
14	Ecology & Evolutionary
	Biology
15	Marine Biology
16	Microbiology
17	Molecular, Cellular, &
	 Developmental Biology
18	Neurobiology/Neuroscience
19	Plant Biology (botany)
20	Agriculture/Natural Resources
21	Biochemistry/Biophysics
22	Environmental Science
23	Other Biological Science
BUSINESS
24	Accounting
25	 Business Admin. (general)
26	Entrepreneurship
27	Finance
28	Hospitality/Tourism
29	Human Resources Management
30	International Business
31	Marketing
32	Management
33	Computer/Management
	 Information Systems
34	Real Estate
35	Other Business
EDUCATION
36	Elementary Education
37	Music/Art Education
38	Physical Education/Recreation
39	Secondary Education
40	Special Education
41	Other Education

HEALTH PROFESSIONS
55	Clinical Laboratory Science	
56	 Health Care Administration/
	Studies	
57	 Health Technology
58	Kinesiology	
59	Nursing	
60	Pharmacy	
61	Therapy (occupational,
	 physical, speech)	
62	Other Health Profession
MATH AND COMPUTER
SCIENCE
63	Computer Science
64	Mathematics/Statistics	
65	Other Math and Computer
	Science	
PHYSICAL SCIENCE
66	 Astronomy & Astrophysics	
67	Atmospheric Sciences	
68	Chemistry	
69	Earth & Planetary Sciences	
70	Marine Sciences	
71	Physics	
72	Other Physical Science	
SOCIAL SCIENCE
73	Anthropology	
74	Economics	
75	Ethnic/Cultural Studies	
76	Geography	
77	Political Science (gov’t.,
	 international relations)
78	Psychology	
79	Public Policy	
80	 Social Work	
81	Sociology	
82	Women’s/Gender Studies	
83	Other Social Science
OTHER MAJORS
84	Architecture/Urban Planning
85	Criminal Justice	
86	Library Science	
87	Security & Protective
	Services	
88	Military Sciences/
	Technology/Operations	
89	OTHER
90	UNDECIDED	

ENGINEERING
42	Aerospace/Aeronautical/
	 Astronautical Engineering
43	Biological/Agricultural
	Engineering
44	Biomedical Engineering
45	Chemical Engineering
46	Civil Engineering
47	Computer Engineering
48	Electrical/ Electronic/
	 Communications Engineering
49	Engineering Science/
	 Engineering Physics
50	Environmental/Environmental
	 Health Engineering
51	Industrial/Manufacturing
	Engineering
52	Materials Engineering
53	Mechanical Engineering
54	Other Engineering

Turn over for Question 25

Carefully detach this section after
answering Questions 24 and 25

`
`
`
`
`

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

`
`
`
`
`
`

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. Please select how many individuals in your
household (including yourself) are dependent on
your parent(s)/guardian(s) for financial support.
(Mark one)

`

I am not dependent on
my parent(s)/guardian(s)

`
`

1
2

`
`
`
`

3
4
5
6 or more

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...........

2

...
...

`
`

FON
FON
FON
FON
FON
FON
FON

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

s

`````
`````

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

Parent/
Guardian 2

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

FON
FON
FON

Not at
all

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

Averag
e
Averag
e
Below
Averag
e
Lowes
t 10%

t 10%

Above

`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
`````
1 Disagree Strongly
2 Disagree Somewhat

hat

Modera

tely

FON
FON

Highes

Not at
All

ntly

ionally

Oc c a s

Freque

FON
FON

Somew

tely
Very

Absolu

Not at
All

ntly

`
`
`
`
`
`
`
`

Oc c a s

Freque

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

e
Somew
hat We
ak
A Majo
r Weak
nes

Parent/
Guardia
Parent/ n 1
Guardia
n2

Yours

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

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

42. Mark one in each row:

3 Agree Somewhat
4 Agree Strongly

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.......................
Sexual activity that occurs without the presence of explicit, affirmative
consent (i.e., “yes means yes”) is considered sexual assault..........................
There is little that a person can do to be better at math – you are either
“good” or “bad” at math.....................................................................................
Intelligence is something that can be improved by studying or working harder..

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

VSN
VSN
3

Very
Impo
rta
Som nt
Impoewhat
rtant
Not
Impo
rtant

`.
`.
`
`
`

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

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

FON

hat Im
portan
t
Not Im
portan
t

Military grants...................................
Work-study.......................................
Pell Grant.........................................
Need-based grants or scholarships...
Merit-based grants or scholarships...

No

FON
FON

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

FON

t

Yes

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

FON
FON

FON

Very Im
portan

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

FON

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

``````

Y12
Y12
Y12
Y12

FON
FON
FON
FON
FON

Averag

``````

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

FON
FON

Streng
th
hat Str
ong

``````

FON
FON
FON

Somew

``````

Felt overwhelmed by all I
had to do.............................
Felt depressed.......................
Performed volunteer work.....
Asked a teacher for advice
after class............................
Voted in a student election....
Socialized with someone of
another racial/ethnic group...
Been late to class..................
Discussed religion.................
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...........................

A Majo
r

$15,000+

$14,999

9,999

$10,000-

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.).........................

5,999

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)

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

Not at
All

````
````

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............................
None...........................................

Highest Plann
at This Colle ed
ge

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

Retired

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

Employed
Seasonal
ly
Employed
Unemploy
ed

Parent/Guardian 2 career

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)
ionally

`

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

ionally

HEALTHCARE SUPPORT
36	Dietician/Nutritionist
37	 Home Health Worker
38	 Medical/Dental Assistant
	 (e.g., Hygienist, Lab Tech,
	 Nursing Asst.)
39	Registered Nurse
40	Therapist (e.g., Physical,
	 Occupational, Speech)

Some (but I probably will have enough
funds)

Occas

GOVERNMENT
32	Military
33	Federal/State/Local
	 Government Official
34	Protective Services
	 (e.g., Homeland Security,
	 Law Enforcement, Firefighter)
35	 Postal Worker

`

Highest Plann
ed

61	CLERGY
62	 HOMEMAKER/STAY AT
	 HOME PARENT
63	OTHER
64	UNDECIDED	

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

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

$6,000-$

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

`

ntly

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

SCIENCE AND ENGINEERING
52	Engineer
53	Research Scientist (e.g., Biologist,
	 Chemist, Physicist)
54	Urban Planner/Architect

Parent/Guardian 1 career

$3,000-$

COMMUNICATIONS
19	Journalist
20	Public Relations/Media
	Relations
21	Advertising

MEDICAL PRACTITIONERS
46	Clinical Psychologist
47	Dentist/Orthodontist
48	Medical Doctor/Surgeon
49	Optometrist
50	Pharmacist
51	Veterinarian

Your intended career

9

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

LAW
44	Lawyer/Judge
45	Paralegal

$1-$2,99

AGRICULTURE
06	Farmer or Forester
07	Natural Resource
	Specialist/Environmentalist

INFORMATION TECHNOLOGY
41	Computer Programmer/Developer
42	 Computer/Systems Analyst
43	Web Designer

None

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. 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


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