Form 4 HERI College Senior Survey

OMB #0925-XXXX
EXP. XX/XXXX

Attachment 11:
HERI College Senior Survey

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SIS

UNIVERSITY OF CALIFORNIA LOS ANGELES SURVEY INFORMATION SHEET
2016 Cooperative Institutional Research Program (CIRP) College Senior Survey
Purpose of the Study
You are asked to complete this survey as part of a national study conducted by the Higher Education
Research Institute (HERI) at the University of California, Los Angeles. This study is designed as an
exit survey for seniors. Your college or university may then use this information to measure
students’ cognitive and affective growth during college. The ultimate goal is to measure the impact
of college.
Procedures
To participate in this study, please complete and submit the attached survey. Most
respondents complete this questionnaire in about 45 minutes, although individual progress
will vary by how quickly you move through the questions.
You may decide 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
date for follow-up study.
Potential Benefits to Subjects and/or Society
You may have the opportunity to reflect on your experiences in 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.
Potential Risks and Discomforts
There could be survey items that you are uncomfortable answering or to which you would simply
prefer not to respond. Your participation in this study is strictly voluntary, and you will be under no
obligation whatsoever to answer any questions that you are not inclined to answer. You may choose
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not to answer any specific questions you do not want to answer and still remain in the study.
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 secured 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 will only be used for research purposes 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.
Identification of Investigators
If you have any questions or concerns about the research, please contact the Managing Director of
HERI and Director of CIRP, Dr. Kevin Eagan, at this address:
Higher Education Research Institute
UCLA Graduate School of Education and Information Studies
Box 951521 Los Angeles, CA 90095-1521
Email: heri@ucla.edu
Phone: 310-825-1925
Rights of Research Subjects
You may withdraw your consent at any time and discontinue participation without penalty. You are not
waiving any legal claims, rights or remedies because of your participation in this research study. If you
have questions regarding your rights as a research subject, contact the UCLA Office for Protection of
Research Subjects, 11000 Kinross Avenue, Suite 102, Box 951694, Los Angeles, CA 90095-1694, (310)
825-7122.
Public reporting burden for this collection of information is estimated to average 45 minutes per
response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. An
agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a currently valid OMB control number. Send
comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge
Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-xxxx*). Do not return the completed
form to this address.
Do you consent to participate in the 2016 College Senior Survey?
Yes, please take me to the survey
No, I wish to opt out

Welcome to the 2016 College Senior Survey
This survey is a partnership between your institution and the Higher Education Research Institute at
the University of California, Los Angeles.
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Please click "next" to access the survey. To advance through the survey, please click the "next" button.
If you need to review or change your response, please use the "back" button.

Info

Please provide the following information:

First Name

${m://FirstName}

MI
Last Name

${m://LastName}

Email

${m://Email1}

Student ID

${m://ExternalDataRefere

Please enter your date of birth:

Birth Month (MM):
Birth Date (DD):
Birth Year (YY):

Are you currently a student at or did you complete your degree from
${e://Field/InstitutionName}?
Yes
No, I am currently enrolled elsewhere (please type school name below):
No, I completed a degree elsewhere (please type school name below):
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No, I am not currently enrolled at any college or university

Block 1

Please enter the appropriate two-digit code based upon the instructions below:

Please enter the appropriate two-digit code based upon the instructions below:

Your sex:
Male
Female

Are you:
(Mark all that apply)
White/Caucasian
African American/Black
American Indian/Alaska Native
East Asian (e.g., Chinese, Japanese, Korean, Taiwanese)
Filipino
Southeast Asian (e.g., Cambodian, Vietnamese, Hmong)

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South Asian (e.g., Indian, Pakistani, Nepalese, Sri Lankan)
Other Asian
Native Hawaiian/Pacific Islander
Mexican American/Chicano
Puerto Rican
Other Latino
Other

Do you identify as multiracial?
Yes
No

What year did you first enter:
(Mark one in each row)

2015 or 2016

2014

2013

2012

2011 or
earlier

Your 1st College
This College

Please indicate your current enrollment status below:
(Mark one response only)

Full-time undergraduate
Part-time undergraduate
Not enrolled

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Expected graduation date:
(Mark one response only)
2015
2016
Other
Not sure

Please indicate the highest degree you will have earned as of June 2016. (Mark one
response only)
None
Vocational certificate
Associate (A.A. or equiv.)
Bachelor's (B.A., B.S., etc.)
Master's (M.A., M.S., etc.)
Ph.D. or Ed.D.
M.D., D.O., D.D.S., or D.V.M.
LL.B. or J.D. (Law)
B.D. or M.Div. (Divinity)
Other

Please indicate the highest degree you plan to complete eventually at any institution.
(Mark one response only)
None
Vocational certificate
Associate (A.A. or equiv.)
Bachelor's (B.A., B.S., etc.)

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Master's (M.A., M.S., etc.)
Ph.D. or Ed.D.
M.D., D.O., D.D.S., or D.V.M.
LL.B. or J.D. (Law)
B.D. or M.Div. (Divinity)
Other

Do you identify as transgender?
Yes
No

What is your sexual orientation? (Mark one response only)
Heterosexual/Straight
Gay
Lesbian
Bisexual
Queer
Other

How often in the past year did you:
(Mark one in each row)

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Frequently

Occasionally

Not at All

Ask questions in class
Support your opinions with a logical argument
Seek solutions to problems and explain them to

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others
Revise your papers to improve your writing
Evaluate the quality or reliability of information you
received
Take a risk because you felt you had 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
Seek feedback on your academic work
Integrate skills and knowledge from different
sources and experiences

Since entering college, indicate how often you:
(Mark one in each row)
Frequently

Occasionally

Not at All

Worked on independent study projects
Discussed course content with students outside of
class
Failed to complete homework on time
Came late to class
Studied with other students
Performed community service as part of a class
Posted on a course-related on-line discussion board
Accessed your campus' library resources
electronically
Missed class due to employment
Missed class for other reasons

Since entering college, indicate how often you:
(Mark one in each row)

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Frequently

Occasionally

Not at All

Frequently

Occasionally

Not at All

Tutored another college student
Met with an advisor/counselor about your career
plans
Fell asleep in class
Had difficulty getting the courses you needed
Demonstrated for a cause (e.g., boycott, rally,
protest)
Challenged a professor's ideas in class
Communicated regularly with your professors

Since entering college, how often have you:
(Mark one in each row)

Worked with classmates on group projects
Took a class that required:
One or more 10+ page papers
Multiple short papers
Made a presentation in class
Contributed to class discussions
Helped raise money for a cause or campaign
Publicly communicated your opinion about a
cause (e.g., blog, email, petition)

How many months since entering college (including summer) did you work on a
professor's research project? (Mark one response only)
Zero months
1-3 months
4-6 months
7-12 months
13-24 months
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25+ months

Since entering college, have you:
(Mark yes or no for each item)
Yes

No

Failed one or more courses
Taken a remedial course
Taken an ethnic studies course
Taken a women's studies course
Withdrawn from school temporarily
Taken an honors course
Participated in a campus program that promotes
STEM careers (e.g. BUILD, MARC, HHMI, SSTEM)
Transferred from a 2-year college
Transferred from a 4-year college
Taken courses for credit at another institution
Completed a culminating experience for your
degree (e.g., capstone course/project, thesis,
comp exam)
Taken courses from more than one institution
simultaneously
Taken a course exclusively online

Please indicate your primary undergraduate major.

Mark your secondary undergraduate major (omit if you do not have a secondary major).

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Mark your graduate major (omit if you do not plan to go to graduate school).

Please mark your probable CAREER/OCCUPATION:
(Mark one response only)
Accountant or actuary
Actor or entertainer
Architect or urban planner
Artist
Business (clerical)
Business executive (management, administrator)
Business owner or proprietor
Business sales person or buyer
Clergy (minister or priest)
Clergy (other religious)
Clinical psychologist
College administrator/staff
College teacher
Computer programmer or analyst
Conservationist or forester
Dentist (including orthodontist)
Dietitian or home economist
Engineer
Farmer or rancher

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Foreign service worker (including diplomat)
Homemaker (full-time)
Interior decorator (including designer)
Lab technician or hygienist
Law enforcement officer
Lawyer (attorney) or judge
Military service (career)
Musician (performer, composer)
Nurse
Optometrist
Pharmacist
Physician
Policymaker/government
School counselor
School principal or superintendent
Scientific researcher
Social, welfare or recreation worker
Therapist (physical, occupational, speech)
Teacher or administrator (elementary)
Teacher or administrator (secondary)
Veterinarian
Writer or journalist
Skilled trades
Other
Undecided

Since entering college, have you:
(Mark yes or no for each item)
Yes

No

Joined a social fraternity or sorority
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Joined a pre-professional or departmental club
Held a full-time job (approx. 40 hours) while taking
classes
Attended a racial/cultural awareness workshop
Had a roommate of a different race/ethnicity
Played club, intramural, or recreational sports
Played intercollegiate athletics (e.g., NCAA or NAIAsponsored)
Been a leader in an organization
Voted in a national, state, or local election
Participated in:
An internship program
Study-abroad
Leadership training
Student government
An ethnic/racial student organization
An undergraduate research program
An LGBTQ student organization

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)
Highest
10%

Above
Average

Average

Below
Average

Lowest
10%

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

During the past year, how much time did you spend during a typical week doing the
following activities?
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(Mark one in each row)

None

Less
than 1
hr/wk

1-2
hrs/wk

3-5
hrs/wk

6-10
hrs/wk

11-15
hrs/wk

16-20
hrs/wk

Over 20
hrs/wk

Studying/homework
Socializing with friends in
person
Using online social
networks (Facebook,
Twitter, etc.)
Partying
Participating in student
clubs/groups
Exercising/sports
Working (for pay) on
campus
Working (for pay) off
campus
Performing
housework/childcare
Commuting
Praying/meditating
Career planning (job
searches, internships, etc.)

Please indicate your agreement with each of the following statements.
This institution has contributed to my: (Mark one in each row)
Strongly
Agree

Agree

Disagree

Strongly
Disagree

Knowledge of a particular field or discipline
Knowledge of people from different
races/cultures
Understanding of the problems facing your
community
Understanding of national issues
Understanding of global issues
Critical thinking skills
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Problem-solving skills
Foreign language ability
Interpersonal skills
Preparedness for employment after college
Preparedness for graduate or advanced
education
Ability to conduct research
Ability to work as part of a team

Please rate your satisfaction with your college in each area:
(Mark one in each row)
Can't Rate/
No
Very
Very
Satisfied Satisfied Neutral Dissatisfied Dissatisfied Experience
General education or core curriculum
courses
Laboratory facilities and equipment
Library resources
Technology resources
Tutoring or other academic assistance
Academic advising
Student housing (e.g., res. halls)
Financial aid package
Student health services
Student psychological services
Career-related resources and support

Please rate your satisfaction with your college in each area:
(Mark one in each row)
Very
Satisfied

Satisfied

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Neutral

Dissatisfied

Very
Dissatisfied
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Courses in your major field
Amount of contact with faculty
Class size
Relevance of coursework to everyday
life
Relevance of coursework to future
career plans
Overall quality of instruction
Overall sense of community among
students
Availability of campus social activities
Respect for the expression of diverse
beliefs
Ability to find a faculty or staff mentor
Racial/ethnic diversity of the student
body
Overall college experience

What is the average grade you received during your college career, both overall and in
your major?
(Mark one in each row)
A or A+

A-

B+

B

B-

C+

C

D

Overall GPA
Primary Major GPA

For the activities listed below, please indicate how often you engaged in each during the
past year.
(Mark one in each row)
Frequently

Occasionally

Not at All

Felt depressed
Felt overwhelmed by all I had to do
Attended a religious service

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Consumed beer
Consumed wine or liquor
Performed volunteer or community service
work
Discussed politics

For the activities listed below, please indicate how often you engaged in each during the
past year.
(Mark one in each row)
Frequently

Occasionally

Not at All

Sought personal counseling
Discussed religion
Worked on a local, state, or national political
campaign
Contributed money to help support my family
Felt that faculty provided me with feedback that
helped me assess my progress in class
Felt that my contributions were valued in class
Felt that faculty encouraged me to ask questions and
participate in discussions

Please indicate the extent to which you agree or disagree with the following statements:
(Mark one in each row)
Strongly
Agree

Agree

Disagree

Strongly
Disagree

I have felt discriminated against at this institution
because of my race/ethnicity, gender, sexual
orientation, disability status, or religion
I see myself as part of the campus community
Faculty showed concern about my progress
There is a lot of racial tension on this campus
Faculty empower me to learn here
If asked, I would recommend this college to others
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At least one staff member has taken an interest in
my development
I feel valued at this institution
Faculty believe in my potential to succeed
academically

Please indicate the extent to which you agree or disagree with the following statements:
(Mark one in each row)
Strongly
Agree

Agree

Disagree

Strongly
Disagree

In class, I have heard faculty express stereotypes
based on race/ethnicity, gender, sexual
orientation, disability status, or religion
Faculty encouraged me to meet with them outside
of class
I am interested in seeking information about
current social and political issues
I feel a sense of belonging to this campus
At least one faculty member has taken an interest
in my development
I feel I am a member of this college
I have effectively led a group to a common
purpose

Indicate the importance to you personally of each of the following:
(Mark one in each row)

Essential

Very
Important

Somewhat
Important

Not Important

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
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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 work (paintings,
sculpture, etc.)

Indicate the importance to you personally of each of the following:
(Mark one in each row)

Essential

Very
Important

Somewhat
Important

Not Important

Becoming successful in a business of my
own
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
Integrating spirituality into my life
Improving my understanding of other
countries and cultures

To what extent have you experienced the following with students from a racial/ethnic
group other than your own?
(Mark one in each row)
Very Often

Often

Sometimes

Seldom

Never

Dined or shared a meal
Had meaningful and honest discussions
about race/ethnic relations outside of class

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Had guarded, cautious interactions
Shared personal feelings and problems
Had tense, somewhat hostile interactions
Had intellectual discussions outside of
class
Felt insulted or threatened because of your
race/ethnicity
Studied or prepared for class
Socialized or partied

How often have professors at your college provided you with:
(Mark one in each row)
Frequently

Occasionally

Not at All

Encouragement to pursue graduate/professional
study
An opportunity to work on a research project
Advice and guidance about your educational
program
Emotional support and encouragement
A letter of recommendation
Help to improve your study skills
Feedback on your academic work (outside of
grades)
An opportunity to discuss coursework outside of
class
Help in achieving your professional goals
An opportunity to apply classroom learning to
"real-life" issues

Please indicate your agreement with each of the following statements.
(Mark one in each row)
Agree
Strongly

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Agree
Somewhat

Disagree
Somewhat

Disagree
Strongly

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Abortion should be legal
Racial discrimination is no longer a major problem
in America
Students from disadvantaged social backgrounds
should be given preferential treatment in college
admissions
Colleges should prohibit racist/sexist speech on
campus
Wealthy people should pay a larger share of taxes
than they do now
Sexual activity that occurs without the presence of
explicit, affirmative consent (i.e., "yes means yes") is
considered sexual assault

If you borrowed money to help pay for college expenses, estimate how much you will
owe as of June 30, 2016 (please do NOT use commas):

How much of the past year's educational expenses (room, board, tuition, and fees) were
covered from each of the following sources?
(Mark one answer for each possible source)

None

$1 to
$2,999

$3,000 to
$5,999

$6,000 to
$9,999

$10,000 to $15,000 or
$14,999
more

Family resources (parents,
relatives, spouse, etc.)
My own resources (income
from work, work-study, etc.)
Aid which need not be repaid
(grants, scholarships, military,
etc.)
Aid which must be repaid
(loans, etc.)

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To what extent are the following statements true of you:
Strongly
Agree

Agree
Somewhat

Neutral

Disagree
Somewhat

Strongly
Disagree

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

How confident are you that you can:
Absolutely

Very

Moderately

Somewhat

Not at All

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

Will you pursue a science-related research career?
Definitely yes
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Probably yes
Uncertain
Probably no
Definitely no

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)

Highest 10%

Above
Average

Average

Below
Average

Lowest 10%

Academic ability
Artistic ability
Computer skills
Creativity
Drive to achieve
Emotional health
Leadership ability
Mathematical ability
Physical health

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)

Highest 10%

Above
Average

Average

Below
Average

Lowest 10%

Public speaking ability
Risk-taking
Self-confidence (intellectual)
Self-confidence (social)
Spirituality
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Understanding of others
Writing ability

When thinking about your career path after college, how important are the following
considerations:
(Mark one in each row)
Very
Important

Essential

Somewhat
Important

Not
Important

Working for social change
High income potential
Social recognition or status
Stable, secure future
Creativity and initiative
Expression of personal values
Availability of jobs
Leadership potential
Work/life balance
Ability to pay off debt
Connection to college major

Do you plan to do the following in fall 2016?
(Mark yes or no for each item)
Yes

No

Work full-time
Work part-time
Attend graduate/professional school full-time
Attend graduate/professional school parttime
Complete additional undergraduate
coursework/Post-baccalaureate program
Participate in an organization like the Peace
Corps, AmeriCorps/VISTA, or Teach for
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America
Serve in the Armed Forces
Travel
Perform volunteer work
Stay at home to be with or start a family

With respect to being employed after graduation, which best describes the current state
of your employment plans?
(Mark one response only)
Not actively looking for a position
Looking, but no offers yet
Received an offer for a position, but declined
Currently considering an offer
Accepted an offer of employment
Not planning on employment this fall

With respect to graduate or professional school, which of the following best estimates
the current state of your educational plans?
(Mark one response only)
Accepted and will be attending in the fall
Accepted and deferred admission until a later date
Placed on waiting list, no acceptances
Still awaiting responses, no acceptances
Will be applying this coming fall
Not applying this fall, but might apply at a future date
No plans to apply to school now or in the future

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How would you characterize your political views?
(Mark one response only)

Far left
Liberal
Middle-of-the-road
Conservative
Far right

Are you currently registered to vote?
(Mark one response only)
Ineligible
Yes
No

Military Status:
(Mark one response only)
None
ROTC, cadet, or midshipman at a service academy
In Reserves or National Guard
On Active Duty
A discharged veteran NOT serving on Active Duty, in the Reserves, or in the National Guard

If you could make your college choice over, would you still choose to enroll at your
current college?
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Qualtrics Survey Software

(Mark one response only)

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Definitely yes
Probably yes
Probably no
Definitely no

Your current religious preference:
(Mark one response only)
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

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