Form 2 Student Annual Followup Survey

OMB #0925-0747
EXP. 11/2019

Attachment 13:
Student Annual
Follow-up Survey

Public reporting burden for this collection of information is estimated to vary from 25
to 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 (0925-0747). Do not return the completed form
to this address.

You have been selected to be a part of the Enhance Diversity Study, a national study on student
experiences and career choices. Your school is part of this study, sponsored by the Diversity
Program Consortium, a major national initiative funded by the National Institutes of Health. This
study will help us identify the best strategies to support and encourage success for the next
generation of students from diverse backgrounds in science and research.
The University of California, Los Angeles (UCLA) serves as the coordinating center for this
national effort and is in charge of collecting information about the experiences and career
choices of a variety of students such as you. The information you provide on the survey will
allow the investigators at UCLA and at your school and the other members of the Diversity
Program Consortium to understand how well students are prepared for and succeeding in
biomedical research careers.
Your school has provided UCLA your name and contact information. You may have previously
contributed to this effort by completing one of the national student surveys offered at your
institution this past academic year or completing one of our surveys in the past. By taking this
survey, you are giving permission for your school to share information from your student record
such as demographics, the courses you take, and the grades you receive in your courses with
the UCLA team. You are also giving the UCLA team permission to share the information you
provide on the survey with your institution for their review of local programs and to allow UCLA
to contact you every year or so for follow-up surveys to understand your career choices after
you leave your school. Only with the continued participation and support of students such
as yourself will we be able to show the value of the various programs offered through
your institution to help students such as yourself succeed. All of the information you
provide is protected by a federal Certificate of Confidentiality.
In this survey, we will ask you about publications and grants. You have the option to upload a
document that includes such information (such as a resume or curriculum vitae) instead of
entering this information directly for each publication or grant in the survey.

FOR RESPONDENTS WHO LOGIN WITH A NEW EMAIL SO WE CANNOT DETERMINE
INSTITUTION:
DBLDUNK Our survey is interested in students at specific institutions. Please indicate the
school at which you are currently enrolled or have been enrolled in the past:
California State University, Long Beach
California State University, Northridge
Morgan State University
Portland State University
San Francisco State University
University of Alaska, Fairbanks
University of Detroit-Mercy
University of Maryland, Baltimore County
University of Texas at El Paso
Wayne State University
Xavier University of Louisiana

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ITEMS #1-14 ARE FOR RESPONDENTS WHO ARE FLAGGED AS “NEW” ON INVITATION
LIST:
1. DTRANSER Did you transfer into this institution from another college/university?
No
Yes, from a 2-year College
Yes, from a 4-year College or university
Yes, from another type of postsecondary institution (e.g., technical, vocational, business)
I choose not to answer
IF ANY YES RESPONSE IN #1:
1a. DTRANSERPREP Did you participate in a transfer preparation program before
enrolling here?
No
Yes
I choose not to answer
1b. DTRANSERCRS How many college courses taken at another institution were
accepted for credit here?
Very few
Less than half
About half
Most but not all
All
Don’t Know / I choose not to answer

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ITEMS #1-14 ARE FOR RESPONDENTS WHO ARE FLAGGED AS “NEW” ON INVITATION
LIST:
3. DCOLLGPA What is your overall grade average (as of your most recent academic term?
A or A+
AB+
B
BC+
C
D
I choose not to answer
4. DSUMBRIDGE Did you participate in a summer bridge program prior to starting college?
No
Yes
I choose not to answer
5. Have you participated in any of the following training programs?
DSITEPROG01 AREA
DSITEPROG02 B2B (Bridge to Baccalaureate)
DSITEPROG03 IMSD
DSITEPROG04 LSAMP
DSITEPROG05 MARC
DSITEPROG06 MBRS
DSITEPROG07 PREP
DSITEPROG08 RISE
DSITEPROG09 SC1
DSITEPROG11 Howard Hughes Medical Institute funding (HHMI)
DSITEPROG10 Other
6. Do you consider yourself:
DPREMED Pre-Med
DPRELAW Pre-Law

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No

Yes

I choose not to answer

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ITEMS #1-14 ARE FOR RESPONDENTS WHO ARE FLAGGED AS “NEW” ON INVITATION
LIST:
7. DYRGRADHS In what year did you graduate from high school?
2017
2016
2015
2014 or earlier
Did not graduate but passed G.E.D. test
Never completed high school
I choose not to answer
8. From what high school did you graduate?
DHSNAME Name of high school: ____________
DHSCITY City: _____________
DHSSTATE State: ______________
9. Which of the following courses did you complete in high school?
No
DMATH1 Algebra II
DMATH2 Pre-calculus/Trigonometry
DMATH3 Probability & Statistics
DMATH4 Calculus
DMATH5 AP Probability & Statistics
DMATH6 AP Calculus
DMATH7 AP Computer Science A

Yes

I choose not to answer

10. DNATENGSP Is English your primary language?
No
Yes
I choose not to answer
11. DFOSTER At any time since you were 13, were you in foster care or were you a dependent
of the court?
No
Yes
I do not know
I choose not to answer
12. DMILITARY Military status (Mark one):
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
I choose not to answer
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ITEMS #1-14 ARE FOR RESPONDENTS WHO ARE FLAGGED AS “NEW” ON INVITATION
LIST:
13. What is the highest level of formal education obtained by your parents/guardians?

DPAREDUC1
Parent/
Guardian 1
DPAREDUC2
Parent/
Guardian 2

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

I
choose
not to
answer

14. DPELL Have you received any Pell grant funding for financial aid?
No
Yes
I choose not to answer

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School and work
We would like to ask you about any current school or work activities.
15. DSCHNOW Are you still in school?
No
Yes
I choose not to answer
16. DJOB Are you currently working (for pay), interning, or volunteering?
No
Yes
I choose not to answer
17. DPRGCM During the past 12 months, did you complete any degree or certificate program?
Certificate programs are those that require completion of multiple units over extended
months or years. Do not include one-time workshops.
No
Yes
I choose not to answer
18. DPRAPP During the past 12 months, did you apply to any degree or certificate program?
No
Yes
I choose not to answer
19. DDEGASP Please indicate the highest academic degree that you intend to obtain:
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 (Specify: ______________________)
I choose not to answer

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20. DSCICAREER Will you pursue a science-related research career?
Definitely yes
Probably yes
Uncertain
Probably no
Definitely not
I choose not to answer

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Mentoring
This next section concerns your experiences with mentoring in a variety of contexts.
A mentor is someone who provides guidance, assistance, and encouragement on
professional and academic issues. A mentor can be either someone who is more
experienced (or senior) than you or someone who is at an educational or professional
level similar to you (a “peer”).
A mentee is someone who receives guidance or assistance from a mentor. A mentee can
be someone less experienced (or junior) than you or someone who is your peer.
A mentoring relationship can be formal (with a set schedule and perhaps arranged by your
institution) or informal.
21. DMTECS First, we would like to ask you about a mentor who is senior to you. Do you have
a faculty member or someone else who is more senior than you whom you consider a mentor?
No
Yes
I choose not to answer
In addition to having mentors who are senior to themselves, many people also have mentors
that are at a similar educational or professional level as themselves (a peer).
22. DMTECP Do you have someone at a similar educational or professional level as you (i.e., a
peer) whom you consider an academic/career mentor?
No
Yes
I choose not to answer
Now we would like to ask you about any mentoring that you do.
23. DMTRCJ Do you have anyone who you currently mentor about academic issues who is
junior to you?
No
Yes
I choose not to answer
This next item focuses on people you mentor who are peers to you (at a similar educational and
professional level).
24. DMTECP Do you have anyone who you currently mentor on academic/career issues who is
at a similar level to yours (a peer)?
No
Yes
I choose not to answer

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25. Indicate to what extent the following statements are true of you:

a. DSPOCM I have a strong
sense of belonging to the
community of scientists
b. DSPOTM I derive great
personal satisfaction from
working on a team that is
doing important research
c. DSPOTK I have come to
think of myself as a
‘scientist’
d. DSPOBL I feel like I
belong in the field of
science

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Strongly
Agree

Agree

Neutral

Disagree

Strongly
Disagree

I choose not
to answer

5

4

3

2

1

9

5

4

3

2

1

9

5

4

3

2

1

9

5

4

3

2

1

9

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26. Indicate to what extent you are confident that you can complete the following tasks:

a. DSPTSK Use technical
science skills (use of
tools, instruments,
and/or techniques)
b. DSPTRQ Generate a
research question
c. DSPTCD Determine
how to collect
appropriate data
d. DSPTER Explain the
results of a study
e. DSPTRP Use scientific
literature to guide
research
f. DSPTDT Integrate
results from multiple
studies

Absolutely
confident

Very
confident

Somewhat
Confident

A little
Confident

Not at all
Confident

I choose
not to
answer

5

4

3

2

1

9

5

4

3

2

1

9

5

4

3

2

1

9

5

4

3

2

1

9

5

4

3

2

1

9

5

4

3

2

1

9

27. 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.
Highest
Above
Below
Lowest
I choose not to
10%
Average Average
Average
10%
answer
DSPRAC Academic
ability
DSPRDR Drive to
achieve
DSPRMT
Mathematical ability
DSPRSF Selfconfidence
(intellectual)

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Research Experiences and Activity
28. DCONFA Have you attended or presented at a scientific conference in the past 12 months
(including posters)?
No
Yes, I attended at least one conference but did not present at any
Yes, I attended and presented at least once at a conference
I choose not to answer
29. DPUBS Do you have any scientific publications accepted, in-press, or published (including
as a co-author) in the past 12 months?
No
Yes
I choose not to answer
30. DGRNOP In the past 12 months, have you had any opportunity to conduct your own
scientific research or to participate in scientific research directed by others?
No
Yes
I choose not to answer
31. DGRNT In the past 12 months, have you applied for or received funding to support your own
research? Please do not include fellowships or scholarships that primarily pay for tuition, fees,
or living expenses. Also, please do not include service projects unless they include a research
component.
No
Yes
I choose not to answer

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32. DAWARD Have you received any honors or awards in the past 12 months?
No (skip to question #33)
Yes
I choose not to answer
DAWARX If yes, please provide the name/ title of the honors or awards you’ve received:
________________________________________________________________
33. DORGMB Have you been a member or participated in any pre-professional, departmental,
or professional organizations in the past 12 months?
No (skip to question #34)
Yes
I choose not to answer
DORGOX If yes, please list any offices you have held in pre-professional, departmental,
or professional organizations in the past 12 months. If you have not held any offices,
please write “NONE”:
________________________________________________________________
34. Consider making available only for those still enrolled at prime institution
List of Academic Advising & Support access: SEE SITE SPECIFIC ITEMS IN SEPARATE
FILES
35. DSPPTR In the past 12 months, have you participated in any training for at least 4 hours
total to improve your skills as a mentor or as a mentee?
No
Yes
I choose not to answer
36. In the past 12 months, have you completed formal training/workshops for at least 4 hours
total related to your career or research?
No
Yes
I choose not to answer

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37. DSCHLR During the past 12 months, did you receive any scholarships or grants for
education expenses that you do not need to repay?
No
Yes
I choose not to answer
38. DEDEBT Do you have any education debt?
No
Yes
I choose not to answer
39. DFINCON Do you have any concern about your ability to finance your college education?
None (I am confident that I will have sufficient funds)
Some (but I probably will have enough funds)
Major (not sure I will have enough funds to complete college)
I choose not to answer
40. During the past 12 months, how much time did you spend during a typical week on each of the
following? (Mark one in each row)
None

Less

1-2

3-5

6-10

11-15

16-20

Over

than

hrs/wk

hrs/wk

hrs/wk

hrs/wk

hrs/wk

20
hrs/ wk

1 hour
Studying/homework
Participating in student clubs/groups
Working (for pay) on campus
Working (for pay) off campus
Family responsibilities (child or
sibling care, elder care, chores, etc.)
Commuting
Career planning (job searches,
networking , etc)

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41. DDISABL Are any of the following statements true for you?
•
•
•
•
•
•

I am deaf or have serious difficulty hearing
I am blind or have serious difficulty seeing, even when wearing glasses
I have serious difficulty concentrating, remembering, or making decisions because of a
physical, mental, or emotional condition
I have serious difficulty walking or climbing stairs
I have difficulty dressing or bathing
I have difficulty doing errands alone such as visiting a doctor’s office or shopping
because of a physical, mental, or emotional condition
No, none of these statements are true for me
Yes, at least one statement is true for me
I choose not to answer

42. Have you registered with your school’s Office of Disability/Student Accessibility?
No
Yes
I choose not to answer

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COMPLETE ITEMS 43-45 ONLY IF FIRST-TIME RESPONDER
43. Which categories describe you? Select all boxes that apply. Note, you may report more than
one group.
DWHITE White – For example, German, Irish, English, Italian, Polish, French, etc.
DHISP Hispanic, Latino/a, or Spanish Origin – For example, Mexican or Mexican
American, Puerto Rican, Dominican, Salvadoran, Peruvian, Mestizo, Chicano, etc.
DBLACK Black or African American – For example, Jamaican, Haitian, Nigerian,
Ethiopian, Somali, Creole, Caribbean, etc.
DAMRIN American Indian or Alaska Native – For example, Navajo Nation, Blackfeet
Tribe, Mayan, Aztec, Quechua, Native Village of Barrow Inupiat Traditional Government,
Nome Eskimo Community, etc.
DASNIN Asian – For example, Chinese, Filipino, Asian Indian, Vietnamese, Korean,
Japanese, etc.
DNHAWA Native Hawaiian or Other Pacific Islander – For example, Native Hawaiian,
Samoan, Guamanian or Chamorro, Tongan, Fijian, Marshallese, etc.
DMENA Middle Eastern or North African – For example, Lebanese, Iranian,
Egyptian, Syrian, Moroccan, Algerian, Armenian, etc.
DROTH Some other race, ethnicity, or origin (Specify: DROTX _________________)

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COMPLETE ITEMS 43-45 ONLY IF FIRST-TIME RESPONDER
IF WHITE CHECKED IN 43:
44a. Select all boxes that apply and/or enter details in the space below.
German
Irish
English
Italian
Polish
French
Enter details - for example, Scottish, Norwegian, Dutch, etc.
___________________________________________________
IF HISPANIC, LATINO, OR SPANISH CHECKED IN 43:
44b. Select all boxes that apply and/or enter details in the space below.
Mexican or Mexican American
Puerto Rican
Cuban
Salvadoran
Dominican
Colombian
Enter details - for example, Guatemalan, Spaniard, Ecuadorian, Chicano, etc.
___________________________________________________
IF BLACK OR AFRICAN AMERICAN CHECKED IN 43:
44c. Select all boxes that apply and/or enter details in the space below.
African American
Jamaican
Haitian
Nigerian
Ethiopian
Somali
Enter details - for example, Ghanaian, South African, Barbadian, etc.
___________________________________________________

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COMPLETE ITEMS 43-45 ONLY IF FIRST-TIME RESPONDER
IF AMERICAN INDIAN OR ALASKAN NATIVE CHECKED IN 43:
44d. Enter details in the space below.
AMERICAN INDIAN
Enter details - for example, Navajo Nation, Blackfeet Tribe, Muscogee (Creek) Nation, etc.
_____________________________________________________________________
ALASKA NATIVE
Enter details - for example, Native Village of Barrow Inupiat Traditional Government, Nome
Eskimo Community, Orutsararmiut Native Council, etc.
____________________________________________________________________________
CENTRAL OR SOUTH AMERICAN INDIAN
Enter details - for example, Mayan, Aztec, Taino, etc.
____________________________________________________________________________
IF ASIAN CHECKED IN 43:
44e. Select all boxes that apply and/or enter details in the space below.
Chinese
Filipino
Asian Indian
Vietnamese
Korean
Japanese
Enter details - for example, Pakistani, Cambodian, Uyghurs, etc.
___________________________________________________
IF NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER CHECKED IN 43:
44f. Select all boxes that apply and/or enter details in the space below.
Native Hawaiian
Samoan
Chamorro
Tongan
Fijian
Marshallese
Enter details - for example, Palauan, Tahitian, Chuukese, etc.
___________________________________________________

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COMPLETE ITEMS 43-45 ONLY IF FIRST-TIME RESPONDER
IF MIDDLE EASTERN OR NORTH AFRICAN CHECKED IN 43:
44g. Select all boxes that apply and/or enter details in the space below.
Lebanese
Iranian
Egyptian
Syrian
Moroccan
Enter details - for example, Israeli, Iraqi, Tunisian, Armenian, etc.
___________________________________________________
45. DGEND What is your current gender identity?
Man
Woman
Trans man
Trans woman
Gender queer/Gender non-conforming
Different identity
I choose not to answer

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IF #15 = YES, COMPLETE ITEM #46
Earlier, you told us you are currently in school. These next few questions ask some detail about that.
46. a. DCURYR What year do you expect to complete your degree program? _____
b. Which of the following best describes your class standing?
Freshman
Sophomore
Junior
Senior
Graduate student/trainee in professional program
I choose not to answer
b. DCURSS What is your current enrollment status at school?
Full Time
Part Time
I choose not to answer
c. DCURSI What school do you attend? _________________
d. DCURSM Major:

_________________

[Pull down menu – see final page for list]
Go to next module

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If #15 = NO, COMPLETE ITEM #47
47. DCURST Earlier, you told us that you are not in school. Please tell us a bit more about that
I graduated from my previous institution
I did not graduate but do have plans to attend school in the next 2 years
I did not graduate and do NOT have plans to attend school in the next 2 years
I choose not to answer
Go to next module

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If #16 = YES, COMPLETE ITEM #48
Please tell us more about the work and volunteering you do:
48. a. Please describe any work, internship, or volunteering (check all that apply):
DCURFT Working full time for pay
DCURPT Working part time for pay
DCURIN Internship or student placement
DCURSN Seasonal (full-time or part-time)
DCURNP Volunteer, unpaid internship, or other unpaid position (If this is only response
checked, Skip to question #56d)
b. Please briefly describe your paid position(s):
Directly related to my major or field of study
Indirectly related to my major or field of study
Not at all related to my major or field of study
I choose not to answer
c. DCURPR Is this paid position related to research?
No
Yes
If no volunteer activity, go to next module
d. Volunteer
Please briefly describe your volunteer / unpaid position:
Directly related to my major or field of study
Indirectly related to my major or field of study
Not at all related to my major or field of study
I choose not to answer
e. DCURVR Is this volunteer position related to research?
No
Yes

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IF #17 = YES, COMPLETE ITEM #49
Earlier you told us you completed at least one degree or certificate program in the past 12
months. Please tell us a bit more about that1:
49. a. DPRGDG Degree / certificate: _________________
b. DPRGMJ Major / area of study: _________________
c. DPRGIN From which institution or school: _________________
d. DPRGDM / DPRGDY Date awarded: MM / YR

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IF #18 = YES, COMPLETE ITEM #50
Earlier you told us you applied to at least one degree or certificate program in the past 12
months. Please tell us more detail about those applications:
50. a. DPRADG Degree / certificate the program awards: _________________
b. DPRAMJ Major / area of study: _________________
c. DPRAIN Institution: _________________
d. DPRADM / DPRADY Date applied: MM / YR
e. DPRAST Status of application:
Accepted and will attend
Accepted and will not attend
Waitlisted
Pending
Not accepted

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IF #21 = YES, COMPLETE ITEMS #50-57
Earlier you told us you have mentors who are more senior than you.
50. DMTEN How many different mentors do you regularly work with? ______
51. How many mentors help you with (please enter “0” if none of your mentors help you with
that topic):
a. Research-related issues ____
b. Educational choices ____
c. Career planning_______
d. Personal support______
e. Other topics: __________
52. For the mentor you work with most closely (your primary mentor), please provide the
following information:
DMTEPO Position: ____________________________
DMTEIN Institution/ Company: __________________________
DMTEDI Discipline: ___________________________
53. Does your primary mentor help you with research?
No
Yes

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IF #21 = YES, COMPLETE ITEMS #50-57
54. Please indicate how frequently each of the following occurred in your relationship with your
primary research mentor.

a. DECOPP My mentor
created opportunities for me
to bring up issues of
race/ethnicity as they arose.
b. DECLEX My mentor
encouraged me to think
about how research relates
to my own lived experience.
c. DECDRE My mentor was
willing to discuss race and
ethnicity, even if it may
have been uncomfortable
for him/her.
d. DECTRE My mentor
raised the topic of
race/ethnicity in our
mentoring relationship when
it was relevant.
e. DECRMN My mentor
approached the topic of
race/ethnicity with me in a
respectful manner.

Never

Rarely

Sometimes Frequently

All of the
time

1

2

3

4

5

I choose
not to
answer
9

1

2

3

4

5

9

1

2

3

4

5

9

1

2

3

4

5

9

1

2

3

4

5

9

55. DEOVAQ How would you rate the overall quality of the mentoring you are receiving from
your primary mentor?
Very low
1

2

3

Average
4

5

6

Very High
7

I choose not to answer
9

56. DESATF Overall, how satisfied are you with your primary mentoring relationship?
Not at all
1

2

3

Moderately
4

5

6

Completely
7

I choose not to answer
9

57. DEMTEX To what extent do you feel that your primary mentor is meeting your
expectations?
Not at all
Moderately
Completely
I choose not to answer
1
2
3
4
5
6
7
9

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IF #22 = YES, COMPLETE ITEM #58
58. DMEPN How many different peer mentors do you have? _________

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IF #23 = YES, COMPLETE ITEMS #59-63
Earlier, you told us you mentor people who are junior to you.
59.a. DMTJN How many different people do you regularly mentor currently? ______
b. At what education level are the people you mentor? (Choose all that apply)
DMTJCS College students
DMTJHS High school students
DMTJMS Middle or elementary school students
60. DTOVAQ How would you rate the overall quality of the mentoring you are providing your
mentees?
Very low
1

2

Average
4

3

5

Very High
7

6

I choose not to answer
9

61. DTSATF Overall, how satisfied are you with your mentoring relationships?
Not at
all
1

Moderately
2

3

4

I choose not to answer

Completely
5

6

7

9

62. DTMTEX To what extent do you feel that you are meeting your mentees' expectations?
Not at
all
1

Moderately
2

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3

4

Completely
5

6

7

I choose not to answer
9

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ONLY FOR RESPONDENTS WHO ARE GRADUATE STUDENTS (#46=5) WHO ARE
MENTORING COLLEGE STUDENTS (#59B/COLLEGE STUDENTS > 0)
63. For the next set of questions we would like for you to think of your current or most recent
research mentoring relationship where the mentee was of a different racial/ethnic background
than yourself. If you have not had a research mentoring relationship where the mentee was of a
different racial/ethnic background then please think of your most recent mentoring relationship.
Never
a. DTCOPP I created opportunities
for my mentees to bring up issues
of race/ethnicity as they arose.
b. DTCLEX I encouraged mentees
to think about how the research
relates to their own lived
experience.
c. DTCDRE I was willing to
discuss race and ethnicity with my
mentees, even if it made me
uncomfortable.
d. DTCDEX I reflected upon how
the research experience might
differ for mentees from different
racial/ethnic groups.
e. DTCTRE I raised the topic of
race/ethnicity in my research
mentoring relationships when it
was relevant.
f. DTCSRE I implemented specific
strategies to address racial/ethnic
diversity in my research
mentoring relationships.
g. DTCRMN I approached the
topic of race/ethnicity with my
mentee(s) in a respectful manner.

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Rarely

Sometimes

Frequently

1

2

3

4

All of
the
time
5

I choose
not to
answer
9

1

2

3

4

5

9

1

2

3

4

5

9

1

2

3

4

5

9

1

2

3

4

5

9

1

2

3

4

5

9

1

2

3

4

5

9

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IF #24 = YES, COMPLETE ITEM 64
64.a. DMEPN How many different peers do you regularly mentor currently? ______

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IF #29 = YES, COMPLETE ITEM #65-66
65. The next set of items ask about publications. If you have a list of these and did not
upload already, you can upload it now.
Upload now

I do not want to upload now

I do not have a document to upload

66.a. DPTY Publication Type:
Journal article
Chapter in a book
Book
Other, specify: ____________
b. DPBAU List all Authors (Last FM, comma separated): ______, ______, ______
Complete items c-j if journal article selected
c. DPMID PMID #: ________________(if provided, all other items skipped)
d. DPBTL Title: __________________
e. DPBJN Journal Name: __________________
f. DPBYR Year Published (or indicate “in press” or “epub ahead”): ________
g. DPBVL Volume: ______
h. DPBIS Issue: ______
i. DPBPG Page Numbers: ______
j. DPBDO DOI or URL for epubs: ____________________
Complete the applicable information below depending on publication type:
k. DPOBT [if Book or Chapter] Publication Title: __________________
l. DPOCT [if Chapter] Chapter Title : __________________
m. DPOER [If Chapter] Editors: __________________
n. DPOYR Year Published: ______
o. DPOED [If Book or Chapter] Edition: ______
p. DPOPB [If Book or Chapter] Publisher: ________________
q. DPOCY City: ________________
r. DPOST State: __________
s. DPOPG [If Book or Chapter] Page Numbers: ______
t. DPODO DOI or URL for epubs: ____________________

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IF #30 = YES, COMPLETE ITEM #67
67. Please check all research activities you participated in last year (Choose all that apply)
DGRCLA Hands-on research activities with laboratory equipment in a class
DGRCOL Worked in a laboratory in a college/university
DGRNOA Worked on research in a non-academic location
DGROWN Designed your own research experience or project
DGRLIT Literature review, synthesis of existing knowledge, and/or conceptual
DGRSEC Analysis of existing (secondary) data
DGRPRI Analysis of data you collect (primary analysis)
DGRSUM A summer research experience
DGRPPT As a research participant/subject
DGROTH Other (Specify: DGROTX ______________)
DGRNON None of the above

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IF #31 = YES, COMPLETE ITEM #68
68. Please complete or update information for each grant or proposal:
a. DGRA Funding Agency Type:
Your university
National Institutes of Health (NIH)
Other federal agency (e.g., NSF)
Nonfederal governmental
Nonprofit (e.g., foundations)
For-profit
Other (specify): ____________
b. DGRR Role:
Principal Investigator
Co-Principal Investigator
Investigator
Other (specify): _____________
c. DGRS Submission status:
Submitted (first time for this proposal)
Re-submitted with revisions
Not funded
Funded
d. IF FUNDING AGENCY=NIH: DGRNIHT What was the type of funding mechanism?
Research (R or U series)
Training (T or K series)
Other _______________
e. IF FUNDING AGENCY NOT NIH: DGRFP What was the main purpose of the
funding?
Research
Training of others (e.g., students, peers, workforce)
Your career development
Other (specify): _____________________

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IF #37 = YES, COMPLETE ITEM #69
Tell us more about the scholarships and grants you have received.
69.a. DSCHNM Name of scholarship/grant: ______________________________
(Please enter “Don’t know” if you are not sure of the name.)
b. DSCHTO Amount (total value including value of any fee/tuition waivers):
Less than $1,000
$1,000-4,999
$5,000-9,999
$10,000 or more
c. DSCHY Was this award based on:
Need
Merit
Need and Merit
Other (specify): DSCHYX ________________

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IF #38 = YES, COMPLETE ITEM #70
Earlier you told us that you have education debt. Please tell us a bit more about that.
70a. DEDTOT Total amount that you owe: $ __ __ __, __ ___ ___
I don’t know how much I owe
b. DEDPYT How much you borrowed during the past year: $ __ __ __, __ __ __
I don’t know how much I borrowed

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ITEMS 71-75 WILL BE COMPLETED ONLY BY FRESHMEN STUDENTS (SELECTED
YFCY ITEMS FOR HALLMARKS)
71. Since entering this college, how often have you interacted with the following people
(e.g., by phone, e-mail, text, or in person):
Daily
2 or 3 Once
1 or 2
1 of 2 Never I
times
a
times
times
choose
per
week
per
per
not to
week
month term
answer
DINTACT1 Faculty
6
5
4
3
2
1
9
during office hours
DINTACT2 Faculty
6
5
4
3
2
1
9
outside of class or
office hours
DINTACT3 Academic
6
5
4
3
2
1
9
advisors/counselors
DINTACT4 Graduate
6
5
4
3
2
1
9
students/teaching
assistants
72. Since entering this college, how often have you felt:
Frequently Occasionally
DAFFACT01 Lonely or homesick
DAFFACT02 Isolated from campus
life
DAFFACT03 Unsafe on this campus
DAFFACT04 Worried about your
health
DAFFACT05 That your courses
inspired you to think in new ways
DAFFACT06 That your job
responsibilities interfered with your
schoolwork
DAFFACT07 That your family
responsibilities interfered with your
schoolwork
DAFFACT08 Family support to
succeed
DAFFACT09 That faculty provided
me with feedback that helped me
assess my progress in class
DAFFACT10 That my contributions
were valued in class
DAFFACT11 That faculty encouraged
me to ask questions and participate in
discussions

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3
3

2
2

Not at
all
1
1

I choose not to
answer
9
9

3
3

2
2

1
1

9
9

3

2

1

9

3

2

1

9

3

2

1

9

3

2

1

9

3

2

1

9

3

2

1

9

3

2

1

9

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ITEMS 71-75 WILL BE COMPLETED ONLY BY FRESHMEN STUDENTS (SELECTED
YFCY ITEMS FOR HALLMARKS)
73. Since entering this college, how has it been to:
Very
Somewhat Somewhat
Easy
Easy
Difficult
DEASY1 Understand what
4
3
2
your professors expect of you
academically
DEASY2 Develop effective
4
3
2
study skills
DEASY3 Adjust to the
4
3
2
academic demands of college
DEASY4 Manage your time
4
3
2
effectively
DEASY5 Develop close
4
3
2
friendships with other
students

Very
Difficult
1

I choose not
to answer
9

1

9

1

9

1

9

1

9

74. Please indicate the extent to which you agree or disagree with the following statements:
Strongly
Agree Disagree Strongly
Agree
Disagree
DCOLOPN02 I see myself as part of the
campus community
DCOLOPN03 Faculty showed concern
about my progress
DCOLOPN07 I have been able to find a
balance between academics and
extracurricular activities
DCOLOPN09 Faculty empower me to
learn here
DCOLOPN10 If asked, I would
recommend this college to others
DCOLOPN12 I feel valued at this
institution
DCOLOPN13 Faculty believe in my
potential to succeed academically
DCOLOPN15 My college experiences
have exposed me to diverse opinions,
cultures, and values
DCOLOPN17 Faculty encouraged me to
meet with them outside of class
DCOLOPN19 I feel a sense of belonging
to this campus
DCOLOPN20 At least one faculty member
has taken an interest in my development
DCOLOPN21 I feel I am a member of this
college
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4

3

2

1

I choose
not to
answer
9

4

3

2

1

9

4

3

2

1

9

4

3

2

1

9

4

3

2

1

9

4

3

2

1

9

4

3

2

1

9

4

3

2

1

9

4

3

2

1

9

4

3

2

1

9

4

3

2

1

9

4

3

2

1

9

Page 37 of 43

ITEMS 71-75 WILL BE COMPLETED ONLY BY FRESHMEN STUDENTS (SELECTED
YFCY ITEMS FOR HALLMARKS)
75. Please rate your satisfaction with your college in each area:

DCOMPSAT01
Amount of
contact with
faculty
DCOMPSAT02
Ability to find a
faculty or staff
mentor
DCOMPSAT14
Overall sense
of community
among students

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Very
Satisfied
6

Satisfied

Neutral

Dissatisfied
3

Very
Dissatisfied
2

Can’t Rate / No
Experience
1

5

4

6

5

4

3

2

1

6

5

4

3

2

1

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ITEMS 76-80 ONLY FOR FIRST-TIME RESPONDER
76. DCITIZEN Please indicate your citizenship status?
U.S. citizen
Permanent resident (green card)
International student (i.e., F-1, J-1, or M-1 visa)
None of the above
I choose not to answer
77. DSCAREER Please indicate your intended career
See list below
78. Please indicate the careers of your parents/guardians.
DPCAREER1 Parent/Guardian 1
DPCAREER2 Parent/Guardian 2
ARTS
Actor or Entertainer
Artist
Graphic Designer
Musician
Writer/Producer/Director
AGRICULTURE
Farmer or Forester
Natural Resource Specialist/Environmentalist
BUSINESS
Accountant
Administrative Assistant
Business Manager/Executive
Business Owner/Entrepreneur
Retail Sales
Sales/Marketing
Human Resources
Finance (e.g., Actuary, Banking, Loan Officer, Planner)
Management Consultant
Real Estate Agent/Realtor/Appraiser/Developer
Sports Management
COMMUNICATIONS
Journalist
Public Relations/ Media Relations
Advertising
EDUCATION
College Administrator/Staff
College Faculty
Early Childcare Provider
Elementary School Teacher
Secondary School Teacher
Librarian
Teacher’s Assistant/Paraprofessional
K-12 Administrator
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Other K-12 Professional
GOVERNMENT
Military
Federal/State/Local Government Official
Protective Services (e.g., Homeland Security, Law Enforcement, Firefighter)
Postal Worker
HEALTHCARE SUPPORT
Dietician/Nutritionist
Home Health Worker
Medical/Dental Assistant (e.g. Hygienist, Lab Tech, Nursing Asst.)
Registered Nurse
Therapist (e.g., Physical, Occupational, Speech)
INFORMATION TECHNOLOGY
Computer Programmer/Developer
Computer/Systems Analyst
Web Designer
LAW
Lawyer/Judge
Paralegal
MEDICAL PRACTITIONERS
Clinical Psychologist
Dentist/Orthodontist
Medical Doctor/Surgeon
Optometrist
Pharmacist
Veterinarian
SCIENCE AND ENGINEERING
Engineer
Research Scientist (e.g., Biologist, Chemist, Physicist)
Urban Planner/Architect
SERVICE INDUSTRY
Custodian/Janitor/Housekeeper
Food Service (e.g., Chef/Cook, Server)
Hair Stylist/Aesthetician/Manicurist
Interior Designer
Skilled Trades (e.g., Plumber, Electrician, Construction)
Social/Non-Profit Services
CLERGY
HOMEMAKER/STAY AT HOME PARENT
OTHER
UNDECIDED
I CHOOSE NOT TO ANSWER

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ITEMS 76-80 ONLY FOR FIRST-TIME RESPONDER
79. How much of the past year’s educational expenses (room, board, tuition, and fees) were
covered from each of the following sources?
None

$1 to
$2,999

$3,000 to
$5,999

$6,000 to
$9,999

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

DAID1 Family
resources (parents,
relatives, spouse, etc.)
DAID2 My own
resources (income
from work, workstudy, etc.)
DAID3 Aid which
need not be repaid
(grants, scholarships,
military, etc.)
DAID4 Aid which must
be repaid (loans)
80. DDOB When were you born? MM_ / DD / YYYY

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I choose
not to
answer

ALL RESPONDENTS COMPLETE NEXT SET OF ITEMS
81. To allow us to follow your professional accomplishments, please provide any of the
following identifiers that you may have:
a. DORCID LinkedIn ID _______________________
DNOORC I do not have one
b. DERAID ORCID ID _________________
DNOERA I do not have one
c. DLNKID NIH eRA Commons ID ___________________
DNOLNK I do not have on

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Keeping in Touch with You
Your input to the Enhance Diversity Study is extremely valuable and important.
So, we want to be sure we can stay in touch with you over the next few years to ask for your
input on an annual basis.
Please provide the following information to help us be sure we can reach you:
82. Please provide any additional email addresses that you use other than the one we
reached you at for this survey:
a. DEMAIL1 _________________________
b. DEMAIL2___________________________
c. DEMAIL3___________________________
83. Please provide one or more phone numbers where you can usually be reached:
a.

DPHONE1 (__ __ __) __ __ __ - __ __ __ __

b.

DPHONE2 (__ __ __) __ __ __ - __ __ __ __

84. DFCBK Please provide your Facebook name:

_________________________

85. Please provide the name and contact information for a family member or close friend who
will likely know how to reach you in the future:
DCTNAM Name: ___________________
DCTEML Email: _____________________
DCTPHN Phone: (__ __ __) __ __ __ - __ __ __ __
ONLY IF FIRST-TIME RESPONDERS:
86. DPADDR What is your permanent address?
____________________________________________________________
87. DCADDR What is your current address (if different from your permanent address)?
____________________________________________________________

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