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pdfOMB #0925-0747
EXP. 11/2019
Attachment 16:
Faculty Annual
Follow-up Survey
Public reporting burden for this collection of information is estimated to average 25
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.
As you may recall, you have been selected to be a part of the Enhance Diversity Study, a national study on faculty
and 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 effort, the NIH Diversity
Consortium, is seeking to understand what programs and strategies can benefit faculty and their students interested
in biomedical, behavioral, clinical, and social science fields.
The University of California, Los Angeles (UCLA) serves as the coordinating center for this national effort and is in
charge of collecting information about these programs in order to evaluate the extent to which these efforts are
successful in improving outcomes for students and faculty. If we can show benefits, this can increase the likelihood
of continuation and expansion of these efforts.
Your school has provided UCLA your name and contact information because you have previously contributed to this
effort by completing the Higher Education Research Institute (HERI) Faculty Survey offered at your institution this
past academic year or you previously completed one of our annual surveys or you participated in a program
sponsored by the Consortium. Only with the continued participation and support of faculty such as yourself will we
be able to determine the value of the various programs offered through your institution to help students succeed.
All of the information you provide will be protected and secured to the extent permitted by law.
In this survey, we will ask you about your activities during this past academic year, including teaching practices,
research, scholarly productivity, and mentoring. You will have the option to upload a document that includes
information about publications or grants (such as a resume or CV) instead of entering this information directly for
each publication or grant in the survey.
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Mentoring
This 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 (with unstructured meetings or independently sought).
1. EMTRCJ Do you have anyone you currently mentor about academics, career or research? We are
interested in undergraduates, post-bacs or graduate students, post-docs, or faculty, not elementary or high
school students.
No
Yes
2. EGRNT During the past 12 months, have you applied for any grant funding or other financial support for
your research (either as Principal Investigator or as Co-Investigator or other paid position)?
No
Yes
3. EGRNTF During the past 12 months, have you received support from any grant funding or other
financial support for your research?
No
Yes
4. ERESO In the past 12 months, have you conducted research that is not covered by the grants listed
above?
No
Yes
5. EANYPUB Have you had publications accepted, in-press, or published in the past 12 months? This
may include peer-reviewed abstracts included in conference proceedings.
No
Yes
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6. ECONF Have you presented research at a scientific conference in the past 12 months (including
posters)?
No (skip to question 7)
Yes
a. Did this conference presentation include: (choose all that apply)
ECONFU Undergraduate student(s)
ECONFB Post-baccalaureate student(s)
ECONFG Graduate student(s)
ECONFP Post-doctoral scholar(s)
ECONFF Faculty
7. ETTRAN During the past 12 months, have you participated in any technology transfer activities
(including being named in patents, completed licenses, and any drug, device, or diagnostic approvals)?
No (skip to question #8)
Yes
a. Please indicate the type of technology transfer (check all that apply):
ETTRIP New patent issued
ETTRLI License completed
ETTRDA Drug, device, or diagnostic received regulatory approval
ETTRBR Result of basic research commercialized
ETTROT Other (specify): _ ETTACX ____________________
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IF RETURNING RESPONDENT, COMPLETE ITEMS 8-9
We would like to be sure our information is correct about your current position.
8. EJOB Our records indicate you are ______ [position] at ______ [institution]. Has that changed?
No (skip to question #9)
Yes
9. What is your current primary position? (Please indicate all that apply)
ECURSC In school (skip to question #9a-d)
ECURWK Working (including internships and significant volunteer positions)
(skip to question #9e-g)
ECURRT Retired (skip to question #10)
ECURUN Unemployed, looking for work (skip to question #10)
ECURO1 Otherwise not in labor force (skip to question #10)
ECURO2 Other (specify): ____ ECUROX _____________
a. ECURYR Expected completion date for degree program (year): _____
ECURDG Expected degree: _____
b. ECURSS Status:
Full Time
Part Time
c. ECURSI Institution: _________________
d. ECURSM Major/Program:
_________________
Go to question #10
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e. Paid Employment (check all that apply):
ECURFT Full Time
ECURPT Part Time
ECURIN Internship
ECURSN Seasonal (full-time or part-time)
ECURNP Volunteer, unpaid internship, or other unpaid position (If this is only item
checked, skip to question #9g)
Briefly describe your paid position(s):
ECURPP Position: _________________
ECURPC Institution or Company: _________________
f. ECURPR Is this paid position related to research?
No
Yes
g. ECURPM Is this new job/position considered a promotion or advancement?
No
Yes
10. To allow us to follow your professional accomplishments, please provide any of the following identifiers
that you may have:
INCLUDE ONLY IF ID TYPE NOT PROVIDED BEFORE (REFER TO INVITATION LIST FLAG)
a. EORCID ORCID ID _________________
ENOORC I do not have one
b. EERAID NIH eRA Commons ID ___________________
ENOERA I do not have one
c. ELNKID LinkedIn ID _______________________
ENOLNK I do not have one
d. EPBURL My NCBI (PubMed or SciEnv) Publications list (URL):
ENOURL I do not have or use
e. Any other public listing with your updated publications
Site name (e.g. ResearchGate, Academia.edu, etc.)__ EPBSITE ___________
ID _ EPBID _____________
ENOPBS I do not have or use one
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11. EAWARD During the past 12 months, were you formally honored, or received an award in recognition
of your teaching, research, or other professional activity?
No (skip to question #12)
Yes
a. For what were you recognized? (Choose all that apply.)
EAWART Teaching
EAWARR Research
EAWARO Other professional activity
11. EORGOF During the past 12 months, were you a member of any professional or scientific
organization?
No (skip to question #12)
Yes
EORGOX If yes, please list any offices you held in professional or scientific organizations during this time.
Please note if you would like us to refer to your CV.
______________________________________________________________________
12. ESRVFD Did you provide service to any federal agencies (e.g. reviewer for NIH/NSF/CDC or similar
proposals, member of federal agency advisory council, etc.) during the past 12 months?
No (skip to question #13)
Yes
ESRVFX If yes, please list any service to federal agencies you have performed during this time (e.g.
reviewer for NIH/NSF/CDC or similar proposals, member of federal agency advisory council, etc.): Please
note if you would like us to refer to your CV.
______________________________________________________________________
13. ESRVOT Did you provide service to any non-federal agencies such as state agencies or foundations
during the past 12 months?
No (skip to first module question)
Yes
ESRVOX If yes, please list any service to non-federal agencies you have performed during this time:
______________________________________________________________________
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If #1 = YES, COMPLETE ITEMS 14-19:
Earlier, you told us that you regularly mentor people. We have a few more questions about that.
14. How many different people do you regularly mentor currently? (Enter 0 if you do not mentor anyone in
a category.)
a.
b.
c.
d.
e.
f.
EMTRST Undergraduate Students: _____
EMTRPB Post-baccalaureate Students: ______
EMTRGS Graduate Students: _____
EMTRPD Post-docs: _____
EMTRJR Faculty: _____
EMTRNO Others: _____
15. Which of the following do you help your mentees with? (Choose all that apply)
EMTRRG Research in general (e.g., general advice/supervision in a lab or on a project)
EMTRRS Specialized research issues (e.g., statistics or instrumentation, writing for a
publication)
EMTRGR Research-related grant writing and funding
EMTRED Educational choices and strategies (e.g., guidance in selecting coursework, other
educational opportunities)
EMTRCR Career planning (e.g., giving advice, helping network, linking to opportunities)
EMTRPS Personal support (e.g., listening to personal concerns, work-life balance)
EMTRHO Other (specify): _______________EMTRHX_________________
16. EMRQUA How would you rate the overall quality of the mentoring you are providing to your mentees?
Very Low
1
Average
2
3
4
5
6
Very High
I choose not
to answer
7
8
17. EMRRST Overall, how satisfied are you with your mentoring relationships?
Not at all
1
Completely I choose not
to answer
Moderately
2
3
4
5
6
7
8
18. EMREXP To what extent do you think you are meeting your mentee’s expectations?
Not at all
1
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Completely I choose not
to answer
Moderately
2
3
4
5
6
7
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8
AVAILABLE ONLY IF SUM OF 14A-E > 0:
19. Please indicate how frequently each of the following has occurred in your research mentoring
relationships during the past 12 months, including any current research mentoring relationships.
a. ECRROP I created
opportunities for my mentees to
bring up issues of race/ethnicity
as they arose.
b. ECRREX I encouraged
mentees to think about how the
research relates to their own
lived experience.
c. ECRRUN I was willing to
discuss race and ethnicity with
my mentees, even if it made
me uncomfortable.
d. ECRRDF I reflected upon
how the research experience
might differ for mentees from
different racial/ethnic groups.
e. ECRRRE I raised the topic
of race/ethnicity in my research
mentoring relationships when it
was relevant.
f. ECRRST I implemented
specific strategies to address
racial/ethnic diversity in my
research mentoring
relationships.
g. ECRRRM I approached the
topic of race/ethnicity with my
mentee(s) in a respectful
manner.
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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
1
2
3
4
5
9
1
2
3
4
5
9
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If #2 OR #3 = YES, COMPLETE ITEMS 20-21:
You told us that you are supported by grant funding or have applied for grant funding. The next set of
items ask about these. If you have a document that lists these (such as a CV), you can upload that
document and skip some of the items below. Otherwise, we will ask you to provide information
about each grant.
Upload now
I do not want to upload now
I do not have a document to upload
20. Please complete or update information for each grant or proposal:
a. EGRA Funding Agency Type:
NIH
Other federal (e.g. NSF)
Nonfederal governmental
Nonprofit (e.g. foundations)
For-profit
Other (specify): ___ EGRAOX _________
b. EGRX [If Nonfederal, Nonprofit, For-Profit, Other]
Agency/Foundation/Company Name: __________________
c. EGRR Role:
Principal Investigator
Co-PI
Investigator
Other (specify): _____________
d. EGRS Submission status:
Submitted (first time for this proposal) (skip to e or f)
Re-submitted with revisions (skip to e or f)
Not funded (skip to 21)
EGRINNIH Impact score (if applicable): ______
Funded (skip to f if not NIH)
EGRIY NIH Impact score (if applicable): ______
e. IF FUNDING AGENCY=NIH: What was the type of funding mechanism?
Research (R or U series)
Training (T or K series)
Other _______________
f.
EGRFP [If non-federal] What was the main purpose of the funding?
Research
Training of others (e.g., students, peers, workforce)
Your career development
Other (specify): __ EGRFPX ___________________
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IF ITEM #4=YES, COMPLETE ITEM #21
Earlier you told us you did research not funded by grants in the past 12 months. Please tell us more about
that:
21a. What type of research was this? (select all that apply)
ERESTR Literature review, synthesis of existing knowledge, and/or conceptual
ERESTS Analysis of existing (secondary) data
ERESTP Analysis of data you collected (primary analysis)
b. What was your role? (select all that apply)
ERESRL PI /Co-PI or Project Lead
ERESRI Investigator
ERESRO Other (Specify): ___ ERESRX _______________________________
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IF #4=YES, COMPLETE ITEMS 22-24:
22. 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
23. EPBPRV Do you have any peer-reviewed publications accepted, in-press, or published in the
past 12 months? This may include peer-reviewed abstracts included in conference proceedings.
No (skip to question #24)
Yes (skip to question #23a)
If yes, please answer the following questions:
a. EPMID PMID # if available: ________________(if provided, skip to question #24)
b. EPBAU List all Authors (Last FM, comma separated): ______, ______, ______, ______
c. EPBTI Title: __________________
d. EPBJN Journal Name: __________________
e. EPBYR Year Published (or indicate “in press” or “epub ahead”): ________
f. EPBVL Volume: ______
g. EPBIS Issue: ______
h. EPBPG Page Numbers: ______
i. EPBDO DOI or URL for epubs: ____________________
24. EPBOT Do you have other research or scientific publications to add to this list? (e.g. book
chapters, books, reports, non-peer reviewed journal articles, working papers, other)
No (skip to question #25)
Yes
a. EPOTY Publication Type:
Chapter
Book
Other, specify: _ EPOTYX ___________
b. EPOAU List all Authors (Last FM, comma separated): ______, ______, ______, ______
Complete the applicable information below depending on publication type:
c. EPOBT [if Book or Chapter] Book/Anthology Title: __________________
d. EPOCT [if Chapter] Chapter Title : __________________
e. EPOER [If Chapter] Editors: __________________
f. EPOYR Year Published: ______
g. EPOED [If Book or Chapter] Edition: ______
h. EPOPB [If Book or Chapter] Publisher: ________________
i. EPOCY City: ________________
j. EPOST State: __________
k. EPOPG [If Book or Chapter] Page Numbers: ______
l. EPODO DOI or URL for epubs: ____________________
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FOR ALL RESPONDENTS:
24. We would like to know how confident you are today that you can successfully perform the
tasks listed below. Using a 0-10 scale, indicate your level between No Confidence (0) and Total
Confidence (10) in your current abilities in these general areas of research and grant writing. Use
NA when a task statement does not seem appropriate for your training.
No
Confidence
a. ESETOP Select a suitable
topic area for study.
b. ESEPRB Refine a problem
so that it can be investigated.
c. ESELOG Develop a logical
rationale for a particular
research idea.
d. ESEWRT Organize your
proposed research ideas in
writing.
e. ESEART Articulate a clear
purpose for the research.
f. ESEPLC Place your study in
the context of existing
research and justify how it
contributes to important
questions in the area.
g. ESETHY Relate your
specific questions of interest to
underlying theory.
h. ESEGRV Convince grant
reviewers your proposed study
is worth funding.
i. ESEHYP Choose an
appropriate research design
that will answer a set of
research questions and/or test
a set of hypothesis.
j. ESEDGN State the purpose,
strengths, and limitations of
each study design.
k. ESESMP Determine the
universe, population, and
appropriate sample for a given
study.
l. ESENUM Determine an
adequate number of subjects
for your research project.
m. ESEMTH Select methods
of data collection appropriate
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Total
Confidence
0
1
2
3
4
5
6
7
8
9
10
N/A
0
1
2
3
4
5
6
7
8
9
10
N/A
0
1
2
3
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6
7
8
9
10
N/A
0
1
2
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7
8
9
10
N/A
0
1
2
3
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5
6
7
8
9
10
N/A
0
1
2
3
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5
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7
8
9
10
N/A
0
1
2
3
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5
6
7
8
9
10
N/A
0
1
2
3
4
5
6
7
8
9
10
N/A
0
1
2
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7
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9
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N/A
0
1
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N/A
0
1
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N/A
0
1
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N/A
0
1
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8
9
10
N/A
Page 13 of 30
to the study population and
variable(s) of interest.
n. ESEVAR Determine how
each variable will be
measured.
o. ESESTR Design the best
data analysis strategy for your
study.
p. ESEFSC Identify
appropriate funding sources
(local, state, national) to
support a study.
q. ESEFAG Speak with a
person at the funding agency
regarding your project or
project ideas.
r. ESEFRV Describe a major
funding agency's (e.g., NIH,
foundation) proposal review
and award process.
s. ESEGAP Write a
competitive grant application.
t. ESEWRF Write-up research
findings for publication in a
peer-reviewed journal.
u. ESESTA Conduct the
appropriate statistical analyses
to answer your research
questions.
v. ESERPT Summarize
research findings in a
traditional research report.
w. ESEHRF Summarize and
highlight research findings for
publication in a peer-reviewed
journal.
x. ESEKEY Communicate key
research findings to a wide
audience of stakeholders.
y. ESESUB Submit paper
and/or poster presentations to
conferences related to your
topic area.
z. ESEPST Present research
findings at conferences related
to your topic area.
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0
1
2
3
4
5
6
7
8
9
10
N/A
0
1
2
3
4
5
6
7
8
9
10
N/A
0
1
2
3
4
5
6
7
8
9
10
N/A
0
1
2
3
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7
8
9
10
N/A
0
1
2
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8
9
10
N/A
0
1
2
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N/A
0
1
2
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9
10
N/A
0
1
2
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8
9
10
N/A
0
1
2
3
4
5
6
7
8
9
10
N/A
0
1
2
3
4
5
6
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8
9
10
N/A
0
1
2
3
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5
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8
9
10
N/A
0
1
2
3
4
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10
N/A
0
1
2
3
4
5
6
7
8
9
10
N/A
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[REMAINING ITEMS FOR FIRST-TIME SURVEY RESPONDERS]
25. EACADRANK What is your present academic rank?
(1) Professor
(2) Associate Professor
(3) Assistant Professor
(4) Lecturer
(5) Instructor
(6) Graduate Student/Teaching Assistant
26. ETENURE What is your tenure status at this institution?
(1)
(2)
(3)
(4)
Tenured
On tenure track,but not tenured
Not on tenure track, but institution has tenure system
Institution has no tenure system
27. EPRINACT What is your principal activity in your current position at this institution?
(1) Administration
(2) Teaching
(3) Research
(4) Services to clients and patients
(5) Other
28. Personally, how important to you is:
Very Essential
Important
Somewhat
Important
Not Important
EIMPTRTS1 Research
4
3
2
1
EIMPTRTS2 Teaching
4
3
2
1
EIMPTRTS3 Service
4
3
2
1
29. During the past 3 years, have you:
Yes
1
1
No
2
2
EACT12 State or federal government
1
2
EACT13 Business or industry
1
2
EACT10 Written research grants
Received funding for your work from:
EACT11 Foundations
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30. EUGEXP How would you rate the overall experience of working with undergraduates on research
projects?
4 Excellent
3 Good
2 Fair
1 Poor
9 I have not worked with undergraduates on research projects
31. EUGADVISE How many undergraduates do you currently advise?
(0) 0
(1) 1
(2) 2
(3) 3
(4) 4
(5) 5
(6) 6
(7) 7
(8) 8
(9) 9
(10) 10
(11) 11-20
(12) 21-30
(13) 31-40
(14) 41-50
(15) 51-60
(16) 61-70
(17) 71-80
(18) 81-90
(19) 91-100
(20) 101 or more
32. During the past year, how often have you done each of the following with your
undergraduate advisees?
EADVACT01 Informed them of academic support
options (e.g., study skills advising, financial aid
advising, Writing Center, Disability Resource Center)
EADVACT02 Helped them to plan their course of
study
EADVACT03 Discussed their academic
performance
EADVACT04 Provided information on other
academic opportunities (e.g., study abroad,
internships, undergraduate research)
EADVACT05 Discussed career and post-graduation
goals
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Frequently
3
Occasionally
2
Not at all
1
3
2
1
3
2
1
3
2
1
3
2
1
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33. How many of the following have you published?
EPUBLISH01 Articles in academic or professional
journals
EPUBLISH02 Chapter in edited volumes
EPUBLISH03 Books, manuals, or monographs
EPUBLISH04 Other (e.g., patents, computer
software products
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None
1
1
1
1
1-2
2
3-4
3
5-10
4
11-20
5
21-50
6
51+
7
2
2
2
3
3
3
4
4
4
5
5
5
6
6
6
7
7
7
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36. ESALARY Please select your base institutional salary.
(1) Less than $10,000
(2) $10,000-19,999
(3) $20,000-29,999
(4) $30,000-39,999
(5) $40,000-49,999
(6) $50,000-59,999
(7) $60,000-69,999
(8) $70,000-79,999
(9) $80,000-89,999
(10)
$90,000-99,999
(11)
$100,000-124,999
(12)
$125,000-149,999
(13)
$150,000-199,999
(14)
$200,000-249,999
(15)
$250,000-499,999
(16)
$500,000 or higher
37. ESALARYBASE Your base institutional salary reported above is based on:
(1) Less than 9 months
(2) 9/10 months
(3) 11/12 months
38. EDEGEARN Please indicate the highest degree you have earned:
(1) Bachelor's (B.A., B.S., etc.)
(2) Master's (M.A., M.S.)
(3) Terminal Master's (M.F.A., M.B.A.)
(4) J.D.
(5) M.D., D.D.S., D.V.M., etc. (Medical)
(6) Ph.D.
(7) Professional Doctorate (Ed.D., Psy.D., etc.)
(8) Other
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39. 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 _________________)
40. 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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42. EMARITAL Are you currently:
(1) Single
(2) In a civil union
(3) In a domestic partnership
(4) Married
(5) Unmarried, living with partner
(6) Separated
(7) Divorced
(8) Widowed
43. How many children do you have in the following age ranges?
0 1
2
3
4+
ENCHILD01 Under 18 years old
0 1
2
3
4
ENCHILD02 18 years or older
0 1
2
3
4
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1. During the 2016-17 academic year or the summer of 2017, have you taken advantage of
any of the following professional development opportunities at this institution?
EPOTCH Funded workshops focused on teaching
EPOMTR Funded workshops focused on mentoring
EPORES Funded workshops focused on conducting
research
EPOWNF Funded workshops focused on NIH funding
EPOWOF Funded workshops focused on other funding
EPOWCD Funded workshops on other career
development topics (e.g., publishing, gaining tenure)
EPOSAB Paid sabbatical leave
EPOTFI Travel funds paid by the institution
EPOTFG Travel funds paid by a grant (e.g. BUILD)
EPOING Internal grants for research
EPOTAL Training for administrative leadership
EPODNC Incentives to develop new courses
EPOINT Incentives to integrate new technology into
your classroom
EPOICC Incentives to integrate culturally competent
practices into your classroom
Yes
No
Not
Not
Eligible Available
2. During the 2016-17 academic year or the summer of 2017, have you engaged in any of
the following activities? (CHOOSE ALL THAT APPLY)
EACEXS Participated in the development of curriculum (enhancing an existing course or
creating a new course)
EACTNC Taught a newly developed course
EACPSU Participated in the development of supplementary cultural curriculum for students
or faculty (e.g. stereotype threat, cultural assets, cultural competency, etc.)
EACTSU Taught a newly developed supplemental cultural course for students or faculty
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3. How confident are you that you can do the following:
Not at all
Confident
Slightly
Confident
Somewhat
Confident
Very
Confident
Extremely
Confident
a. EGOAL Setting learning goals
1
2
3
4
5
b. EREAD Selecting reading materials
1
2
3
4
5
c. EDSGN Designing assignments
1
2
3
4
5
d. EPLAN Planning class activities
1
2
3
4
5
e. ESTRT Using various teaching
strategies
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
f.
EENG Engaging students in learning
g. EPOPP Providing students
opportunities to practice skills
h. EPROM Promoting student
collaboration
i. EASK Encouraging students to ask
questions
j. EEXPR Encouraging students to
express ideas
k. EMINR Encouraging participation
from women and minorities
l. EKNOW Accurately assessing
students’ knowledge
m. EGRAD Grading assignments using
criteria
n. ESUGG Providing students
constructive suggestions
o. EFDBK Providing students with
prompt feedback
p. ETHNK Fostering students’
independent thinking
q. EWAY Addressing sensitive issues
in ways that help students to deal
with them maturely
r. ELRN Fostering students’ confidence
in ability to learn
s. EDISCP Providing students an
overview of discipline
t. EPSSN Demonstrating passion for
teaching
u. ESTAY Staying current in subject
knowledge
v. EHELP Helping students understand
the relevance of learning
w. EENRIC Enriching teaching with
research
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10. Please rate how skilled you feel you are in each of the following mentoring areas:
Not at all
Moderately
Extremely
Skilled
Skilled
Skilled
a. ESLSTN Active listening
1
2
3
4
5
6
7
N/A
b. ESFDBK Providing constructive
1
2
3
4
5
6
7
N/A
feedback
c. ESTRST Establishing a
1
2
3
4
5
6
7
N/A
relationship based on trust
d. ESSTYL Identifying and
accommodating different
1
2
3
4
5
6
7
N/A
communication styles
e. ESIMPR Employing strategies
to improve communication with
1
2
3
4
5
6
7
N/A
mentees
f. ESOMTR Coordinating
effectively with your mentees’
1
2
3
4
5
6
7
N/A
other mentor
g. ESSEXP Working with mentees
to set clear expectations of the
1
2
3
4
5
6
7
N/A
mentoring relationship
h. ESAEXP Aligning your
1
2
3
4
5
6
7
N/A
expectations with your mentees’
i. ESIEXP Considering how
personal and professional
1
2
3
4
5
6
7
N/A
differences may impact
expectations
j. ESSGOA Working with mentees
1
2
3
4
5
6
7
N/A
to set research goals
k. ESDGOA Helping mentees to
1
2
3
4
5
6
7
N/A
develop strategies to meet goals
l. ESELVL Accurately estimating
your mentees’ level of scientific
1
2
3
4
5
6
7
N/A
knowledge
m. ESEABI Accurately estimating
your mentees’ ability to conduct
1
2
3
4
5
6
7
N/A
research
n. ESENHN Employing strategies
to enhance your mentees’
1
2
3
4
5
6
7
N/A
knowledge and abilities
o. ESMOTV Motivating your
1
2
3
4
5
6
7
N/A
mentees
p. ESBULD Building mentees’
1
2
3
4
5
6
7
N/A
confidence
q. ESSTMU Stimulating your
1
2
3
4
5
6
7
N/A
mentees’ creativity
r. ESACKN Acknowledging your
mentees’ professional
1
2
3
4
5
6
7
N/A
contributions
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s. ESINDP Negotiating a path to
professional independence with
your mentees
t. ESBIASTaking into account the
biases and prejudices you bring to
your mentor/mentee relationship
u. ESDIFF Working effectively with
mentees whose personal
background is different from your
own (age, race, gender, class,
region, culture, religion, family
composition etc.)
v. ESNTWK Helping your mentees
network effectively
w. ESCGOA Helping your
mentees set career goals
x. ESBLNC Helping your mentees
balance work with their personal
life
y. ESROLE Understanding your
impact as a role model
z. ESRESC Helping your mentees
acquire resources (e.g. grants,
etc.)
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1
2
3
4
5
6
7
N/A
1
2
3
4
5
6
7
N/A
1
2
3
4
5
6
7
N/A
1
2
3
4
5
6
7
N/A
1
2
3
4
5
6
7
N/A
1
2
3
4
5
6
7
N/A
1
2
3
4
5
6
7
N/A
1
2
3
4
5
6
7
N/A
Page 24 of 30
15. Please indicate your agreement with the following statements:
Strongly Disagree Neutral Agree
Disagree
a. ECRCRE It is important
to consider the mentee’s
and the mentor’s
race/ethnicity in mentoring
relationships
b. ECRSIM It is important
to me to have others in my
research work environment
that have a similar
racial/ethnic background to
mine.
c. ECRASM I am aware of
the assumptions that I
have about race/ethnicity
16. Please indicate how frequently you do the following:
Never
Rarely Sometimes
a. ECRRRE I raised the
topic of race/ethnicity in my
research mentoring
relationship when it was
relevant.
b. ECRHOW I asked my
mentees how they were
doing in general
17. How confident are you in your ability to:
Not at all
2
Confident
ECRCNF address the
role of race and ethnicity
in the mentoring
relationship
Version 01/17/19
3
Strongly
Agree
Frequently All of
the
Time
4
NA
NA
Completely NA
confident
Page 25 of 30
RECEIVING MENTORING
Now we would like to ask you about any mentoring that you receive. This first set of items asks
about mentoring you may do from those who you are SENIOR to you.
16. EMTECS Do you have a faculty member or someone else who is more senior than
you who you currently consider a mentor?
No (skip to question #23)
Yes
17. EMTEN How many different mentors do you regularly work with? __
18. Which of the following does your primary mentor help you with? (choose all that
apply)
EMTERG Research in general (e.g., general advice/supervision in a lab or on a
project)
EMTERS Specialized research issues (e.g., statistics or instrumentation, writing
for publication)
EMTEGR Research-related grant writing and funding
EMTEED Educational choices and strategies (e.g., guidance in selecting
coursework, other educational opportunities)
EMTECR Career planning (e.g., giving advice, helping network, linking to
opportunities)
EMTEEM Personal support (e.g., listening to personal concerns, work-life
balance)
EMTEHO Other (specify): ___ EMTEHX ______________
19. EMTELK How did you find this mentor?
They sought you out
You sought out your mentor independently
They were assigned by your department or campus
Through NRMN
Matched / linked through some other formal program
Other (specify): _____ EMTECX ____________
20. Please tell us how frequently you communicate with your primary mentor with each
of these approaches:
Weekly or Monthly Every 2-3 A few times Annually Never
more
months
a year
or less
often
EMTECI In-person
EMTECP Phone/
Skype
EMTECE Email/
Text
EMTECY Other
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21. EMEQUA How would you rate the overall quality of the mentoring you are receiving?
Very Low
1
Average
2
3
4
Very High
5
6
7
22. EMEEXP To what extent are your mentors meeting your expectations?
Not at all
1
Moderately
2
3
4
Completely
5
6
7
23. During the past year, have you engaged in any of the following activities? (Choose all
that apply)
a. ETMRP Participated in a mentor training program, as an attendee
(preparation to mentor)
b. ETMEP Participated in a mentee training program, as an attendee
(preparation to be mentored)
c. ETMRD Participated in the development of mentoring program
curriculum for students or faculty
Yes
No
d. ETMRT Led/Taught a mentor training program
e. ETMET Led/Taught a mentee training program
f. ETAMN Accessed the National Research Mentoring Network
(NRMN)
EAWARX If yes, please list any honors or awards you received during this time in recognition of
your teaching, research, or other professional activity:
______________________________________________________________________
a. EGRN [If NIH or Other Federal] Full grant number if available
____________________________________
g. EGRE Your percent effort: ____% or EGRM ____ calendar months
a. EGRT Project Title: __________________
b. EGRC Annual direct cost (average across all years) :
Less than $50,000
$50,000-$99,999
$100,000-$249,999
$250,000-$499,999
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$500,000 or more
e.
c. EGRSD Start Date (e.g., 07/2015)
___ / ___
d. EGRED End Date (e.g., 07/2016)
___ / ___
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41. Do you have any of the following disabilities or medical conditions?
a.
b.
c.
d.
e.
f.
Yes
No
Yes
No
EMLRN Learning disability (dyslexia, etc.)
EMADHD Attention deficit hyperactivity disorder (ADHD)
EMAUTI Autism spectrum/Asperger’s syndrome
EMPHY Physical disability (speech, sight, mobility, hearing, etc.)
EMCHRN Chronic illness (cancer, diabetes, autoimmune
disorders, etc.)
EMPSY Psychological disorder (depression, etc.)
Other (please specify): EMOTX_______________________
42. Please indicate “Yes” or “No” for each of the following:
a. EMHEAR Are you deaf or do you have serious difficulty hearing?
b. EMSEE Are you blind or do you have serious difficulty seeing, even
when wearing glasses?
c. EMREM Because of a physical, mental, or emotional condition, do
you have serious difficulty concentrating, remembering, or making
decisions?
d. EMWALK Do you have serious difficulty walking or climbing stairs?
e. EMBATH Do you have difficulty dressing or bathing?
f. EMALON Because of a physical, mental, or emotional condition, do
you have difficulty doing errands alone such as visiting a doctor’s
office or shopping?
45. ESEX Your sex:
(1) Male
(2) Female
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34. Below are some statements about your college or university. Indicate the extent to which you
agree or disagree with each of the following: (Mark one for each item)
Strongly Somewhat Disagree
Disagree
Agree
Agree
Somewhat
Strongly
EINSTOPN01 This institution has effective hiring
4
3
2
1
practices that increase faculty diversity
EINSTOPN02 Student Affairs staff have the
4
3
2
1
support and respect of faculty
EINSTOPN03 There is a lot of campus racial
4
3
2
1
conflict here
EINSTOPN04 My research is valued by faculty in
4
3
2
1
my department
EINSTOPN05 My teaching is valued by faculty in
my department
EINSTOPN06 My service is valued by faculty in
4
3
2
1
my department
EINSTOPN07 Faculty are sufficiently involved in
4
3
2
1
campus decision making
EINSTOPN08 The faculty are typically at odds
4
3
2
1
with campus administration
EINSTOPN09 Faculty here respect each other
4
3
2
1
EINSTOPN10 Administrators consider faculty
4
3
2
1
concerns with making policy
EINSTOPN11 The institution takes responsibility
4
3
2
1
for educating underprepared students
EINSTOPN12 The criteria for advancement and
4
3
2
1
promotion decisions are clear
EINSTOPN13 Most of the students I teach lack
4
3
2
1
the basic skills for college level work
EINSTOPN14 There is adequate support for
4
3
2
1
faculty development
EINSTOPN15 Faculty are not prepared to deal
4
3
2
1
with conflict over diversity issues in the
classroom
EINSTOPN16 The institution takes mentoring
4
3
2
1
into consideration in the promotion process
EINSTOPN17 Faculty of color are treated fairly
4
3
2
1
here
EINSTOPN18 Women faculty are treated fairly
4
3
2
1
here
EINSTOPN19 LGBTQ faculty are treated fairly
4
3
2
1
here
35. Indicate how important you believe each priority listed below is at your college or university:
Highest
High
Medium Low
Priority
Priority
Priority
Priority
EINSTPRIORITY01 Increase or maintain institutional
4
3
2
1
affordability
EINSTPRIORITY02 Develop a sense of community
4
3
2
1
among students and faculty
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EINSTPRIORITY03 Facilitate student involvement in
community service
EINSTPRIORITY04 Help students learn how to bring
about change in society
EINSTPRIORITY05 Increase or maintain institutional
prestige
EINSTPRIORITY06 Hire faculty “stars”
EINSTPRIORITY07 Recruit more traditionally
underrepresented students
EINSTPRIORITY08 Increase the selectivity of the
student body through more competitive admissions
criteria
EINSTPRIORITY09 Promote gender diversity in the
faculty and administration
EINSTPRIORITY10 Promote racial and ethnic diversity in
the faculty and administration
EINSTPRIORITY11 Provide resources for faculty to
engage in community- based teaching or research
EINSTPRIORITY12 Create and sustain partnerships with
surrounding communities
EINSTPRIORITY13 Pursue extramural funding
EINSTPRIORITY14 Strengthen links with the for-profit,
corporate sector
EINSTPRIORITY15 Develop leadership ability among
students
EINSTPRIORITY16 Develop an appreciation for
multiculturalism.
EINSTPRIORITY17 Prepare students for the workplace
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3
2
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4
3
2
1
4
3
2
1
4
4
3
3
2
2
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1
4
3
2
1
4
3
2
1
4
3
2
1
4
3
2
1
4
3
2
1
4
4
3
3
2
2
1
1
4
3
2
1
4
3
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Page 31 of 30
| File Type | application/pdf |
| Author | Vardanyan, Tatevik T. |
| File Modified | 2019-11-20 |
| File Created | 2019-11-02 |