Fellow Mid-Program Survey

OMB Control No. 0551-New

Expiration Date: ##/##/####

Mid-Program Survey [Fellow]

Please complete this form and return no later than the third week of the visit to the Host Institution.

For urgent issues please contact your Borlaug Fellowship Program Manager.

Basic Information

Your Name and contact information (email, phone, and mailing address):

Home Country:

Sex:

Highest education level at application: Masters/PhD/other (specify: ) Fellowship start year:

Initial Impressions about Your Borlaug Fellowship

We are interested in learning about your experience with the Borlaug Fellowship program. Please indicate where appropriate, on a scale of 1 to 5, your response to each of the questions below, with 1 = not at all and 5 =better than expected. For each question, explain the reason for your scoring.

1. Did you and your Mentor discuss the work plan for this 12-week fellowship prior to your arrival?

Check one: YES ☐ NO ☐

Comments (optional):

2. Were you contacted by someone from the host institution 4-8 weeks prior to your arrival to ensure you had all the necessary information for your arrival?

Check one: YES ☐ NO ☐

Comments (optional):

3. Did you receive an orientation upon arrival to the host institution?

Check one: YES ☐ NO ☐

Comments (optional):

4. How many hours per week did you spend working with your Mentor?

Comments (optional):

5. How many hours per week do you spend working with other faculty members?

Comments (optional):

6. Is there a sufficient mix of classroom, laboratory and field activities?

Score (Please circle your answer): 1 2 3 4 5

Explain your answer:

7. Is the housing provided by your host institution sufficient?

Score (Please circle your answer): 1 2 3 4 5

Explain your answer:

8. Is the transportation provided by your host institution sufficient?

Score (Please circle your answer): 1 2 3 4 5

Explain your answer:

9. Did you receive your first allowance payment within your first week at your host institution?

Check one: YES ☐ NO ☐

Comments (optional):

10. How often do you receive your allowance payments?

[free response]

11. Are the other resources provided by your host institution sufficient?

Score (Please circle your answer): 1 2 3 4 5

Explain your answer:

12. Do you have other questions and concerns?

Public Burden Statement. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The public reporting burden for this information collection is estimated to average 20 minutes per response, including the time for reviewing instructions, and completing and submitting the collection of information.

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