3 Data Request Form

OMB #0925-0747
EXP. 05/2023

Attachment 13:
BUILD Institutional Records &
Program Data Requests

Public reporting burden for this collection of information is estimated to average 16
hours 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.

OMB #0925-0747
EXP. 05/2023

BUILD Student IR Data
Initial request – these items requested one time only for each entering freshman cohort (1-1 records; i.e., one
case for each student)
Sample: Entire incoming cohort (entire cohort will provide census coverage for these items, which will fill in holes
from survey non-response
Student ID
Name
Sex
Race/Ethnicity
Name of high school
Zip code of high school
Zip code of permanent address
SAT Math score
SAT Verbal score
ACT Math score
ACT composite score
High School GPA
Pell grant status
Disability status (if available)
Annual Request (1-1 records; i.e., several cases – multiple terms – for each student; each line of data represents
an academic term)
Sample: BUILD students (however defined) and comparison group identified based on data from initial request and
HERI Freshman Survey
Academic term
Sex
Student ID
Enrollment status (full-time, part-time, not enrolled)
Current major
Completed units/credits
Class standing
Cumulative GPA

OMB #0925-0747
EXP. 05/2023
Degree earned*
Degree field*
Annual Request (many-1 records; i.e., multiple cases – multiple classes – for each student; each line of data
represents a course in which a student enrolled)
Sample: BUILD students (however defined) and comparison group identified based on data from initial request and
HERI Freshman Survey
Science courses:
Course ID
Student ID
Course title
Number of units
Grade
Term enrolled
Annual Request (1-1 records; i.e., one case for each student)
Sample: Annual cohort of transfer students – get this information once for each entering cohort of transfers
Student ID
Sex
Race/Ethnicity
Name of high school
Zip code of high school
Zip code of permanent address
Transfer status
Previous institution attended (if transferred)
SAT Math score
SAT Verbal score
ACT Math score
ACT composite score
High School GPA
Pell grant status
Disability status (if available)
Annual request to BUILD program (rosters)
Rosters of students who have participated in BUILD-sponsored activities (e.g., mentoring workshops, workshops on
conducting research, graduate school preparation workshops)

*these may actually constitute a separate database depending on how an institution tracks this information, and
we may want to decide whether we need this every year or when precisely (i.e., just for the cohort starting in
2015) we want/need the degree information from the IR/registrar office.

OMB #0925-0747
EXP. 05/2023
BUILD Faculty IR Data
Initial request – these items requested one time only for science faculty; annual requests for any new hires made
(1-1 records; i.e., one case for each faculty)
Sample: All science faculty employed by the institution in spring 2016
Name
Employee ID
Race/ethnicity
Sex
Academic rank
Department affiliation
Hire date
Administrative position (e.g., chair, dean)
Last sabbatical date
Email
Annual request – courses taught (1-many records; multiple cases – multiple classes – for each faculty; each line
of data represents a course the faculty member taught)
Sample: All BUILD faculty and comparison group of non-BUILD science faculty
Employee ID
Course title
Number of units
Total student enrolled
Type of course (general education, remedial, major requirement, graduate)
Term taught
Annual request – research grants (1-many records; multiple cases – multiple grants – for each faculty; each line
of data represents a grant)
Sample: All BUILD faculty and comparison group of non-BUILD science faculty
Employee ID
Funder
Date of initial award
Amount of total award
Title of award
Annual request – dissertation/thesis service (1-many records; multiple cases – multiple committees – for each
faculty; each line of data represents a dissertation/thesis committee on which the faculty member served)
Sample: All BUILD faculty and comparison group of non-BUILD science faculty
Employee ID
Type of committee (master’s thesis, dissertation)
Role on committee (chair, member)
Title of manuscript
Name of author
Date of final oral defense

OMB #0925-0747
EXP. 11/2019
BUILD Course-Level Data

Annual request – aggregate course data (20 sciences courses per term identified by the CEC and BUILD site; track
changes in course enrollment and grade distribution over time)
Course number
Course title
Total enrollment
Percent female
Percent Pell
Percent of students by race/ethnicity (Latino, White, Black, Native American, Asian American, Pacific Islander,
Other, Multiracial/Multiethnic)
Final grade distribution (A, B, C, D, F, W, with +/- if applicable)

OMB #0925-0747
EXP. 05/2023
Annual request to BUILD program (rosters)
Rosters of faculty who have participated in BUILD-sponsored activities (e.g., mentoring workshops, teaching
workshops, workshops on cultural responsiveness, workshops on conducting research)

o

Faculty participation in BUILD
o Employee ID
 Recipients of BUILD specific funding (CHECK ALL THAT APPLY + AMOUNT)
 Curriculum developer
 Workshop developer
 Workshop facilitator
 Internal grant for research (pilot project)
 Travel funds
 Sabbatical leave
 Participation in BUILD Faculty Development Activities (specific to this institution
– forthcoming) (CHECK ALL THAT APPLY + HOURS)
 Workshops on Teaching
 Workshops on Cultural Responsiveness
 Workshops on Conducting Research
 Workshops on Mentoring
o As mentor
o As mentee