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National Research Council (US) Committee to Examine the Methodology for the Assessment of Research-Doctorate Programs; Ostriker JP, Kuh CV, editors. Assessing Research-Doctorate Programs: A Methodology Study. Washington (DC): National Academies Press (US); 2003.

Cover of Assessing Research-Doctorate Programs

Assessing Research-Doctorate Programs: A Methodology Study.

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DSample Questionnaires

(These questionnaires are subject to further review and revision.)

  1. Institutional Questionnaire
  2. Program Questionnaire
  3. Faculty Questionnaire
  4. Student Questionnaires
    1. Questionnaire for Admitted-to-Candidacy Doctoral Students
    2. Questionnaire for Program Graduates

Institutional Questionnaire

To the institutional coordinator: This questionnaire is intended to collect data about university-provided resources that are available to all doctoral programs. Typically, the ideal respondent will be in the university's office of institutional research. Most of the questions apply to all programs. One, on laboratory space, applies only to the sciences (including some social sciences). In listing programs, please refer to the attached taxonomy and answer for those programs that are present at your institution.

1. For the libraries at your institution: (Please enter the average over the past three years)

a. What is the average size of your professional library staff in total FTEs?______

b. What is the average annual library budget?______

c. What is the average annual budget for acquisition of books?______

d. What is the average annual budget for acquisition of:

print journals______electronic journals______?

e. What is the average annual budget for microprint and electronic databases?______

2. Is health care insurance available to graduate students under an institutional plan?

Yes No

a. If available, health care insurance is made available to:

❏ Students only ❏ Students and faculty

b. If available, what is the level of institutional support? (Check all that apply)

Institution covers premium costs for:

❏ Teaching assistants ❏ Research assistants

❏ All other full-time graduate students ❏ All graduate students

Institution covers partial premium costs for:

❏ Teaching assistants ❏ Research assistants

❏ All other full-time graduate students ❏ All graduate students

No institutional contribution for:

❏ Teaching assistants ❏ Research assistants ❏ Other graduate students

3. Does the university provide childcare facilities that are available to graduate students?

❏ Yes ❏ No

a. If yes, is the cost subsidized by the institution?

❏ Yes ❏ No

b. If not, does the institution provide a listing of childcare providers to graduate students?

❏ Yes ❏ No

4. Is university-subsidized student housing available to doctoral students?

❏ Yes ❏ No

If so, what is the percentage of the doctoral students who live in university-provided housing? _______

5. Are graduate students are unionized on your campus?

❏ Yes ❏ No

If yes, ❏ Some students ❏ All students

If yes, are teaching assistants unionized? ❏ Yes ❏ No

If yes, ❏ Some teaching assistants ❏ All teaching assistants

If yes, are research assistants unionized? ❏ Yes ❏ No

If yes, ❏ Some research assistants ❏ All research assistants?

6. Which of the following apply to the doctoral program at the institutional level?

a. The institution confers awards to honor graduate students for teaching and/or research.

❏ Yes ❏ No

b. Awards are given to faculty for mentoring or other activities that promote scholarship of doctoral students.

❏ Yes ❏ No

c. The institution provides some form of travel support for doctoral students to attend professional meetings.

❏ Yes ❏ No

d. There is an organized program at the institutional level to help doctoral students improve their teaching skills.

❏ Yes ❏ No

e. The institution provides an office that assists doctoral students in learning about employment opportunities. ❏ Yes ❏ No

7. For the information displayed in the following table, please provide in a file sent by email to ude.san@tolipdr

For the each doctoral program in science (including the social sciences) and engineering at your institution, what is the net assignable square feet (NASF) of research space dedicated to the program (exclude space that is used only for undergraduates)? Please use the same definitions for NASF and research space that are used in the NSF Survey of Scientific and Engineering Research Facilities. See [Taxonomy] for a list of the program fields in the study, and provide the information in the Email file for only those doctoral programs that are offered at your institution.

ProgramResearch space NASFShared space with other programs (Y/N)
Program #1
Program #2
Program #3

Program Questionnaire

Background Information

This information will enable the National Research Council to contact you if there are any questions about the data. It will also permit us to contact faculty for the purpose of administering a questionnaire to elicit reputational ratings and background data and to contact students to obtain information about their perceptions of the practices and offerings of the doctoral program.

Please note that in addition to the web questionnaire, we would like lists of faculty and previous employers to be sent to us via e-mail.

Please indicate the doctoral program to which the following information applies

________________________________________

1. Please provide the name and e-mail address of the program respondent who will serve as the primary contact with the graduate program.

Name:_____________________________________________

Title:______________________________________________

E-mail address:______________________________________

Mailing Address:_____________________________________

__________________________________________________

City______________________State_______Zip Code_______

If this is an interdisciplinary program, please list the departments affiliated with the program.

___________________________________________________

___________________________________________________

For each individual identified in questions 2 and 3, please provide in a file sent by email to ude.san@tolipdr the information displayed in the table for the question.

2. Program Faculty: For each faculty member or senior research fellow or associate who participates in your doctoral program by directing theses, serving on doctoral committees, or teaching graduate courses, please provide the following information.

NameRankHighest DegreeGender (M or F)Race/EthnicityUS Citizen or Permanent Resident (Y/N)Tenure StatusE-mail Address
        
        
        

3. Faculty Employment History: For each faculty member listed in Question 2 who joined your program within the past five years, please provide the institution, company, or organization where he or she was employed immediately before joining your institution.

NamePrior employerPosition at that employer
   
   

4. For the doctoral students in your program, please provide the number of students that fall into each of the following categories.

a. Total number of students:______

b. Status: Full-time______ Part-time______ Unknown______

c. Gender: Male______ Female______ Unknown______

d. Citizenship:U.S._______
Permanent Resident_______
Temporary Visa_______
Unknown_______

d. Race/Ethnicity (if U.S. citizen or Permanent Residents)

American Indian or Alaskan Native______
Asian or Pacific Islander______
Black______
White______
Hispanic______
Mexican American_______
Puerto Rican______
Other______
Multiracial______
Unknown______

e. Percentage of doctoral students with master's degree

Program Information

5. Does your program have a mission statement?

❏ Yes No ❏

If so, what is the mission statement? (50 words or less)

_______________________________________________

_______________________________________________

_______________________________________________

_______________________________________________

If there are particular areas of research emphasis in your doctoral from the subfields in [Taxonomy]:

______________________ _______________________

______________________ _______________________

______________________ _______________________

______________________ _______________________

______________________ _______________________

6. How many Ph.D.s have been awarded in the program in each of the past five years? (Note: Years span from July 1 to June 30)

2001–02 ____ 2000–01_____ 1999–00_____ 1998–99_____ 1997–98_____

7. For each of the academic years listed in the following table, enter the number of students who entered the program in the year and the number who completed their degrees in 4, 6, or 8, years or are still in the program. (Note: Years span from July 1 to June 30)

Image p200088e7g111001.jpg

7a. Averaged over the past three years, what percent of entering students withdrew from the program before completing two years of study? ______%

7b. Averaged over the past three years, what has been the median time to degree for those who completed the program?_____(Note: the median time is the number of years it takes half of the number of students from the same entering year who are admitted to candidacy to complete their degree.)

8. Is a master's degree required of students prior to admission to your program?

❏ Yes ❏ No

9. What proportion of your full-time first-year doctoral students receive full support throughout their first year (tuition and an adequate living allowance provided as stipend or salary in program related work (TA or RA)? ________

10. How many years of full financial support could students entering your doctoral program expect to receive from your institution or an external source? _________

11. Over the past five years approximately what fraction of the first-year students in your program received financial support either from your institution or from extramural grants or fellowships?

Tuition only _____

Tuition and stipend _____

Stipend only __________

12. What proportion of currently enrolled doctoral students in your program (included in multiple categories if appropriate) are currently supported by:

Externally funded fellowships:______
Externally funded traineeships:______
Externally funded research assistantships:______
University funded teaching assistantships:______
University funded research assistantships:______
University funded tuition waivers, fellowships, or stipends:______

13. Averaged over the past three years, what are the average and minimum GRE scores for students accepted into the program?

Average Verbal GRE: _____Average Quantitative GRE: ____
Minimum Verbal GRE: ____Minimum Quantitative GRE: ___

Do you require GRE subject scores for all students entering the program?

❏ Yes ❏ No

14. In each of the last three academic years, how many students did you accept into your doctoral program, and how many enrolled?

AcceptedEnrolled
2000–2001__________________
2001–2002__________________
2002–2003__________________

15. What percentage of the doctoral students in your program have individually assigned workspaces for their exclusive use?

TAs _____RAs _____ All students _____

16. On average, how many courses per term is each graduate teaching assistant in the program expected to teach or assist a faculty member in teaching?

With sole responsibility ____ As an Assistant to a faculty member ____

17. Which of the following apply to your doctoral program?

a. The program confers awards to honor graduate students for teaching and/or research.

❏ Yes ❏ No

b. Awards are given to faculty for mentoring or other activities that promote scholarship of doctoral students.

❏Yes ❏ No

c. The program provides some form of travel support for doctoral students to attend professional meetings.

❏ Yes ❏ No

d. There is an organized program to help doctoral students improve their teaching skills.

❏ Yes ❏ No

e. The program provides organized assistance to help doctoral students explore employment opportunities.

❏ Yes ❏ No

18. List up to 5 institutions with which your program normally competes for graduate students:

Institution #1________________________________________

Institution #2________________________________________

Institution #3________________________________________

Institution #4________________________________________

Institution #5________________________________________

19. Does your program collect data about employment outcomes for your graduates?

❏ Yes ❏ No

If yes, do you provide potential applicants with this information?

❏ Yes ❏ No

20. Please list those interdisciplinary centers in which doctoral students from your program participate (conduct research or teach).

_______________________

_______________________

_______________________

_______________________

Faculty Questionnaire

This questionnaire is part of the National Research Council's Pilot Test of the Assessment of Research Doctoral Programs. Your university has volunteered to participate in this pilot test to assist the National Research Council's study of the methodology used to assess doctoral programs. Further information about the methodology study may be found at www7.nationalacademies.org/resdoc/index.html

You have been selected to receive this questionnaire because you are a member of the faculty who participates in the education of doctoral students at your university. This means that you either teach courses to doctoral students or supervise their dissertations. If this is not the case, please indicate that in question 1.

The assessment of research doctoral programs is conducted approximately every ten years and consists of a reputational survey of doctoral programs and the collection of data about doctoral faculty and students in fifty-seven areas of study. This questionnaire provides information that will assist the study in a number of ways: 1)it will help us construct a pool from which to select raters for the reputational survey; 2)it will provide us enough information about you that we can collect data on grants, citations, and publications from other sources; and 3)it will permit a statistical description of the faculty in the graduate program or programs with which you are affiliated. Your answers will be treated as completely confidential by the National Research Council and will only be released as part of a statistical analysis.

I. Program Identification

a. Do you supervise dissertations, serve on doctoral committees, or teach graduate courses in a doctoral program?

❏ Yes ❏ No

If your answer was “No”, you do not need to complete the rest of the questionnaire.

b. From the pulldown list, please choose the program of your primary affiliation/appointment

___________________________[Pull Down List of Res-Doc Programs]

If you have difficulty locating your program on the list, please refer to the [Taxonomy] list with fields and subfields

c. Please list all programs in which you supervise dissertations, serve on dissertation committees, or teach graduate courses and the average percentage of your time during the past year that you spent in all activities for each program with which you are associated. (Do not list programs where you are an outside reader.)

ProgramSupervise dissertations (Y/N)Teach courses (Y/N)Serve on dissertation committees (Y/N)Percent of time spent in all activities for this program (total =100%)
     
     
     

d. For the articles and books that you have published in the past five years, please list what fields you have published in Table 1. If you have a single publication that spans multiple fields, please indicate them and their fields in Table 2.

Table 1Books and articles in a single field published in the past 3 years

Field (see Taxonomy)ArticlesBooks
   
   
   

Table 2Books and articles in multiple fields published in the past 3 years

Field (Enter all that apply)ArticlesBooks

II. Current Employment

a. Department affiliation:_________________

b. Rank:❏ Instructor ❏ Assistant Professor
❏ Associate Professor ❏ Full Professor ❏ Other______
c. Tenure status:❏ Tenure-track, not tenured
❏ Tenured
❏ Non-tenure-track

d. Year first employed at current institution: [If employment was not continuous, please list year of most recent appointment at this institution.] __________________

e. Have you received an extramural grant or contract support in the past year?

❏ Yes ❏ No

f. Subfields of current research interest (refer to [Taxonomy] with subfields):

Subfield # 1: _________________

Subfield #2: __________________

Subfield #3: __________________

g. Do you consider part of your research to be interdisciplinary? ❏ Yes ❏ No If so, what is the area of that research? _____________________

h. Under what names or variants of your name have you published books or articles?

____________________________________________

III. Prior Experience

What was your status prior to your current position?

❏ Student ❏ Postdoc ❏ Faculty. ❏ Other:________________

Previous employer:_______________________________

Address: ______________________________________

City_____________________State/Country_______Zip Code______

Title: __________________________________________________

Employment Sector:

❏ Industry (for profit)

❏ National laboratory

❏ State or local government

❏ Federal government agency

❏ International agency

❏ 4-year college or university

❏ 2-year college

❏ K-12 school

❏ Hospital or clinic

❏ Foundation or nonprofit

❏ Military

❏ Other (specify: __________)

IV. Educational Background

a. Highest degree earned:❏ Bachelor's ❏ Master's ❏ Ph.D.
❏ Professional (M.D., J.D., D.V.M., for example)

b. Institution that conferred highest degree:

_________________________________________

c. Field of highest degree:

_________________________________[Pulldown List]

Other: ____________________________

d. Year of highest degree:

e. To what extent does the field of your current research, teaching, or professional activities differ from the field of your highest degree?

❏ Very similar ❏ Somewhat similar ❏ Very different

V. Demographic Information

a. Date of birth: __________(mm/dd/yy)

b. Gender:❏ Male
❏ Female
c. Citizenship❏ U.S.
❏ Permanent Resident
❏ Temporary Visa
d. Race/Ethnicity (if U.S. citizen or permanent resident)
❏ American Indian or Alaskan Native
❏ Asian or Pacific Islander
❏ Black
❏ White
❏ Hispanic (❏ Mexican American, ❏ Puerto Rican, ❏ Other)
❏ Multiracial

VI. Please provide your preferred e-mail address (where you can be reached if there are questions.)

________________________________________________

Thank you for your time.

Questionnaire for Admitted-to-Candidacy Doctoral Students

This questionnaire is part of the National Research Council's Pilot Test of the Assessment of Research Doctoral Programs. Your university has volunteered to participate in this pilot test to assist the National Research Council's study of the methodology used to assess doctoral programs. One innovation we are considering is adding student responses about the educational processes of the program. We believe that students' input is important to improving the quality of the educational experience. Further information about the methodology study may be found at www7.nationalacademies.org/resdoc/index.html

You have been selected to receive this questionnaire because you are a student who has completed over half of your doctoral program. If this is not the case, please indicate that in question 1.

The assessment of research doctoral programs is conducted approximately every ten years and consists of a reputational survey of doctoral programs and the collection of data about doctoral faculty and students in fifty-four areas of study. This questionnaire will provide information that will assist the study in a number of ways: 1) it will provide a statistical description of students in your program; 2) it will provide information about practices in your program; and 3) it will help future students in the selection of graduate programs.

Your answers will be treated as completely confidential by the National Research Council and will only be released as part of a statistical analysis. Individual answers will not be shared with faculty or administrators of your doctoral program except in aggregated form.

Institution: _______________________________________________

Doctoral Program: _________________________________________

1. Educational Program

A. Year of enrollment in this doctoral program:_________

B. Year you expect to receive your doctorate:__________

C. Did you (or will you) receive a master's degree before this doctorate? ❏ Yes ❏ No

D. Did you (or will you) receive a master's degree in your doctoral field as part of your training?

⇍ Yes ⇍ No

If yes, did you write a master's thesis? ❏ Yes ❏ No

E. During the course of your study for the Ph.D. will you also receive any of the following as part of a joint, concurrent, or combined degree program:

Professional doctorate (e.g., MD, DOS, OD, JD)? ❏ Yes ❏ No

Professional master's (e.g., MBA, MPA, MPH)? ❏ Yes ❏ No

F. During the course of your study for the Ph.D. will you also receive a certificate in another field?

❏ Yes ❏ No

G. What were your career goals at the time you entered graduate school? [check all that apply]

U.S. Employment:

❏ Industry ❏ Government ❏ Nonprofit ❏ University

❏ 2-yr. college ❏ 4-yr. college Other: ______________

Non-U.S. Employment:

❏ Industry ❏ Government ❏ Nonprofit ❏ University

❏ 2-yr. college ❏ 4-yr. college Other: _______________

❏ Unknown

H. What are your current career plans? [check all that apply]

U.S. Employment:

❏ Industry ❏ Government ❏ Nonprofit ❏ University

❏ 2-yr. college ❏ 4-yr. college Other: _______________

Non-U.S. Employment:

❏ Industry ❏ Government ❏ Nonprofit ❏ University

❏ 2-yr. college ❏ 4-yr. college Other: _______________

❏ Unknown

I. Of the following sources of support, which have been your primary sources during your doctoral studies? (Check the three largest)

1.Personal/family funds
2.Research Assistant (RA)
3.Teaching Assistant (TA)
4.Training grant
5.Fellowship
6.Loans
7.Concurrent employment related to your degree
8.Concurrent employment unrelated to your degree

2. Program Characteristics

A. Professional Development

1. During your doctoral program have you received (or will you receive) instruction, practice or professional development training in:

a.Oral communication and presentation skills:❏ Yes ❏ No
b.Writing proposals for funding:❏ Yes ❏ No
c.Preparing articles for publication:❏ Yes ❏ No
d.Working in collaborative groups:❏ Yes ❏ No
e.Conducting independent research/scholarship:❏ Yes ❏ No
f.Project management❏ Yes ❏ No
g.Research/professional ethics❏ Yes ❏ No
h.Speaking to nonacademic audiences❏ Yes ❏ No

2. In your doctoral program did you have an opportunity to obtain teaching experience? Check the type(s) of teaching experience you have had:

a.mentoring a high school student
b.mentoring an undergraduate student
c.grading papers for undergraduate or graduate courses
d.leading discussion sections of undergraduate or graduate courses
e.leading laboratory sections of undergraduate or graduate courses
f.lecturing in undergraduate or graduate courses
g.tutoring undergraduates

If you have had teaching experience, please answer the following,

h.I received formal instruction in teaching.❏ Yes ❏ No
i.I received formal supervision and evaluation.❏ Yes ❏ No
j.I had opportunities to teach in a variety of academic environments.❏ Yes ❏ No

B. Program Environment

1. Does your program provide an annual or more frequent assessment of your progress?

❏ Yes ❏ No

2. Do you receive timely feedback on your research?

❏ Yes ❏ No

3. Do you have access to career advice covering a variety of employment sectors?

❏ Yes ❏ No

a. If yes, are you encouraged to use it? ❏ Yes ❏ No

4. Do you have one or more faculty members at your institution that you consider mentors (i.e., individuals from whom you seek advice about your education, career development, and other matters of concern to you as a graduate student)?

❏ Yes ❏ No

5. How would you rate the quality of teaching by faculty in your program?

❏ Excellent ❏ Good ❏ Fair ❏ Poor

6. How would you rate the quality of your research experience?

❏ Excellent ❏ Good ❏ Fair ❏ Poor

7. How would you rate the curriculum of your Ph.D. program?

❏ Excellent ❏ Good ❏ Fair ❏ Poor

8. How would you rate the overall quality of your program?

❏ Excellent ❏ Good ❏ Fair ❏ Poor

9. How would you rate the intellectual liveliness of your program?

❏ Excellent ❏ Good ❏ Fair ❏ Poor

10. Considering the overall intellectual environment of your university, how much do you feel you have benefited from it?

❏ A lot ❏ Some ❏ A little ❏ Not at all

C. Infrastructure

1. Does your program give you access to:

a.Your own personal work space❏ Yes ❏ No
b.Computer facilities❏ Yes ❏ No
c.Other research facilities; if so, describe:________________

2. Does your program provide adequate space for interaction among students?

❏ Yes ❏ No

3. Are the library resources available to you adequate to support your research and education? ❏ Yes ❏ No

D. Research productivity

1. How many research presentations (including poster presentations) have you made at research conferences

a.on your campus?_______
b.at national or regional meetings?_______

2. How many research publications have you authored or co-authored during your doctoral studies (include pieces accepted for publication but not yet published)?

a.Refereed articles_______
b.Book chapters_______
c.Reviews_______
d.Books or edited volumes_______

3. Background Information

A. Date of birth: __________(mm/dd/yy)
B.Gender:❏ Male
❏ Female
C.Citizenship❏ U.S.
❏ Permanent Resident
❏ Temporary Visa
D. Race/Ethnicity (if U.S. citizen)
❏ American Indian or Alaskan Native
❏ Asian or Pacific Islander
❏ Black
❏ White
❏ Hispanic (❏ Mexican American, ❏ Puerto Rican, ❏ Other)
❏ Multiracial

E. Dependent care responsibilities:

1. Number of children living with you:

Age 6 or under ______ Over age 6 _______

3. Parents or other dependents

❏ Yes ❏ No

G. Marital Status:

Do you have a spouse or partner who lives with you?

❏ Yes ❏ No

F. Level of Parents'Education:MotherFather
High school diploma or less
Some college/Bachelor's degree
Advanced degree

Five-Seven Years Post-Ph.D Questionnaire

This questionnaire is part of the National Research Council's Pilot Test of the Assessment of Research Doctoral Programs. Your university has volunteered to participate in this pilot test to assist the National Research Council's study of the methodology used to assess doctoral programs. One innovation that we are considering is to add student responses to questions about the educational process of the program. Further information about the methodology study may be found at www7.nationalacademies.org/resdoc/index.html

You have been selected to receive this questionnaire because you are a student who has received a Ph.D. from this program five to seven years ago. If this is not the case, please indicate that in question 1.

The assessment of research doctoral programs is conducted approximately every ten years and consists of a reputational survey of doctoral programs and the collection of data about doctoral faculty and students in fifty-four areas of study. This questionnaire provides information that will assist the study in a number of ways: 1) it will help us learn whether a high enough percentage of students respond so that we can add student observations to the larger study; 2) it will provide us enough information about practices in your program that we can compare the practices of graduate programs in your field at different universities; and 3) it will permit a statistical description of the first-year students in the graduate program. Your answers will be treated as completely confidential by the National Research Council and will only be released as part of a statistical analysis. Individual answers will not be shared with faculty or administrators of your former doctoral program except in aggregated form.

1. Educational Program

a. Name of the program where you received your Ph.D. degree:

__________________________________________

b. Year of enrollment in the above Ph.D. program:___________

c. Year you received your Ph.D.: _________

d. Did you receive a master's degree at this institution before this Ph.D.? ❏ Yes ❏ No

e. Were you enrolled as a full-time student throughout your Ph.D. program? ❏ Yes ❏ No

f. Did you attend graduate school prior to enrollment in the above Ph.D. program?

❏ Yes ❏ No

If so, what degrees or certificates, if any, do you hold?

❏ Certificate ❏ Master's ❏ Doctoral ❏ Professional

g. What was your career goal when you completed your Ph.D.?

U.S. Employment:

❏ Industry ❏ Government ❏ Nonprofit ❏ University

❏ 2-yr. college ❏ 4-yr. college Other: ______________

Non-U.S. Employment:

❏ Industry ❏ Government ❏ Nonprofit ❏ University

❏ 2-yr. college ❏ 4-yr. college Other: ______________

❏ Unknown

h. Have your career goals changed since you received your Ph.D.? ❏ Yes ❏ No

i. During your Ph.D. program, were you supported by funds from outside the institution? ❏ Yes ❏ No

(Check all that apply)

Type: ❏ Fellowship ❏ Training Grant ❏ Research Grant

❏ Your employer ❏ Other(Specify:_________)

j. Did you receive institutional support?

❏ Yes ❏ No

(Check all that apply)

Type: ❏ Teaching Assistantship ❏ Research Assistantship ❏ Fellowship

❏ Tuition scholarship or waiver only ❏ Loan ❏ None ❏ Other(Specify:_)

2. Employment and Career Status

a. First employer or place of postdoctoral study after Ph.D. completion:

Name: __________________________________________

Address: ________________________________________

City___________________State/Country_______Zip Code______

Title: _________________________________________________

b. Employment Sector:

❏ Industry (for profit)

❏ National laboratory

❏ State or local government

❏ Federal government agency

❏ International agency

❏ University

❏ 4-year college

❏ 2-year college

❏ K-12 school

❏ Hospital or clinic

❏ Foundation or nonprofit

❏ Military

❏ Other (specify)

c. If you hold or have held a postdoctoral position or positions, how many_______, and at what institutions, companies or government agencies were they located? List chronologically starting with the most recent.

Position # 1: _______________________Dates: _______
Position # 2: _______________________Dates: _______
Position # 3: _______________________Dates: _______
Position #4: _______________________Dates: _______

d. Current employer:

Name: __________________________________________________

Address:_________________________________________________

City______________State/Country__________Zip Code____________

Title:_____________________________________________________

e. Current Employment Sector:

❏ Industry (for profit)

❏ National laboratory

❏ State or local government

❏ Federal government agency

❏ International agency

❏ University

❏ 4-year college

❏ 2-year college

❏ K-12 school

❏ Hospital or clinic

❏ Foundation or nonprofit

❏ Military

❏ Other (specify)

3. Ph.D. Program Characteristics

a. During your Ph.D. education, in which of the following areas was training PROVIDED, which skills or experiences have you USED since graduation, and which area do you wish you had learned MORE about? (check all that apply)

1) Teaching experiemce ❏ Provided ❏ Used ❏ More

2) Oral communication; presentation skills ❏ Provided ❏ Used ❏ More

3) Writing proposals for funding ❏ Provided ❏ Used ❏ More

4) Manuscript preparation ❏ Provided ❏ Used ❏ More

5) Experience working in collaborative groups ❏ Provided ❏ Used ❏ More

6) Critical analysis ❏ Provided ❏ Used ❏ More

7) Locating and applying information ❏ Provided ❏ Used ❏ More

8) Experience working with people of varied educational levels ❏ Provided ❏ Used ❏ More

9) Experience working with people from diverse backgrounds ❏ Provided ❏ Used ❏ More

10) Experience working in teams ❏ Provided ❏ Used ❏ More

b. Research Productivity

1) How many books or edited books have you published or are currently accepted for publication? ___

2) How many articles or book chapters have you published or are currently accepted for publication? ___

3) How many books or articles have you reviewed for publication? ______

4) How many reviews, enumerated in 3), have been or will be published?

5) How many refereed papers have you or a coauthor presented at professional conferences? ___

6) How many awards have you received? (Respond to all categories.)

a) For teaching: _______

b) For research: _______

c) From professional societies: _______

d) From your institution or employer:________

7) How many patents or licenses have you received? ________

8) How many grants have you received from your employer or institution? _____

9) How many grants have you received from extramural funding agencies? _____

4. Background Information

a. Date of birth: __________(mm/dd/yy)

b.Gender:❏ Male
❏ Female
c.Citizenship❏ U.S.
❏ Permanent Resident
❏ Temporary Visa

d. Race/Ethnicity (if U.S. citizen)

❏ American Indian or Alaskan Native

❏ Asian

❏ Pacific Islander

❏ Black

❏ White

❏ Hispanic (❏ Mexican American, ❏ Puerto Rican, ❏ Other)

❏ Multiracial

e.Martial Status❏ Married
❏ Single

f. Number of Children: Age 6 and unde r______ Over age 6

g. Level of Parents' Education:MotherFather
      Less than high school
      High school diploma
      Some college
      Bachelor's degree
      Master's degree
      Professional degree
      Doctoral degree

h. Is English your first language? Yes ❏ No ❏

Copyright © 2003, National Academy of Sciences.
Bookshelf ID: NBK43481

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