Under-Represented Populations Instruments

Student Surveys

Instrument 1: Intake Questionnaire for Entering 9th Grades

Project: The Douglass Science Institute Program Series: Encouraging Precollege Women to Persist in Math and Science Studies
Rutgers University, New Brunswick

Funding Source: NSF: Program for Women and Girls (HRD)

Purpose: To collect demographic and self-assessment information on entering 9th grade students

Administered To: Entering 9th grade students

Topics Covered:

• Attitudes & Beliefs (Student): family, identity issues, profession, skills, understanding
• Comparisons: expectations
• Identity Issues: achievement, gender roles
• Mentoring & Support: family support, instructor, peers
• Plans & Expectations (Student): academic interests
• Self-Assessment (Student): confidence, intelligence, participation, skills, support
• Background Characteristics & Activities (Student): current coursework, extracurricular activities, family characteristics, honors

Format/Length: 87 questions, 9 open- and 78 closed-ended

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Developer: The Douglass Science Institute Program Series: Encouraging Precollege
Women to Persist in Math and Science Studies
Rutgers University

NSF Funding Source: Program for Women and Girls

Purpose: To collect demographic and self-assessment information on entering 9th grade students

Administered To: Entering 9th grade students

Topics Covered:

• General characteristics of student's family background (e.g., those with whom student lives most of the time, occupation of parents or guardian, involvement of these individuals in math or science careers)
• Student's self-assessment of general intelligence, ability in math, and ability in science in comparison to classmates
• Highest level of education student would like to complete/highest level student expects to complete
• Student's course history in math and science
• Student's career plans
• Student's interest in specific careers
• Student's attitudes toward scientists and scientific careers
• Student's participation in class
• Student's participation in extracurriculars
• Information about student's peer interests
• Student's interactions with others correlated with support for student's interest in math and science

Format/Length: 87 questions, 9 open- and 78 closed-ended

1997 INTAKE QUESTIONNAIRE FOR ENTERING 9TH GRADES

1) Provide the following information on each of your brothers and sisters, step-brothers and -sisters, and half-brothers and -sisters.

First Name	Relationship to you	Age	Last year of school completed	Occupation if finished with school or highest degree
1. ___________	______________	______	______________	______________
2. ___________	______________	______	______________	______________
3. ___________	______________	______	______________	______________
4. ___________	______________	______	______________	______________
5. ___________	______________	______	______________	______________
6. ___________	______________	______	______________	______________
7. ___________	______________	______	______________	______________
8. ___________	______________	______	______________	______________

2) Which adults do you live with most of the time? Circle each adult with whom you usually live.

1. mother
2. step-mother
3. father
4. step-father
5. other(s) (who? _________________________________________________)

3) What is the occupation and level of education of your parents or guardians? (Skip those that do not apply to you.)

	Occupation	Last year of school completed or highest degree
1. Mother	__________________________	__________________________
2. Father	__________________________	__________________________
3. Stepmother	__________________________	__________________________
4. Stepfather	__________________________	__________________________
5. Other adult with	__________________________	__________________________
whom you live
(who? ______________)
6. Second adult with	__________________________	__________________________
whom you live
(who? ______________)

4) Do any of your relatives have occupations that involve science, mathematics, or computers? Check one:  Yes _____  No ______

For each relative who has an occupation involving science, mathematics, or computers, provide the information requested below: (If none, skip this question and go on to the next.)

First Name	Relationship to you (For example, mother, cousin, uncle)	Last year of school completed or highest degree	Occupation
1. ________	________________	________________	________________
2. ________	________________	________________	________________
3. ________	________________	________________	________________
4. ________	________________	________________	________________
5. ________	________________	________________	________________
6. ________	________________	________________	________________

5) Are any of your relatives still in school preparing or planning to enter an occupation that involves science, mathematics, or computers. Check one:
Yes _____  No ______

For each relative who is preparing or planning to enter an occupation that involves science, mathematics, or computers, provide the information requested below (If none, skip this question and go on to the next.)

First Name	Relationship to you (For example, mother, cousin, uncle)	Last year of school completed or highest degree	Occupation
1. ___________	________________	________________	________________
2. ___________	________________	________________	________________
3. ___________	________________	________________	________________
4. ___________	________________	________________	________________
5. ___________	________________	________________	________________
6. ___________	________________	________________	________________

The following questions focus on your opinions and future plans.

6) Comparing yourself to other students in the ninth grade at your school, how would you rate your overall level of intelligence? Circle one.

1. Top 5%
2. Top 10%
3. Above average, but not in the top 10%
4. Average
5. Below average

7) Comparing yourself to other students in the ninth grade, how would you rate your overall ability in mathematics? Circle one.

1. Top 5%
2. Top 10%
3. Above average, but not in the top 10%
4. Average
5. Below average

8) Comparing yourself to other students in the ninth grade, how would you rate your overall ability in science? Circle one.

1. Top 5%
2. Top 10%
3. Above average, but not in the top 10%
4. Average
5. Below average

9) If you could continue with your schooling as far as you wanted, what is the highest level of education you would complete? Circle one.

1. High School
2. Community College (two-year college program) or Vocational School
3. College (four or five year college program)
4. Graduate School - Master's Degree
5. Graduate School - Doctoral Degree (Ph.D.)
6. Medical, Dental, or Veterinary School
7. Law School
8. Other (specify ______________________________)

10) Realistically, what level of education do you expect to complete? Circle one.

1. High School
2. Community College (two-year college program) or Vocational School
3. College (four or five year college program)
4. Graduate School - Master's Degree
5. Graduate School - Doctoral Degree (Ph.D.)
6. Medical, Dental, or Veterinary School
7. Law School
8. Other (specify ______________________________)

11) Here is a list of math, science, and computer courses. Look over the list and cross off any course not offered by your high school. Then go over the list of remaining courses and indicate how likely it is that you will take each course before graduating. (Circle one answer for each course. If you have ALREADY taken a course, circle the NAME of that course and go on to the next course on the list.

How likely is it that you will take this course?

1. Pre-Calculus			Very likely	Somewhat likely			Somewhat Unlikely	Very Unlikely
2. AP Calculus			Very likely	Somewhat likely			Somewhat Unlikely	Very Unlikely
3. Chemistry			Very likely	Somewhat likely			Somewhat Unlikely	Very Unlikely
4. AP Chemistry			Very likely	Somewhat likely			Somewhat Unlikely	Very Unlikely
5. Physics			Very likely	Somewhat likely			Somewhat Unlikely	Very Unlikely
6. AP Physics			Very likely	Somewhat likely			Somewhat Unlikely	Very Unlikely
7. Biology			Very likely	Somewhat likely			Somewhat Unlikely	Very Unlikely
8. AP Biology			Very likely	Somewhat likely			Somewhat Unlikely	Very Unlikely
9. Computer			Very likely	Somewhat likely			Somewhat Unlikely	Very Unlikely
10. AP Computer Science			Very likely	Somewhat likely			Somewhat Unlikely	Very Unlikely

12) Are there any future jobs or careers that you are seriously thinking about pursuing?
Check one:  Yes _____  No ______

List the careers you are currently thinking about and indicate how confident you are about succeeding in these careers.

				(Circle one.)
1. ________________	Very Confident		Somewhat Confident	Unsure		Somewhat Doubtful		Very Doubtful
2. ________________	Very Confident		Somewhat Confident	Unsure		Somewhat Doubtful		Very Doubtful
3. ________________	Very Confident		Somewhat Confident	Unsure		Somewhat Doubtful		Very Doubtful

13) Listed below are a variety of careers you may or may not have considered. For each career, indicate how much interest you have in entering that career and how likely you think it is that you could succeed in that career. Circle answers for each career.

	Interest						Likelihood of Success
	None		Some	Much			None		Some		Much
Engineering	1	2	3	4	5		1	2	3		4	5
Art	1	2	3	4	5		1	2	3		4	5
Biological science (research or college teaching)	1	2	3	4	5		1	2	3		4	5
Acting or other work in film or theater	1	2	3	4	5		1	2	3		4	5
Mathematics (research or college teaching)	1	2	3	4	5		1	2	3		4	5
Law	1	2	3	4	5		1	2	3		4	5
Physical science (research or college teaching)	1	2	3	4	5		1	2	3		4	5
Business Executive, Management	1	2	3	4	5		1	2	3		4	5
Physician	1	2	3	4	5		1	2	3		4	5
Sales or marketing	1	2	3	4	5		1	2	3		4	5
Nursing, Physical therapy	1	2	3	4	5		1	2	3		4	5
Secretarial work	1	2	3	4	5		1	2	3		4	5
Pharmacy	1	2	3	4	5		1	2	3		4	5
Modeling	1	2	3	4	5		1	2	3		4	5
Computers	1	2	3	4	5		1	2	3		4	5
Social work	1	2	3	4	5		1	2	3		4	5
Teaching (elementary school)	1	2	3	4	5		1	2	3		4	5
Teaching high school (math/science fields)	1	2	3	4	5		1	2	3		4	5
Teaching high school (other fields)	1	2	3	4	5		1	2	3		4	5

14) Below are a series of statements about scientists and scientific careers. How strongly do you agree or disagree with each statement? Circle an answer for each item.

	Strongly Agree	Somewhat Agree	Uncertain	Somewhat Disagree	Strongly Disagree
There are many good jobs available for people with advanced training in math, science, and engineering.	5	4	3	2	1
In order to have a career in math or science, a student has to be more than "good" in these subjects; she/he must be truly exceptional.	5	4	3	2	1
Men and women are about equally represented in math and science careers.	5	4	3	2	1
Careers in math and science offer high salaries.	5	4	3	2	1
Scientists and engineers work longer hours than most other professionals.	5	4	3	2	1
It is more difficult for women to get ahead in math and science careers than for men.	5	4	3	2	1
People who enter math and science careers tend to be "nerds" who lack social skills.	5	4	3	2	1
Having a career in math or science requires too many years of education.	5	4	3	2	1
Scientists and engineers work mainly alone, with equipment rather than people.	5	4	3	2	1
Girls who are good in math or science are just as popular with boys as other girls are.	5	4	3	2	1
Becoming a scientist is a good way to serve humanity.	5	4	3	2	1
Math and science careers are particularly difficult to combine with raising a family.	5	4	3	2	1
Many scholarships and part-time jobs are available to cover the costs of math/science education beyond college.	5	4	3	2	1
Students who good in math and science get picked on, teased, or ignored by other students.	5	4	3	2	1

The following questions are about your activities last year.

15) Compared to other students in your math class this year, how actively did you participate in class (for example, by raising your hand, answering a question, going to the board, volunteering to do a problem or assist in a demonstration)? Circle one.

1. I was among the most active students in the class.
2. I was more active than most, but less than several others.
3. I was about average.
4. I was less active than most, but more than several others.
5. I was among the least active students in the class.

16) Compared to other students in your science class this year, how actively did you participate in class (for example, by raising your hand, answering a question, going to the board, volunteering to do a problem or assist in a demonstration)? Circle one.

1. I was among the most active students in the class.
2. I was more active than most, but less than several others.
3. I was about average.
4. I was less active than most, but more than several others.
5. I was among the least active students in the class.

17) List any extracurricular school activities you participated in this school year that are related to math, science, computers, or engineering or to careers related to these fields. Indicate any offices you held in relevant clubs or organizations.

1. ______________________________________________________________

2. ______________________________________________________________

3. ______________________________________________________________

4. ______________________________________________________________

5. ______________________________________________________________

18) List any awards or special honors you received related to mathematics, science, or computers this school year.

1. ______________________________________________________________

2. ______________________________________________________________

3. ______________________________________________________________

4. ______________________________________________________________

5. ______________________________________________________________

19) During this school year, how often have you gotten together with other students to study for a test in each of the following subjects? Circle an answer for each subject. If you did not have a class in that subject, cross it out.

How often have you studied with other students?

1. Math	Never	Once or twice	Three or more times
2. Social Studies or History	Never	Once or twice	Three or more times
3. Science	Never	Once or twice	Three or more times
4. English	Never	Once or twice	Three or more times
5. Computers	Never	Once or twice	Three or more times
6. Foreign Language	Never	Once or twice	Three or more times

20). Here is a list of people you might have spoken to about being interested in math- or science related subjects or careers. For each group of people, indicate how often you have spoken to them about such interests. Circle an answer for each group.

How often did you discuss your math/science interests?

Teachers	Never	Once or twice	Three or more times
Guidance counselors	Never	Once or twice	Three or more times
Parents or guardians	Never	Once or twice	Three or more times
Brothers or sisters	Never	Once or twice	Three or more times
School friends	Never	Once or twice	Three or more times
Others not listed	Never	Once or twice	Three or more times

21) Did you pursue any math or science-related activities outside of school this year, such as hobbies, visits to exhibitions or museums, trips to colleges, special programs, or part-time jobs? If so, please list them below.

1. _____________________________________________________________

2. _____________________________________________________________

3. _____________________________________________________________

4. _____________________________________________________________

5. _____________________________________________________________

22) We would like to know a little about your friends. How many of your school or community friends are interested in mathematics, science, or computers? Circle an answer for each set of friends.

Male friends who are interested in mathematics science, or computers	None	One	Two	Three	Four or more
Female friends who are interested in mathematics, science, or computers	None	One	Two	Three	Four or more

23) During the last year, how encouraging or discouraging would you say each of the following have been of your interests in mathematics, science, or computers? Some of the people listed may not be relevant to you. For example, you may not have a stepmother or a guardian. Cross these people off the list. Circle one answer for each of the others.

	Very Encouraging	Somewhat Encouraging	Neutral	Somewhat Discouraging	Very Discouraging
1. Mother	5	4	3	2	1
2. Father	5	4	3	2	1
3. Stepmother	5	4	3	2	1
4. Stepfather	5	4	3	2	1
5. Guardian	5	4	3	2	1
6. Math Teacher	5	4	3	2	1
7. Science Teacher	5	4	3	2	1
8. Computer Teacher	5	4	3	2	1
9. Other Teacher (Subject? _________)	5	4	3	2	1
10. Guidance Counselor	5	4	3	2	1

24) Was there any other family member, friend, or acquaintance who was particularly encouraging or discouraging?  Yes ____  No ____

If yes, who were they and how did they encourage or discourage you?
You may write your answer on the back of this page.