Appendix B
DATA ELEMENTS OF THE DATA COLLECTION FOR THE SCIENCE, TECHNOLOGY, ENGINEERING, AND MATHEMATICS (S-STEM) PROGRAM
Common Collection Categories 
 
 Question  | 
		
			 
 Staff and Project Participant Characteristics 1  | 
		
			 
 Project Implementation Characteristics2  | 
		
			 
 Project Outputs 3  | 
	
1) Fellow Name: First, Middle Initial, Last  | 
		X  | 
		
			  | 
		
			  | 
	
2) Fellow Date of Birth: Month, Day, Year  | 
		X  | 
		
			  | 
		
			  | 
	
3) Fellow enrolled in CSEMS program leading to following degree: -Associate -Bachelor -Masters -Doctoral  | 
		X  | 
		
			  | 
		
			  | 
	
4) Fellow Permanent Contact Details: -Home Address -Home City -Home State -Home Zip Code  | 
		X  | 
		
			  | 
		
			  | 
	
5) Fellow School Residential Contact Details: -Address -City -State -Zip Code  | 
		X  | 
		
			  | 
		
			  | 
	
6) Fellow Demographic Information: -Hispanic or Latino -Not Hispanic or Latino - Do not wish to provide  | 
		X  | 
		
			  | 
		
			  | 
	
7) Race (Choose one or more response): -American Indian or Alaska Native -Asian -Black or African American -Native Hawaiian or other Pacific Islander -White -Do not wish to provide  | 
		X  | 
		
			  | 
		
			  | 
	
8) Gender(Choose one): -Male -Female - Do not wish to provide  | 
		X  | 
		
			  | 
		
			  | 
	
9) Disability Status (Choose one or more responses): -Hearing Impairment -Visual Impairment -Mobility/Orthopedic Impairment -Learning Disability -None - Do not wish to provide -Other  | 
		X  | 
		
			  | 
		
			  | 
	
10) Fellow Career Goal  | 
		
			  | 
		
			  | 
		X  | 
	
11 ) Fellow Semester GPA  | 
		
			  | 
		
			  | 
		X  | 
	
13) Stipend Amount: Yes/No  | 
		
			  | 
		
			  | 
		X  | 
	
14) Fellow Academic major  | 
		X  | 
		
			  | 
		
			  | 
	
15) Class: -Freshman -Sophomore -Junior -Senior -Grad Student  | 
		X  | 
		
			  | 
		
			  | 
	
13) Fellow Employment: -<20 hours per week ->20 hours per week -none  | 
		
			  | 
		
			  | 
		X  | 
	
14) Fellow Internship: -Paid -Unpaid -None  | 
		
			  | 
		
			  | 
		X  | 
	
15) Fellow Academic Status: -Active -Graduated -Left the program  | 
		X  | 
		
			  | 
		
			  | 
	
1 Elements of these characteristics include: Name, address, date of birth, gender, ethnicity, race, disability status, class, major, grade point average, yearly fellowship or stipend amount, or project role.
2 Elements of these characteristics include: Sources and amount of funds, fellowships, scholarships, traineeships, partnerships, training, research methods.
3 Elements of these characteristics include: research findings, publications, presentations, degrees granted, educational materials.
| File Type | application/msword | 
| File Title | Common | 
| Author | Larry Suter | 
| Last Modified By | kgimbel | 
| File Modified | 2007-11-12 | 
| File Created | 2007-08-08 |