Scholars Survey

The main objective of the Scholars Research Project is to develop a comprehensive up-to-date database of scholars and professionals in education and business. This information will be useful in establishing a network of educators, administrators and professionals, cooperation on joint research projects, identification of candidates for position vacancies at The City University of New York and other educational institutions, and as a reference guide for aspiring students. (This information will be kept confidential and will be used by the Calandra Institute for research purposes.)

Your title: First: Middle Initial: Last:

Street: City: State: Zip:

Phone: Fax:

Web Address: E-mail Address:

1. Highest degree earned:

2. University degree was conferred from:

3. Year degree was conferred:

4. From which department:

5. Professional license/certification:

6. Presently employed by:

7. Years with current employer:

8. Department:

9. Years in current department: 10. Position:

11. Professional Identification (List up to two additional terms that describe your other professional roles, e.g. nurse, engineer)

Professional identification 1:

Professional identification 2:

12. Research Specialization: (List up to two area that best describe your area of specialization)

Research Specialization 1:

Research Specialization 2:

13. Highest administrative/management position:

14. How many professional societies/organizations are you a member of?

15. Which professional society/organization are you most active in:

16. Gender: 17. Birth Year: 19

18. Marital status: 19. Number of children:

20. Racial/ethnic background:

Other:

21. Generation:

22. If married what is the racial/ethnic background of your spouse?

Other:

23. Generation of your spouse:

24. Would you be willing to be contacted again for additional surveys? YES NO

25. May we include you in our National Directory of Scholars? YES NO

26. Will you send your curriculum vitae or resume? YES NO

27. Would you like to receive information on appropriate job vacancies? YES NO

Thank you for your assistance in completing this form.

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