C.I.R.P. Replacement Survey
DRAFT I
Adapted from ACT Entering Student Survey and College Student Needs Assessment Survey
I
SECTION I- BACKGROUND INFORMATION
A
NAME
a
First:
b
Last:
c
Date of Birth (mm-dd-yyyy):
d
STUDENT ID NUMBER (--)
B
AGE
a
18 or Under
b
19
c
20
d
21
e
22
f
23 to 24
g
26 to 29
h
30 to 39
i
40 to 61
j
62 or Over
C
RACIAL/ETHNIC GROUP
a
African American/Black [Are these the categories Admissions uses?]
b
Asian American
c
Hispanic/Latino
d
International
e
Multi-Racial/Multi-Ethnic
f
Native American/Alaskan
g
Pacific Islander
h
White/Caucasian
i
Decline to respond
j
Other
D
GENDER
a
Male [Are these the categories Admissions uses?]
b
Female
c
Other
E
INDICATE YOUR RESIDENCY CLASSIFICATION AT THIS UNIVERSITY.
a
In-State Student
b
Out-of-State Student
c
International Student (Not a U.S. Citizen)
F
WHAT TYPE OF SCHOOL DID YOU ATTEND PRIOR TO ENTERING THIS UNIVERSITY?
a
High School
b
Vocational/Technical School
c
2-year College (Junior College, Community College, etc.)
d
4-year College or University
e
Other
G WHAT WILL BE YOUR INITIAL ENROLLMENT STATUS AT THIS UNIVERSITY?
a
Full-Time Student (Corvallis)
b
Full-Time Student (Cascades Campus)
c
Full-Time Student (Degree Partnership Program (DPP) Student)
d
Full-Time Student (Extended Campus)
e
Part-Time Student (Corvallis)
f
Part-Time Student (Cascades Campus)
g
Part-Time Student (Degree Partnership Program (DPP) Student)
h
Part-Time Student (Extended Campus)
H
INDICATE YOUR OVERALL HIGH SCHOOL GRADE AVERAGE.
a
to A (3.50-4.00)
b
B to A- (3.00-3.49)
c
to B (2.50-2.99)
d
C to B-(2.00-2.49)
e
to C (1.50-1.99)
f
D to C- (1.00 to 1.49)
g
Below D (0.00 to .99)
h
Does Not Apply
I
INDICATE THE NUMBER OF STUDENTS IN YOUR HIGH SCHOOL GRADUATING CLASS.
a
Fewer Than 25
b
25-99
c
100-199
d
200-399
e
400-599
f
600-799
g
800-999
h
1000 or over
J
INDICATE YOUR PLANNED UNIVERSITY RESIDENCE.
a
University Residence Hall
1
II
b
University Cooperative House
c
Fraternity or Sorority House
d
Student Family Housing
e
Off-Campus Room or Apartment
f
Home of Parents or Families
g
Home I own
h
Other
i
Undecided
K
APPROXIMATELY HOW MANY HOURS PER WEEK WILL YOU BE EMPLOYED DURING YOUR FIRST TERM AT THIS
UNIVERSITY?
a
0 or Only Occasional Jobs
b
1 to 10
c
11 to 20
d
21 to 30
e
31 to 40
f
Over 40
g
Undecided
SECTION II – EDUCATIONAL PLANS AND PREFERENCES
Please respond to the following questions about your postsecondary educational plans and needs
A
INDICATE WHETHER EACH OF THE FOLLOWING WAS A MAJOR REASON, A MINOR REASON, OR NOT A REASON THAT
YOU DECIDED TO CONTINUE YOUR EDUCATION AFTER HIGH SCHOOL
Major Reason for Continuing My Education
Minor Reason for Continuing My Education
Not a Reason for Continuing My Education
a
To Meet Educational Requirements for my Chosen Occupation
b
To Become a Better-Educated Person
c
To Increase My Earning Power
d
To Qualify for a High-Level Occupation
e
To Develop Independence from My Parents/Relatives
f
To Be with Friends Who Attend or Will Attend University
g
To Develop My Mind and Intellectual Abilities
h
To Study New and Different Subjects
i
To Develop Personal Maturity
j
To Meet New and Interesting People
k
To Become a More Cultured Person
l
To Find a Life Partner/Significant Other
m To Develop and Use My Athletic Skills
n
To Take Part in the Social Life Offered at College
o
Parents and/or Relatives Wanted Me to Continue My Education
p
High School Teachers and/or Counselors Suggested that I Continue My Education
q
Couldn’t Find Anything Better to Do at this Time
B
INDICATE WHETHER EACH OF THE FOLLOWING WILL BE A MAJOR SOURCE, A MINOR SOURCE, OR NOT A SOURCE OF
FUNDING FOR YOUR POSTSECONDARY EDUCATION
Major Source of Funds
Minor Source of Funds
Not a Source of Funds
a
Parents or Families
b
Social Security Benefits
c
Veteran’s Benefits
d
Life Partner’s/Significant Other’s Income
e
Educational Grants (Pell Grants, FSEOG, Private Grants, etc.)
f
Scholarships (Private, Federal, University, etc)
g
Student Loans (Perkins Loan, Federal Direct Loan, etc.)
h
Other Loans (Bank Loans, etc.)
i
Employment While Attending College (including Work-Study)
j
Summer Employment
k
Personal Savings
C
FOR WHAT PURPOSE DID YOU ENROLL AT THIS PARTICULAR UNIVERSITY? (SELECT ONLY ONE.)
a
No Definite Purpose in Mind
b
To Take a Few Job-Related Courses
c
To Take a Few Courses for Self-Improvement
d
To Take a Courses Necessary for Transferring to Another College/University
e
To Obtain a Bachelor’s Degree
f
To Obtain a Master’s Degree
g
To Obtain a Doctorate or Professional Degree
D
WHICH OF THE FOLLOWING TYPES OF CLASSES DO YOU MOST PREFER TO ATTEND? (SELECT ONLY ONE.)
a
Morning Classes
b
Afternoon Classes
c
Evening Classes
d
Weekend Classes
e
Online Classes
f
No Preference
E
WHICH TYPE OF CLASS FORMAT DO YOU LEARN BEST? (SELECT ONLY ONE.)
a
Lecture Format
b
Small-Group Format
c
Independent Study Format (Self-Paced Study)
2
d
Laboratory Format (with Hands-On Experience)
e
One-on-One Format
f
Online Course Format
g
Other Format
h
No Preference
F
INDICATE THE EXTRACURRICULAR ACTIVITIES IN WHICH YOU WOULD LIKE TO PARTICIPATE WHILE ATTENDING THIS
UNIVERSITY. (PLEASE RESPOND TO EACH ITEM.)
Would Like to Participate in this Activity
Would Not Like to Participate in this Activity
a
Student Government
b
Student Publications (Newspaper, Yearbook)
c
Music Performance (Vocal, Instrument)
d
Debate
e
Drama, Theater
f
Academic Clubs
g
Religious Organizations
h
Cultural Organizations
i
Varsity Athletics
j
Political Organizations
k
Student Radio or T.V.
l
Fraternity or Sorority
m Special Interest Groups (Sailing Club, Dance Club, Judo Club, etc.)
n
Campus or Community Service Organizations
Using the List of Majors and Occupational Choices included with this questionnaire [Get from Admissions and ACT], please select the threedigit codes for your planned college major and your occupational choice. Write these codes in the boxes at the top of blocks “X” and “Y” and
fill in the appropriate circle in the column below each box. (If you have more than one planned college major, select the one that best
describes your educational program.)
G INDICATE YOUR PLANNED UNIVERSITY MAJOR
a
 [Does Admissions have these already?]
H
INDICATE YOUR OCCUPATIONAL CHOICE
a
 [Does Admissions have these already?]
III
Section III – College Impressions
Indicate your impressions of this university by responding to the following questions.
A
HOW IMPORTANT WAS EACH OF THE FOLLOWING IN YOUR DECISION TO ATTEND THIS UNIVERSITY?
Very Important
Moderately Important
Slightly Important
Not Important
a
Academic Reputation of University
b
Availability of a Particular Program of Study
c
Variety of Courses Offered
d
Location of the University
e
Size of the University
f
Entrance Requirements for the University
g
Cost of Attending the University
h
Type of Community in Which the University is Located
i
Availability of Financial Aid or Scholarship
j
Opportunity for Part-Time Work
k
Sports Opportunities (Varsity Athletics)
l
Social Climate and Activities at the University
m Racial/Ethnic Makeup of the University
n
Male/Female Ratio of the Student Body
o
Type of Housing Available
p
Facilities Available (Laboratories, Classroom Facilities, Recreational Areas, etc.)
q
Extracurricular Activities Available (Drama, Intramural Athletics, Music Programs, etc.)
r
Friends Attend (or Plan to Attend) the University
s
Advice of Parents or Families
t
Advice of High School Counselors or Teachers
u
Advice of Someone Who Has Attended the University
v
Contact(s) with University Representatives
B
INDICATE YOUR LEVEL OF AGREEMENT WITH EACH STATEMENT ABOUT THIS UNIVERSITY.
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Don’t Know/Doesn’t Apply
a
This university has high-quality academic programs.
b
The cost of attending this university is reasonable.
c
University personnel care about individual students?
d
It is difficult to earn good grades at this university?
e
This university has a high-quality program in the subject area I plan to pursue.
f
I will be physically safe at this university
g
This university has many activities and organizations for students.
h
This university has a strong intercollegiate athletic program.
i
There are a large number and variety of courses and programs offered at this university.
3
C
D
E
j
Students at this university are friendly.
k
This university has too many required courses. [Like to take out unless compelling reason to keep]
l
There are excellent recreational facilities for individual student use.
m Many students at this university use drugs and/or alcohol.
n
There are comfortable residences halls at this university.
o
Students from various racial and ethnic backgrounds get along well at this university.
p
There are many students at this university who hold extreme political views.
q
Many students at this university are more interested in having fun than in studying.
r
This university offers many cultural events and programs.
s
Students must be above average to be admitted to this university.
t
There are too many rules and regulations at this university. . [Like to take out unless compelling reason to keep]
u
This university has high-quality classroom and laboratory facilities.
v
This university provides sufficient financial aid for students who need assistance.
w
The foreign language requirement to gain admission to this university is too strict.
x
This university offers many job-oriented courses. . [Like to take out unless compelling reason to keep]
INDICATE YOUR RATING OF THIS UNIVERSITY AT THE TIME YOU APPLIED FOR ADMISSION.
a
It was my first choice.
b
It was my second choice.
c
It was my third choice.
d
It was my fourth choice or lower.
WHEN DID YOU MAKE THE DECISION TO ATTEND THIS UNIVERSITY?
a
Before the 9th grade
b
During the 9th grade
c
During the 10th grade
d
During the 11th grade
e
During the 12th grade
f
After completing High School
INDICATE WHETHER EACH OF THE FOLLOWING WAS A MAJOR SOURCE, A MINOR SOURCE, OR NOT A SOURCE OF
YOUR INFORMATION ABOUT THIS UNIVERSITY.
Major Source of Information
Minor Source of Information
Not a Source of Information
a
Friends at the University
b
High School Teachers
c
High School Counselors
d
High School Administrators (Principals, etc.)
e
Parents or Families
f
High School Classmates
g
University Catalog
h
University Brochure or Pamphlet
i
University Alumni
j
Visit(s) to Campus
k
University Representative’s Visit to High School (College Nights, etc.)
l
Announcements on Radio or Television
m Articles in Newspapers or Magazines
n
High School Library Materials
o
University Website
IV Section VI – Career and Life Goals
A
B
HOW IMPORTANT IS IT TO YOU TO ACCOMPLISH EACH OF THE FOLLOWING CAREER AND LIFE GOALS?
Very Important
Moderately Important
Somewhat Important
Not Important
a
To have a steady, secure job
b
To develop my leadership skills
c
To be recognized as an “expert” by colleagues in my field of study
d
To create or perform artistic or literary works (writing, painting, acting, music performance, etc.)
e
To make a theoretical or practical contribution to science
f
To own or operate my own business
g
To be active in politics
h
To be active in my community (civic organizations, programs, etc.)
i
To make a lot of money
j
To be married or involved in a long-term personal relationship
k
To be a parent
l
To meet new and interesting people
m To travel and see new places
n
To be physically fit
o
To be self-reliant
p
To be well liked and accepted
q
To have the leisure time to explore my own interests
r
To practice my religious/spiritual beliefs
s
To help others who are in need
t
To be a life-long (continuous) learner
INDICATE TO WHAT DEGREE YOU EXPECT THIS UNIVERSITY TO ASSIST YOU IN ACCOMPLISHING EACH OF THE
FOLLOWING CAREER AND LIFE GOALS?
High Expectation
4
C
V
Moderate Expectation
Low Expectation
No Expectation
a
To have a steady, secure job
b
To develop my leadership skills
c
To be recognized as an “expert” by colleagues in my field of study
d
To create or perform artistic or literary works (writing, painting, acting, music performance, etc.)
e
To make a theoretical or practical contribution to science
f
To own or operate my own business
g
To be active in politics
h
To be active in my community (civic organizations, programs, etc.)
i
To make a lot of money
j
To be married or involved in a long-term personal relationship
k
To be a parent
l
To meet new and interesting people
m To travel and see new places
n
To be physically fit
o
To be self-reliant
p
To be well liked and accepted
q
To have the leisure time to explore my own interests
r
To practice my religious/spiritual beliefs
s
To help others who are in need
INDICATE WHEN YOU WANT TO ACCOMPLISH EACH OF THE FOLLOWING CAREER AND LIFE GOALS?
During College
Immediately after College
Sometime During my Life
This is not a career or life goal for me
a
To have a steady, secure job
b
To develop my leadership skills
c
To be recognized as an “expert” by colleagues in my field of study
d
To create or perform artistic or literary works (writing, painting, acting, music performance, etc.)
e
To make a theoretical or practical contribution to science
f
To own or operate my own business
g
To be active in politics
h
To be active in my community (civic organizations, programs, etc.)
i
To make a lot of money
j
To be married or involved in a long-term personal relationship
k
To be a parent
l
To meet new and interesting people
m To travel and see new places
n
To be physically fit
o
To be self-reliant
p
To be well liked and accepted
q
To have the leisure time to explore my own interests
r
To practice my religious/spiritual beliefs
s
To help others who are in need
SECTION V – EDUCATIONAL AND PERSONAL NEEDS
A
INDICATE HOW MUCH HELP YOU NEED IN EACH OF THE FOLLOWING EDUCATIONAL AND PERSONAL AREAS BY
FILLING IN THE APPROPRIATE CIRCLE FOR EACH ITEM. MARK ONLY ONE CIRCLE FOR EACH ITEM.
I need a lot of help in this area.
I need a moderate amount of help in this area.
I need a little help in this area.
I need no help in this area.
This does not apply to me.
Career Development
a
Deciding what to do with my life
b
Identifying career areas that fit my current skills, abilities, and interests.
c
Learning about job opportunities in my career area of interest.
d
Learning more about the educational requirements or training necessary for jobs of interest to me. . [Like to take out
unless compelling reason to keep]
e
Arranging to discuss my career interests with people employed in my planned career area. . [Like to take out unless
compelling reason to keep]
f
Obtaining work experience in career areas of interest to me.
g
Developing effective job seeking skills (i.e. interviewing, résumé writing etc.)
Educational Planning
h
Selecting/changing my major area of study.
i
Selecting courses necessary to complete my educational program.
j
Learning how to get course credit through nontraditional means (i.e. internship).
k
Getting counseling/advice about my educational plants.
l
Obtaining tutorial assistance.
m Coping with academic difficulties (i.e. poor grades).
n
Obtaining adequate funds to finance the education.
o
Learning more about other sources of financial assistance available at this university (i.e. grants, scholarships and loans).
p
Obtaining employment (i.e. work-study, assistantships, off-campus employment etc.) while in school.
q
Learning about educational opportunities after graduation (i.e., professional school graduate school, etc.)
r
Obtaining information about social activities at this institution. . [Like to take out unless compelling reason to keep]
5
s
Obtaining special services for personal physical, mental, and learning disabilities.
t
Obtaining child care services.
u
Securing transportation to and from campus( i.e. carpooling mass transit etc.)
Intellectual Skills Development
v
Increasing my skills in mathematics.
w
Expressing my ideas in writing.
x
Developing my public speaking ability.
y
Improving my understanding of what I read.
z
Increasing my reading speed.
aa Improving my study skills and habits.
bb Improving my test taking skills.
cc Improving our problem-solving abilities and reasoning skills.
dd Increasing my understanding of art, literature and other cultural aspects of society.
ee Understanding and using computers.
ff
Learning how to make better use of library resources (i.e. accessing information technologies).
Life Skills Development
gg Identifying my strengths, abilities and limitations.
hh Developing personal values and a philosophy of life.
ii
Learning how to handle stress and anxiety in my life.
jj
Finding the reliable information I need to make decisions or solve problems
kk Expressing my own views and opinions.
ll
Understanding my spiritual/religious beliefs.
mm Developing and demonstrating confidence in myself.
nn Learning how to make decisions effectively.
oo Learning how to solve personal problems.
pp Becoming more self-reliant.
qq Learning how to work effectively on my own.
rr
Managing my time more effectively.
ss Learning how to budget and spend my money wisely (i.e. credit card use).
tt
Learning how to maintain good physical and mental health
uu Understanding my rights responsibilities as a student
Personal Development
vv Developing my leadership skills.
ww Learning how to work effectively with my academic advisor.
xx Learning how to better communicate with instructors.
yy Learning how to get along better with people whom I live/work
zz Getting my family/parents interested in my education career.
aaa Learning how to live and work with others who have values and goals different from mine.
bbb Learning how to deal effectively with community problems and issues.
ccc Learning how to participate in governmental activities.
ddd Coping with discrimination because of my age, race, sex, etc.
eee Dealing with the conflicts of job, family, and education
SECTION VI – OPEN ENDED RESPONSES
1.
Please describe the family/parent support you have for your academic pursuits.
OTHER:
How frequently to you visit your home away from college?
1. Less than once a month
2. Once a month
3. Twice a month
4. Three times a month
5. Four times a month
6. More than four times a month
NOTE:
▪
▪
▪
▪
▪
▪
▪
▪
Check with Ellen Taylor and Tracy Bentley-Towlin regarding mental health question(s).
Check with Anne-Marie regarding information technology question(s). SEE ABOVE IN ORANGE
Check with Kerry and the Academic Advisors Council (AAC) regarding advising question(s).
Check with Tom regarding taking two questions out of career services.
Check with Emilio regarding financial aid question(s).
Check with Michelle regarding admissions university perception questions and definitions (e.g. what do they use for gender, ethnicity, major
and occupational codes).
Check with Student Affairs Assessment Council regarding all questions.
Check with Melody regarding university perception questions.
6