MIT Alumni Survey, February 2014
Name:
Email address:
What role(s) have you had at MIT? Please mark all that apply, including any current affiliation you have with MIT.
 MIT Undergraduate
 MIT Graduate Student
 MIT Postdoctoral Scholar
 MIT Research Staff
 MIT Faculty or Lecturer
 MIT Administrative Staff
 Other affiliation. Please specify ____________________
Do you have any degrees from colleges or universities other than MIT?
___ Yes ___ No
Your Activities
We have a few basic questions about your professional activities.
Yes No
Are you currently employed, including self-employment?
Have you ever started a for-profit company?
Have you ever started a non-profit company or organization? This can include grassroots or political organizations.
Have you ever been an early employee (one of the first 10 employees within the first two years of operation, but not
a founder) of a start-up company or organization?
Do you consider yourself to be an inventor?
Are you the inventor on any patents, including patents on which you were one of several inventors?
Have you ever worked on developing a new product or a new business venture in a company where you were not a
founder?
Are there ways by which you have supported the innovative activities of others?
Yes No
Have you made a direct (equity) investment in a start-up company where you WERE NOT a founder or early
employee? Please include investments where you served as an angel or other investor.
Are you on the board of directors of a privately-held company?
Are you on the board of directors of a public company?
Are you on a scientific advisory board?
Have you participated in “crowd-funding” to support the invention of a new product or service?
Have you made a direct (equity) investment in a start-up where at least one of the founders had an MIT affiliation?
Please do not include companies where you were a founder or early employee.
Have you ever made a "friends and family" contribution in a start-up? Please do not include companies where you
were a founder or early employee.
Have you made a direct (equity) investment in a start-up as a venture capitalist?
Current Employment
Please tell us about your current employment.
Name of company
Current job title
Year you started at company
Select the industry that best describes the work of this company.
 Aerospace and Defense
 Architecture and Urban Planning
 Automotive and Transportation
 Business Services (Advertising, Real Estate, Retail)
 Chemicals and Materials
 Communications, Arts, Entertainment (Sports, Leisure, Media, Film)
 Computer Hardware/Electrical Engineering
 Computer Software (Gaming and Software Development)
 Consulting
 Education - Higher Education (administration, academe)
 Education - K-12
 Energy and Utilities
 Engineering
 Financial Services (Commercial Banking, Insurance)
 Government
 Military
 Health/Medicine
 Industrial and Consumer Manufacturing (Construction, Product Manufacturing, Consumer Products)
 Money Management (Mutual Funds, Private Equity, Hedge Funds and Investment Banking)
 Law
 Non-Profit Agency or NGO
 Pharmaceutics (Biotech, Medical Devices)
 Other ____________________
Is your current job related to your most recent major(s)/program(s) at MIT?
___ Yes ___ No
Are you self-employed in your own business or professional non-group practice?
___ Yes ___ No
Would you consider this a start-up company that was founded in the last 5 years?
___ Yes ___ No
Are you a postdoctoral scholar or member of a faculty?
___ Yes ___ No
Do you work inside or outside the U.S.?
 In U.S. (including Puerto Rico, territories, etc.)
Please specify which state:
 Outside U.S.
Please specify which country:
If you haven’t started a company or organization:
Have you ever seriously considered founding a new company or organization? This can include an incorporated company,
unincorporated business, partnership, informal business, new franchise, or a non-profit organization.
 I have NOT considered founding a new company or organization.
 I have spent A LITTLE time considering founding a new company or organization.
 I have spent SOME time considering founding a new company or organization.
 I have spent A LOT of time considering founding a new company or organization.
For-Profit Companies You Started
If you started any for-profit companies, please list the current location of each company, when it was founded, and if it is still
operating. If the company no longer operates, please list the last location.
Location Location Location
Name of company
City
State
Year
Founded
Country
YYYY
Operating Status
Private
Public
Acquired, Acquired,
Closed
Open
Closed
1
2
3
4
5
6
We'd like to learn a little more about the companies you founded. For any of the items, if you do not have exact figures,
please provide a best guess or estimate, or leave the item blank.
Recent Annual Total For: (please estimate if needed) Fiscal year for totals Industry
Company
Company Revenues
Company Employment
YYYY
1
2
3
4
5
6
Please share which MIT-affiliated individuals (including MIT alumni, students, faculty, and staff) were integral to the launch of
each venture.
MIT affiliates for this venture
Company
1
2
3
4
5
6
Names and Roles
Early Employee of Start-Up
If you started any for-profit companies, please list the current location of each company, when it was founded, and if it is still
operating. If the company no longer operates, please list the last location.
Location Location Location
Name of company
City
State
Year
Founded
Country
YYYY
Operating Status
Private
Public
Acquired, Acquired,
Closed
Open
Closed
1
2
3
4
5
6
We'd like to learn a little more about the companies you founded. For any of the items, if you do not have exact figures,
please provide a best guess or estimate, or leave the item blank.
Recent Annual Total For: (please estimate if needed) Fiscal year for totals Industry
Company
Company Revenues
Company Employment
YYYY
1
2
3
4
5
6
Please share which MIT-affiliated individuals (including MIT alumni, students, faculty, and staff) were integral to the launch of
each venture.
MIT affiliates for this venture
Company
1
2
3
4
5
6
Names and Roles
Non-Profit Organizations You Started
Please list the current location of each organization, when it was founded, and if it is still operating. If the organization no
longer operates, please list the last location.
Location
Location
Location
Year
Operating Status
Were other MIT people
Founded
involved in starting it?
Name of
organization
City
State
Country
YYYY
Open
Closed
Yes
No
1




2




3




4




5




6




We'd like to learn a little more about the organizations you started. For any of the items, if you do not have exact figures,
please provide a best guess or estimate, or leave the item blank.
Recent Annual Total For: (please estimate if needed) Fiscal year for totals Industry
Company
Company Revenues
Company Employment
YYYY
1
2
3
4
5
6
Please share which MIT-affiliated individuals (including MIT alumni, students, faculty, and staff) were integral to the launch of
each venture.
MIT affiliates for this venture
Company
1
2
3
4
5
6
Names and Roles
About You and Your Family
What is the highest degree you have earned?
 Bachelor’s degree (SB, BS, BA)
 Master's degree in the Arts and Sciences (MA, MS)
 MBA
 Other professional master's degree (e.g., MPA, MSW, MSE, MSN, MAT, MPH, MFA)
 Ph.D.
 Medical degree (MD, DO, DDS, DVM)
 Law degree (JD, LLB)
 Other doctoral degree (e.g., EdD, DDiv, ScD, DrPH, DBA)
 Joint degree (e.g., MD/PhD, MBA/JD)
 Other degree or certificate
Where did you earn your highest degree?
 At MIT
 At a university OUTSIDE the United States. Please specify the name of university and the country:
____________________
 At a university other than MIT in the United States. Please specify the name of university and U.S. state:
____________________
Do you have a spouse or partner? ___ Yes ___ No
Do you have children?
___ Yes ___ No
If you have children, please list the birth years of your children. (YYYY)
1st child ________ 2nd child ________ 3rd child ________ 4th child ________ 5th child ________ 6th child ________
What is your current citizenship status?
 U.S. Citizen, since birth
 U.S. Citizen, naturalized. Please specify year you were naturalized (YYYY): ____________________
 Citizen of another country. Please list country of citizenship: ____________________
Do you currently live in the U.S.?
 No
 Yes, living in US with a temporary visa
 Yes, living in US as a permanent resident
Were you a U.S. citizen or permanent resident (held a permanent Visa) when you attended MIT? ___ Yes ___ No
Have you retired from full-time employment? ___ Yes ___ No
Please mark the range below that most closely approximates your total 2013 household income, before taxes.
___ Under $50,000
___ $50,000 - $99,999
___ $100,000 - $149,999
___ $150,000 - $199,999
___ $200,000 - $249,999
___ $250,000 - $499,999
___ $500,000 - $999,999
___ $1,000,000 - $2,999,999
___ Over $3,000,000
What is your estimated net worth (not counting equity in your primary home)?
___ Under $500K
___ $5MM-$9.9MM
___ $500K-$1MM
___ $1MM-$4.9MM
___ $10MM+
Closing Thoughts
MIT is interested in fostering a network of innovators and entrepreneurs. To help us describe this network, we want to know
about innovators to whom you are personally connected. Please list up to five MIT individuals you are personally connected
to that you regard as successful in innovative and/or entrepreneurial activities.
1
2
3
4
5
What could MIT do to better support the innovative activities of MIT students and alumni?
May we follow up with you if we have questions about your responses or future surveys of this type? We hope that you will
be willing to participate in follow-on studies related to your innovative contributions as well as companies you have founded.
 No
 Yes, I am willing to be contacted for follow-on studies. The best email address to reach me is: ____________________