youth with disability tracking systemcourses.cs.washington.edu/projects/sa/altssurvey7-19-1… ·...

UNIVERSITY OF WASHINGTONDO-IT (Disabilities, Opportunities, Internetworking & Technology)

AccessSTEM/AccessComputing/DO-IT Longitudinal Transition Study (ALTS)

DEMOGRAPHICS3. Sex [ ] Male

[ ] Female4. Birth date4a. Is the participant a veteran?

[ ]Yes[ ] No4aa. If Yes, (Please specify Period of Service:___-____)

5. Ethnicity: (indicate all that apply)[ ] African American or Black[ ] American Indian or Alaska Native[ ] Asian American[ ] Pacific Islander[ ] Caucasian or White [ ] Hispanic or Latino[ ] Other5a. Other (please specify): _______________________

6. Primary disability[ ] Amputee – Mobility without Personal Care Attendant [ ] Cerebral Palsy – Mobility without Personal Care Attendant[ ] Hemiparesis – Mobility without Personal Care Attendant [ ] Motor Neuron Disease – Mobility without Personal Care

Attendant [ ] Multiple Sclerosis – Mobility without Personal Care Attendant[ ] Muscular Degenerative Disease – Mobility without Personal

Care Attendant[ ] Orthopedic Conditions (bone or connective tissue) – Mobility

without Personal Care Attendant[ ] Spina Bifida – Mobility without Personal Care Attendant[ ] Spinal cord injury – Mobility without Personal Care Attendant[ ] Traumatic Brain Injury – Mobility without Personal Care

Attendant[ ] Amputee – Mobility with Personal Care Attendant[ ] Cerebral Palsy – Mobility with Personal Care Attendant[ ] Hemiparesis – Mobility with Personal Care Attendant[ ] Motor Neuron Disease – Mobility with Personal Care Attendant[ ] Multiple Sclerosis – Mobility with Personal Care Attendant[ ] Muscular Degenerative Disease – Mobility with Personal Care

Attendant

ALTS Version 3, 7/19/11

[ ] Orthopedic Conditions (bone or connective tissue) – Mobility with Personal Care Attendant

[ ] Spina Bifida – Mobility with Personal Care Attendant[ ] Spinal cord injury – Mobility with Personal Care Attendant[ ] Traumatic Brain Injury – Mobility with Personal Care Attendant[ ] Deaf – Hearing[ ] Hard of Hearing – Hearing[ ] Profound Deafness – Hearing[ ] Blind – Vision[ ] Legal Blind – Vision[ ] Low Vision – Vision[ ] Cardiovascular/Pulmonary – Chronic/Acute Health[ ] Cancer – Chronic/Acute Health[ ] Diabetes – Chronic/Acute Health[ ] Epilepsy/Seizures – Chronic/Acute Health[ ] Organ, Blood, Gastrointestinal, Immune Disorders –

Chronic/Acute Health[ ] Dysgraphia (writing ) – Learning[ ] Dyscalculia (math) – Learning[ ] Dyspraxia (speech) – Learning[ ] Dyslexia (reading) – Learning[ ] Non-verbal Learning Disorder – Learning[ ] ADD – Psycho-social[ ] ADHD – Psycho-social[ ] Aspergers – Psycho-social[ ] Autism – Psycho-social[ ] Brain Injury – Stroke, TBI – Psycho-social[ ] Developmental Disability – Mental Retardation – Psycho-social[ ] Pervasive Developmental Disorder – Psycho-social[ ] Psychiatric – Mental Illness – Psycho-social[ ] Tourette Syndrome – Psycho-social[ ] Speech/Language – Communication Disorder[ ] Other6a. Other (please specify): ______________________________

7. Secondary disability[ ] Amputee – Mobility without Personal Care Attendant [ ] Cerebral Palsy – Mobility without Personal Care Attendant[ ] Hemiparesis – Mobility without Personal Care Attendant [ ] Motor Neuron Disease – Mobility without Personal Care

Attendant [ ] Multiple Sclerosis – Mobility without Personal Care Attendant[ ] Muscular Degenerative Disease – Mobility without Personal

Care Attendant[ ] Orthopedic Conditions (bone or connective tissue) – Mobility

without Personal Care Attendant[ ] Spina Bifida – Mobility without Personal Care Attendant[ ] Spinal cord injury – Mobility without Personal Care Attendant


[ ] Traumatic Brain Injury – Mobility without Personal Care Attendant

[ ] Amputee – Mobility with Personal Care Attendant[ ] Cerebral Palsy – Mobility with Personal Care Attendant[ ] Hemiparesis – Mobility with Personal Care Attendant[ ] Motor Neuron Disease – Mobility with Personal Care Attendant[ ] Multiple Sclerosis – Mobility with Personal Care Attendant[ ] Muscular Degenerative Disease – Mobility with Personal Care

Attendant[ ] Orthopedic Conditions (bone or connective tissue) – Mobility

with Personal Care Attendant[ ] Spina Bifida – Mobility with Personal Care Attendant[ ] Spinal cord injury – Mobility with Personal Care Attendant[ ] Traumatic Brain Injury – Mobility with Personal Care Attendant[ ] Deaf – Hearing[ ] Hard of Hearing – Hearing[ ] Profound Deafness – Hearing[ ] Blind – Vision[ ] Legal Blind – Vision[ ] Low Vision – Vision[ ] Cardiovascular/Pulmonary – Chronic/Acute Health[ ] Cancer – Chronic/Acute Health[ ] Diabetes – Chronic/Acute Health[ ] Epilepsy/Seizures – Chronic/Acute Health[ ] Organ, Blood, Gastrointestinal, Immune Disorders –

Chronic/Acute Health[ ] Dysgraphia (writing ) – Learning[ ] Dyscalculia (math) – Learning[ ] Dyspraxia (speech) – Learning[ ] Dyslexia (reading) – Learning[ ] Non-verbal Learning Disorder – Learning[ ] ADD – Psycho-social[ ] ADHD – Psycho-social[ ] Aspergers – Psycho-social[ ] Autism – Psycho-social[ ] Brain Injury – Stroke, TBI – Psycho-social[ ] Developmental Disability – Mental Retardation – Psycho-social[ ] Pervasive Developmental Disorder – Psycho-social[ ] Psychiatric – Mental Illness – Psycho-social[ ] Tourette Syndrome – Psycho-social[ ] Speech/Language – Communication Disorder[ ] Other7a. Other (please specify): _____________________________

8. Third disability [ ] Amputee – Mobility without Personal Care Attendant [ ] Cerebral Palsy – Mobility without Personal Care Attendant [ ] Hemiparesis – Mobility without Personal Care Attendant


[ ] Motor Neuron Disease – Mobility without Personal Care Attendant

[ ] Multiple Sclerosis – Mobility without Personal Care Attendant

[ ] Muscular Degenerative Disease – Mobility without Personal Care Attendant

[ ] Orthopedic Conditions (bone or connective tissue) – Mobility without Personal Care Attendant

[ ] Spina Bifida – Mobility without Personal Care Attendant [ ] Spinal cord injury – Mobility without Personal Care

Attendant [ ] Traumatic Brain Injury – Mobility without Personal Care

Attendant [ ] Amputee – Mobility with Personal Care Attendant [ ] Cerebral Palsy – Mobility with Personal Care Attendant [ ] Hemiparesis – Mobility with Personal Care Attendant [ ] Motor Neuron Disease – Mobility with Personal Care

Attendant [ ] Multiple Sclerosis – Mobility with Personal Care Attendant [ ] Muscular Degenerative Disease – Mobility with Personal

Care Attendant [ ] Orthopedic Conditions (bone or connective tissue) –

Mobility with Personal Care Attendant [ ] Spina Bifida – Mobility with Personal Care Attendant [ ] Spinal cord injury – Mobility with Personal Care Attendant [ ] Traumatic Brain Injury – Mobility with Personal Care

Attendant [ ] Deaf – Hearing [ ] Hard of Hearing – Hearing [ ] Profound Deafness – Hearing [ ] Blind – Vision [ ] Legal Blind – Vision [ ] Low Vision – Vision [ ] Cardiovascular/Pulmonary – Chronic/Acute Health [ ] Cancer – Chronic/Acute Health [ ] Diabetes – Chronic/Acute Health [ ] Epilepsy/Seizures – Chronic/Acute Health [ ] Organ, Blood, Gastrointestinal, Immune Disorders –

Chronic/Acute Health [ ] Dysgraphia (writing ) – Learning [ ] Dyscalculia (math) – Learning [ ] Dyspraxia (speech) – Learning [ ] Dyslexia (reading) – Learning [ ] Non-verbal Learning Disorder – Learning [ ] ADD – Psycho-social [ ] ADHD – Psycho-social [ ] Aspergers – Psycho-social [ ] Autism – Psycho-social


[ ] Brain Injury – Stroke, TBI – Psycho-social [ ] Developmental Disability – Mental Retardation – Psycho-

social [ ] Pervasive Developmental Disorder – Psycho-social [ ] Psychiatric – Mental Illness – Psycho-social [ ] Tourette Syndrome – Psycho-social [ ] Speech/Language – Communication Disorder [ ] Other8a. Other (please specify): ______________________________

9. Fourth disability [ ] Amputee – Mobility without Personal Care Attendant [ ] Cerebral Palsy – Mobility without Personal Care Attendant [ ] Hemiparesis – Mobility without Personal Care Attendant [ ] Motor Neuron Disease – Mobility without Personal Care

Attendant [ ] Multiple Sclerosis – Mobility without Personal Care

Attendant [ ] Muscular Degenerative Disease – Mobility without Personal


Mobility without Personal Care Attendant [ ] Spina Bifida – Mobility without Personal Care Attendant [ ] Spinal cord injury – Mobility without Personal Care

Attendant [ ] Traumatic Brain Injury – Mobility without Personal Care

Attendant [ ] Amputee – Mobility with Personal Care Attendant [ ] Cerebral Palsy – Mobility with Personal Care Attendant [ ] Hemiparesis – Mobility with Personal Care Attendant [ ] Motor Neuron Disease – Mobility with Personal Care

Attendant [ ] Multiple Sclerosis – Mobility with Personal Care Attendant [ ] Muscular Degenerative Disease – Mobility with Personal


Mobility with Personal Care Attendant [ ] Spina Bifida – Mobility with Personal Care Attendant [ ] Spinal cord injury – Mobility with Personal Care Attendant [ ] Traumatic Brain Injury – Mobility with Personal Care

Attendant [ ] Deaf – Hearing [ ] Hard of Hearing – Hearing [ ] Profound Deafness – Hearing [ ] Blind – Vision [ ] Legal Blind – Vision [ ] Low Vision – Vision [ ] Cardiovascular/Pulmonary – Chronic/Acute Health


[ ] Cancer – Chronic/Acute Health [ ] Diabetes – Chronic/Acute Health [ ] Epilepsy/Seizures – Chronic/Acute Health [ ] Organ, Blood, Gastrointestinal, Immune Disorders –

Chronic/Acute Health [ ] Dysgraphia (writing ) – Learning [ ] Dyscalculia (math) – Learning [ ] Dyspraxia (speech) – Learning [ ] Dyslexia (reading) – Learning [ ] Non-verbal Learning Disorder – Learning [ ] ADD – Psycho-social [ ] ADHD – Psycho-social [ ] Aspergers – Psycho-social [ ] Autism – Psycho-social [ ] Brain Injury – Stroke, TBI – Psycho-social [ ] Developmental Disability – Mental Retardation – Psycho-

social [ ] Pervasive Developmental Disorder – Psycho-social [ ] Psychiatric – Mental Illness – Psycho-social [ ] Tourette Syndrome – Psycho-social [ ] Speech/Language – Communication Disorder [ ] Other9a. Other (please specify): _____________________________

10. Supports used before participation in DO-IT/AccessComputing/Summer Academy activities (Check all that apply)

[ ] Use of a computer [ ] Internet access [ ] Adaptive hardware or software for computer [ ] Aide at school[ ] Extra time on assignments or tests [ ] Texts in alternate formats[ ] Interpreting[ ] Department of Vocational Rehabilitation Services [ ] Support of an adult mentor[ ] Peer group or other students with disabilities[ ] Other10a. Other (please specify): ______________________

11. Academic interest 1 (or favorite course) at the point of entry 12. Academic interest 2 (or favorite course) at the point of entry13. Level of expressed interest in STEM at the point of entry

[ ] Negative interest expressed[ ] No interest expressed[ ] Moderate interest expressed[ ] Strong interest expressed

14. Career goal at the point of entry


15. How did participant hear about this program (choose one)?[ ] Parent/family member[ ] Teachers/educators/counselors[ ] Peers[ ] Mentors[ ] Other activities/projects[ ] Publications[ ] Advocacy groups[ ] Vocational rehabilitation agencies[ ] Other15a. Other (please specify): _______________________

16. Most important reason for participating in DO-IT/AccessComputing/Summer Academy activities (choose one)

[ ] Part of another school activity[ ] Access to technology[ ] Prepare for college[ ] Prepare for career[ ] Social – meeting peers[ ] Mentor support[ ] Other16a. Other (please specify): ______________________

17. Second most important reason for participating in DO-IT/AccessComputing/Summer Academy activities (choose one)

[ ] Part of another school activity[ ] Access to technology[ ] Prepare for college[ ] Prepare for career[ ] Social – meeting peers[ ] Mentor support[ ] Other17a. Other (please specify): _______________________

Comments for Demographics:

INTERVENTIONS18. Year 1st started participating in DO-IT/AccessComputing/Summer Academy activities: ________________19. Status when 1st involved with DO-IT/AccessComputing/Summer Academy:

[ ] Elementary school[ ] Middle school[ ] High school


[ ] Undergraduate[ ] Graduate[ ] Postgraduate[ ] Seeking employment[ ] Other19a. Other (please specify): _______________________

20. Is participant a DO-IT Scholar? [ ] Yes20a. If yes, please indicate the Scholar Year: _______[ ] NoIf no, do not ask/answer question 21.

20.1. Is participant in AccessSTEM?[ ] Yes[ ] No

20.2. Is participant in AccessComputing?[ ] Yes[ ] No

20.3. Is participant in AccessSTEM2?[ ] Yes[ ] No

20.4. Is participant in AccessComputing2?[ ] Yes[ ] No

20.5. Is participant in the Summer Academy Program?[ ] Yes[ ] No

20.6. Is participant in AccessComputing3?[ ] Yes[ ] No

20.7. Is participant in [new DO-IT Project]?[ ] Yes

o [ ] No

INTERVENTIONS - I. Program activities 21. DO-IT Scholar program participation (choose all that apply):

[ ] Phase 1: Internetworking & Mentoring[ ] Phase 1: Summer Study I[ ] Phase 2: Project (indicate type of project below)

[ ] Disability awareness/research


[ ] Career exploration[ ] Computer game or website development

[ ] Other21a. Other (please specify)_______________[ ] Phase 2: Internetworking & Mentoring [ ] Phase 2: Summer Study II[ ] Phase 3/Ambassador: Internetworking & Mentoring[ ] Phase 3/Ambassador: Summer Study Internship

22. Program participation (choose all that apply):22a. Transition to college event or workshop

[ ] Yes[ ] No[ ] How many times__________

22b. Career exploration or preparation event [ ] Yes[ ] No[ ] How many times__________

22c. STEM event or workshop [ ] Yes[ ] No[ ] How many times__________

23a. If the participant is no longer participating in the program, indicate why [ ] Health Limitations[ ] Change in Living Situation[ ] Change in Personal/Educational Goals[ ] Deceased[ ] Other23aa. Other (please specify): ___________________

23b. Indicate the year in which the participant decided to no longer or was unable to participate: ______________

Comments for Program Activities:

INTERVENTIONS - II. Technology Supports 24. Has participant received training in the use of computer hardware/software?

[ ] Yes[ ] No

24a. If yes, was some training provided by DO-IT/AccessComputing/Summer Academy?[ ] Yes[ ] No

25. Has participant received technical support in the use of computer hardware/software?[ ] Yes


[ ] No25a. If yes, was some technical support provided by DO-IT/AccessComputing/Summer Academy?

[ ] Yes[ ] No

26. Was computer equipment provided by DO-IT/AccessComputing/Summer Academy? [ ] Yes[ ] No

27. Does the participant use scanning/reading software with his/her computer? [ ] Yes[ ] No

27a. If yes, was the software provided by DO-IT/AccessComputing/Summer Academy?

[ ] Yes[ ] No

28. Does the participant use word prediction software with his/her computer? [ ] Yes[ ] No


[ ] Yes[ ] No

29. Does the participant use mind mapping/outlining software with his/her computer? [ ] Yes[ ] No


[ ] Yes[ ] No

30. Does the participant use speech recognition software with his/her computer? [ ] Yes[ ] No


[ ] Yes[ ] No

31. Does the participant use screen magnification software with his/her computer?[ ] Yes[ ] No


[ ] Yes[ ] No


32. Does the participant use an alternative keyboard (mini, expanded, on-screen-keyboard, etc.)?

[ ] Yes[ ] No

32a. If yes, was it provided by DO-IT/AccessComputing/Summer Academy? [ ] Yes[ ] No

33. Does the participant use a mouse alternative (trackball, joystick, etc.)? [ ] Yes[ ] No


34. Does the participant use a Braille embosser? [ ] Yes[ ] No


35. Does the participant use a portable digital assistant? Yes No


36. Does the participant use an augmentative communication device?[ ] Yes[ ] No


37. Does the participant use other hardware? [ ] Yes, please specify: _______________ [ ] No


38. Does the participant use other software? [ ] Yes, please specify: _______________ [ ] No



39. Does the participant have regular access to the Internet? [ ] Yes[ ] No

39a. Was Internet access provided by DO-IT/AccessComputing/Summer Academy? [ ] Yes[ ] No

39.1. Does the student use parental or family supports:39.1a. For job or school related tasks (typing, reading, etc.)

[ ] Low[ ] Medium[ ] High[ ] Not applicable

39.1b. For personal care or hygiene[ ] Low[ ] Medium[ ] High[ ] Not applicable

39.1c. Other (please specify): _____________________________[ ] Low[ ] Medium[ ] High

39.2. Level of parental support for participant going to college.[ ] Parents very supportive of participant going to college.[ ] Parents supportive of participant going to college[ ] Parents neutral about participant going to college.[ ] Parents unsupportive of participant going to college.[ ] Parents very unsupportive of participant going to college.

Comments for Technology Supports:

INTERVENTIONS - III. Mentoring 40. Did the participant have access to mentors, including DO-

IT/AccessComputing/Summer Academy staff mentors, through the DO-IT program? If no, please skip to item 42.

[ ] Yes[ ] No

41. Level of communication with DO-IT mentors and DO-IT/AccessComputing/Summer Academy staff?

[ ] Low[ ] Medium[ ] High

42. Level of communication with DO-IT Scholars, Pals, and/or other AccessComputing/Summer Academy participants?

[ ] Low [ ] Medium


[ ] High43. Did the participant participate in any extracurricular STEM professional

organizations, service groups, or clubs?[ ] Yes[ ] No43a. Yes (please specify): _______________________

Comments for Mentoring:

INTERVENTIONS - IV. Internships For each internship, record items #44-54 44. Was (is) the internship developed through DO-IT/AccessComputing/Summer Academy contact?

[ ] Yes[ ] No

45. Job title46. Job responsibilities47. Total hours48. Year in which it was (is) completed/taking place49. Were (are) accommodations used?

[ ] Yes[ ] No

50. If yes, what accommodations were (are) used

51. How were you mentored?[ ] By a co-worker [ ] A supervisor [ ] Was not mentored [ ] Other51a. Other (Please specify): _____________________________

52. Paid? [ ] Yes[ ] No

53a. If paid, hourly wage __________________53b. If paid, salary ____________________53.1. Was salary paid by DO-IT grant or by employer?

[ ] DO-IT grant[ ] Employer

54. Were you asked to return to do another internship?[ ] Yes[ ] No


Comments for Internship:

INTERVENTIONS - V. Other work-based opportunities 55. Has the participant assisted with a DO-IT/AccessComputing/Summer Academy

conference exhibit or information booth?[ ] Yes[ ] No

56. If yes, how many times?57. Has the participant served as a DO-IT/AccessComputing/Summer Academy workshop or lab assistant?

[ ] Yes[ ] No

58. If yes, how many times?59. Has the participant served as a DO-IT/AccessComputing/Summer Academy panelist, co-presenter or presenter?

[ ] Yes[ ] No

60. If yes, how many times?

61. Has the participant participated in mock interviews, resume-writing, or other job preparation workshops?

[ ] Yes[ ] No

62. If yes, how many times?63. Has the participant participated in company tours or visits?

[ ] Yes[ ] No

64. If yes, how many times?65. If yes, what companies?

66. Has the participant participated in any information interviews? [ ] Yes[ ] No

67. If yes, how many times?68. If yes, what industries?

69. Has the participant participated in any job shadows?[ ] Yes[ ] No

70. If yes, how many times?


71. If yes, what careers?

72. Has the participant participated in any other STEM related work experiences?[ ] Yes[ ] No72a. Yes (please specify): _______________________

72.1. Did the student have jobs or internships during college that were related to his/her major area of study?

[ ] Yes[ ] No72.1a. If yes what jobs?

72.2. Did the student have jobs or internships in college in non-major areas?[ ] Yes[ ] No72.2a. If yes what jobs?

Comments for Work-based Opportunities:

EDUCATIONAL OUTCOMES73. List any awards and/or honors related to academic success or extra-curricular activities the participant received.74. Year graduated from high school75. Year first attended college76. Last year attended college77. Did (does) the participant attend a community/junior/technical college?

[ ] Yes[ ] No

78. Major 179. Major 280. Minor81. Did the participant graduate from community/junior/technical college?

[ ] Graduated [ ] Still enrolled[ ] Not enrolled currently[ ] Transferred[ ] Other81a. Transferred (please specify the change) _____________ 81b. Other (please specify) ______________

82. If graduated, what degrees or certificates were earned? 82a. Degree 1 or certificate 1


[ ] A.A. – Associate of Arts[ ] A.S. – Associate of Science[ ] A.A.S. – Associate of Applied ScienceProfessional Technical Programs:

[ ] Accounting[ ] Aeronautical Technology[ ] Apparel Design & Services[ ] Applications Support[ ] Arts Management[ ] Auto Body Collision repair[ ] Automotive Technology[ ] Aviation (airplane) maintenance[ ] Biotechnology[ ] Business Administration (Transfer)[ ] Business Information Technology[ ] Cabinetmaking[ ] Carpentry[ ] Certified Nursing Assistant[ ] Chemical Dependency[ ] Child and Family Studies[ ] Commercial Driver Training[ ] Commercial Photography[ ] Community Health Advocate[ ] Computer Aided Drafting & Design Technology[ ] Computing Technology Programs[ ] Cosmetology[ ] Culinary Arts[ ] Database Design & Administration[ ] Deaf Interpreter Training[ ] Deaf Studies[ ] Diesel and Heavy Equipment Technology[ ] Early Childhood Education[ ] Electronics[ ] Engineering Technology[ ] Graphic Design & Illustration[ ] Graphic Imaging & Printing Technology[ ] Health and Medicine (EMT, Medical & Pharmac[ ] Technicians, Practical Nursing)


[ ] Information Technology[ ] Interpreter Training[ ] Landscape Horticulture[ ] Licensed Practical Nurse[ ] Marine Carpentry[ ] Marine Deck Technology[ ] Marine Engineering Technology[ ] Medical Office Clerk[ ] Network Administration[ ] Network Design & Administration[ ] Network technician[ ] Nursing [ ] Nursing Programs[ ] Occupational Teacher/Trainer Education[ ] Opticianry[ ] Programming[ ] Respiratory Care[ ] Social & Human Services[ ] Software Engineering[ ] Specialty Desserts & Breads[ ] Supervision and Management[ ] Surgical Technology[ ] Teacher Education (Transfer)[ ] Veterinary Assistant[ ] Video Communications[ ] Watch Technology Institute[ ] Web Design[ ] Web Development[ ] Web Media and Technology[ ] Welding Fabrication[ ] Wine Technology[ ] Wireless Communications Technology[ ] Other82aa. Other (please specify) __________________

82aaa. Year for degree or certificate 182b. Degree 2 or certificate 2

[ ] A.A. – Associate of Arts [ ] A.S. – Associate of Science


[ ] A.A.S. – Associate of Applied Science Professional Technical Programs: [ ] Accounting [ ] Aeronautical Technology [ ] Apparel Design & Services [ ] Applications Support [ ] Arts Management [ ] Auto Body Collision repair [ ] Automotive Technology [ ] Aviation (airplane) maintenance [ ] Biotechnology [ ] Business Administration (Transfer) [ ] Business Information Technology [ ] Cabinetmaking [ ] Carpentry [ ] Certified Nursing Assistant [ ] Chemical Dependency [ ] Child and Family Studies [ ] Commercial Driver Training [ ] Commercial Photography [ ] Community Health Advocate [ ] Computer Aided Drafting & Design Technology [ ] Computing Technology Programs [ ] Cosmetology [ ] Culinary Arts [ ] Database Design & Administration [ ] Deaf Interpreter Training [ ] Deaf Studies [ ] Diesel and Heavy Equipment Technology [ ] Early Childhood Education [ ] Electronics [ ] Engineering Technology [ ] Graphic Design & Illustration [ ] Graphic Imaging & Printing Technology [ ] Health and Medicine (EMT, Medical & Pharmac [ ] Technicians, Practical Nursing) [ ] Information Technology [ ] Interpreter Training


[ ] Landscape Horticulture [ ] Licensed Practical Nurse [ ] Marine Carpentry [ ] Marine Deck Technology [ ] Marine Engineering Technology [ ] Medical Office Clerk [ ] Network Administration [ ] Network Design & Administration [ ] Network technician [ ] Nursing [ ] Nursing Programs [ ] Occupational Teacher/Trainer Education [ ] Opticianry [ ] Programming [ ] Respiratory Care [ ] Social & Human Services [ ] Software Engineering [ ] Specialty Desserts & Breads [ ] Supervision and Management [ ] Surgical Technology [ ] Teacher Education (Transfer) [ ] Veterinary Assistant [ ] Video Communications [ ] Watch Technology Institute [ ] Web Design [ ] Web Development [ ] Web Media and Technology [ ] Welding Fabrication [ ] Wine Technology [ ] Wireless Communications Technology [ ] Other82bb. Other (please specify) __________________

82bbb. Year for degree or certificate 2

83. Did (does) the participant attend a 4-year college?[ ] Yes[ ] No

84. Major 1


85. Major 286. Minor

87. Did the participant graduate from a 4-year college?[ ] Graduated [ ] Still enrolled[ ] Not enrolled currently[ ] Transferred[ ] Other87a. Transferred (please specify the change) ______________ 87b. Other (please specify) _________________________

88. If graduated with a degree, what types of degrees were earned? 88a. Degree 1[ ] B.A. – Bachelor of Arts[ ] B.S. – Bachelor of Science[ ] B.A. – Bachelor of Arts in Architectural Studies[ ] B.A. – Bachelor of Arts in Business and Management[ ] B.A. – Bachelor of Arts in Communications[ ] B.A. – Bachelor of Arts in History/Philosophy[ ] B.A. – Bachelor of Arts in Inter-Disciplinary Studies[ ] B.A. – Bachelor of Arts in Multi-Disciplinary Studies[ ] B.A. – Bachelor of Arts in Park and Recreation[ ] B.A. – Bachelor of Arts in Physics and Philosophy[ ] B.A. – Bachelor of Arts in Social Work[ ] B.S. – Bachelor of Science in Applied Mathematics[ ] B.S. – Bachelor of Science in Biology[ ] B.S. – Bachelor of Science in Political Science[ ] B.S. – Bachelor of Science in Psychology[ ] B.S. – Bachelor of Science in Sociology[ ] B.S. – Bachelor of Science in Speech and Hearing Sciences[ ] BASc – Bachelor of Applied Science[ ] BArch – Bachelor of Architecture[ ] BBA – Bachelor of Business Administration[ ] BComm – Bachelor of Commerce[ ] BCompSc – Bachelor of Computer Science[ ] BD – Bachelor of Divinity[ ] BDes – Bachelor of Design (visual design discipline)[ ] BEd – Bachelor of Education[ ] BEng or BE – Bachelor of Engineering[ ] BFA – Bachelor of Fine Arts[ ] BMath – Bachelor of Mathematics[ ] BMus – Bachelor of Music[ ] BPharm – Bachelor of Pharmacy[ ] BSEE – Bachelor of Science in Electrical Engineering[ ] BSF – Bachelor of Science in Forestry[ ] LLB – Bachelor of Laws[ ] Other


88aa. Other (please specify): _________________________88aaa. Year for degree 188b. Degree 2 [ ] B.A. – Bachelor of Arts[ ] B.S. – Bachelor of Science[ ] B.A. – Bachelor of Arts in Architectural Studies[ ] B.A. – Bachelor of Arts in Business and Management[ ] B.A. – Bachelor of Arts in Communications[ ] B.A. – Bachelor of Arts in History/Philosophy[ ] B.A. – Bachelor of Arts in Inter-Disciplinary Studies[ ] B.A. – Bachelor of Arts in Multi-Disciplinary Studies[ ] B.A. – Bachelor of Arts in Park and Recreation[ ] B.A. – Bachelor of Arts in Physics and Philosophy[ ] B.A. – Bachelor of Arts in Social Work[ ] B.S. – Bachelor of Science in Applied Mathematics[ ] B.S. – Bachelor of Science in Biology[ ] B.S. – Bachelor of Science in Political Science[ ] B.S. – Bachelor of Science in Psychology[ ] B.S. – Bachelor of Science in Sociology[ ] B.S. – Bachelor of Science in Speech and Hearing Sciences[ ] BASc – Bachelor of Applied Science[ ] BArch – Bachelor of Architecture[ ] BBA – Bachelor of Business Administration[ ] BComm – Bachelor of Commerce[ ] BCompSc – Bachelor of Computer Science[ ] BD – Bachelor of Divinity[ ] BDes – Bachelor of Design (visual design discipline)[ ] BEd – Bachelor of Education[ ] BEng or BE – Bachelor of Engineering[ ] BFA – Bachelor of Fine Arts[ ] BMath – Bachelor of Mathematics[ ] BMus – Bachelor of Music[ ] BPharm – Bachelor of Pharmacy[ ] BSEE – Bachelor of Science in Electrical Engineering[ ] BSF – Bachelor of Science in Forestry[ ] LLB – Bachelor of Laws[ ] Other88bb. Other (please specify): ____________________________88bbb. Year for degree 2

89. Did (does) the participant attend a graduate school?[ ] Yes[ ] No

90. Major 191. Major 292. Minor


93. Graduated from graduate school?[ ] Graduated [ ] Still enrolled[ ] Not enrolled currently[ ] Transferred[ ] Other93a. Transferred (please specify the change) _____________93b. Other (please specify) ________________

94. If graduated with a degree, what types of degrees were earned? 94a. Degree 1[ ] M.A. - Master of Arts[ ] M.A. – Master in Developmental Psychology[ ] M.S. - Master of Science[ ] MBA - Master of Business Administration[ ] MFA - Master of Fine Arts[ ] MM - Master of Management[ ] MArch - Master of Architecture[ ] LLM - Master of Laws degree[ ] MCP - Microsoft Certified Professional credential[ ] MCRP, M.Pl - Master of Urban Planning, Master of City

Planning, Master of Planning[ ] M.P.A. - The Master of Public Administration[ ] M.P.Aff. - Master of Public Affairs[ ] M.P.H. - Master of Public Health[ ] M.P.M. - Master of Public Management[ ] M.P.P. - The Master of Public Policy[ ] M.S.W. - The Master's Degree in Social Work[ ] MSPT – Master of Science in Physical Therapy[ ] M.I.T. – Master in Teaching[ ] M.Div. - The Master of Divinity[ ] Ph.D. – Doctor of Philosophy-Atmospheric Science[ ] Ph.D. - Doctor of Philosophy-Education[ ] Ph.D. - Doctor of Philosophy-Law[ ] Ph.D. - Doctor of Philosophy-Medicine[ ] Ph.D. - Doctor of Philosophy-Optometry[ ] Ph.D. - Doctor of Philosophy-Osteopathy[ ] Ph.D. - Doctor of Philosophy-Pharmacy[ ] Ph.D. - Doctor of Philosophy-Podiatry[ ] Ph.D. - Doctor of Philosophy-Psychiatrist[ ] Ph.D. - Doctor of Philosophy-Psychology[ ] Ph.D. - Doctor of Philosophy-Veterinary medicine[ ] M.D. - Doctor of Medicine[ ] D.A. - Doctor of Arts[ ] Au.D. – Doctor of Audiology[ ] D.A.S. - Doctor of Applied Science[ ] D.Arch. - Doctor of Architecture[ ] D.B.A. - Doctor of Business Administration


[ ] D.C.J. - Doctor of Criminal Justice[ ] D.C.L. - Doctor of Comparative/Civil Law[ ] D.Chem. - Doctor of Chemistry[ ] D.Crim. - Doctor of Criminology[ ] D.D. - Doctor of Dentistry[ ] D.E.D. - Doctor of Environmental Design[ ] D.E.Sc - Doctor of Engineering Science[ ] D.Eng. - Doctor of Engineering[ ] D.Env. - Doctor of Environment[ ] D.F. - Doctor of Forestry[ ] D.F.A. - Doctor of Fine Arts[ ] D.G.S. - Doctor of Geological Science[ ] D.H.S. - Doctor of Health and Safety[ ] D.I.T. - Doctor of Industrial Technology[ ] D.L.S. - Doctor of Library Science[ ] D.M. - Doctor of Music[ ] D.M.A. - Doctor of Musical Arts[ ] D.M.E. - Doctor of Musical Education[ ] D.M.L. - Doctor of Modern Languages[ ] D.M.Sc. - Doctor of Medical Science[ ] D.Min. - Doctor of Ministry[ ] D.N.Sc. - Doctor of Nursing Science[ ] D.O. - Doctor of Osteopathy[ ] D.P.A. - Doctor of Public Administration[ ] D.P.E. - Doctor of Physical Education[ ] D.P.H. - Doctor of Public Health[ ] D.P.S. - Doctor of Professional Studies[ ] D.R.E. - Doctor of Religious Education[ ] D.Rec./D.R. - Doctor of Recreation[ ] D.S.M. - Doctor of Sacred Music[ ] D.S.Sc. - Doctor of Social Science[ ] D.S.W. - Doctor of Social Work[ ] D.Sc./Sc.D - Doctor of Science[ ] D.Sc.D. - Doctor of Science in Dentistry[ ] D.Sc.H. - Doctor of Science and Hygiene[ ] D.Sc.V.M. - Doctor of Science in Veterinary Medicine[ ] Dr.Des. - Doctor of Design[ ] Ed.D. - Doctor of Education[ ] J.C.D. - Doctor of Canon Law[ ] J.S.D. - Doctor of Juristic Science[ ] L.Sc.D. - Doctor of the Science of Law[ ] Psy.D. - Doctor of Psychology[ ] Rh.D. - Doctor of Rehabilitation[ ] S.J.D. - Doctor of Juridical Science[ ] Th.D. - Doctor of Theology[ ] Other94aa. Other (please specify): __________________________94aaa. Year for degree 1


94b. Degree 2[ ] M.A. - Master of Arts[ ] M.A. – Master in Developmental Psychology[ ] M.S. - Master of Science[ ] MBA - Master of Business Administration[ ] MFA - Master of Fine Arts[ ] MM - Master of Management[ ] MArch - Master of Architecture[ ] LLM - Master of Laws degree[ ] MCP - Microsoft Certified Professional credential[ ] MCRP, M.Pl - Master of Urban Planning, Master of City

Planning, Master of Planning[ ] M.P.A. - The Master of Public Administration[ ] M.P.Aff. - Master of Public Affairs[ ] M.P.H. - Master of Public Health[ ] M.P.M. - Master of Public Management[ ] M.P.P. - The Master of Public Policy[ ] M.S.W. - The Master's Degree in Social Work[ ] MSPT – Master of Science in Physical Therapy[ ] M.I.T. – Master in Teaching[ ] M.Div. - The Master of Divinity[ ] Ph.D. – Doctor of Philosophy-Atmospheric Science[ ] Ph.D. - Doctor of Philosophy-Education[ ] Ph.D. - Doctor of Philosophy-Law[ ] Ph.D. - Doctor of Philosophy-Medicine[ ] Ph.D. - Doctor of Philosophy-Optometry[ ] Ph.D. - Doctor of Philosophy-Osteopathy[ ] Ph.D. - Doctor of Philosophy-Pharmacy[ ] Ph.D. - Doctor of Philosophy-Podiatry[ ] Ph.D. - Doctor of Philosophy-Psychiatrist[ ] Ph.D. - Doctor of Philosophy-Psychology[ ] Ph.D. - Doctor of Philosophy-Veterinary medicine[ ] M.D. - Doctor of Medicine[ ] D.A. - Doctor of Arts[ ] Au.D. – Doctor of Audiology[ ] D.A.S. - Doctor of Applied Science[ ] D.Arch. - Doctor of Architecture[ ] D.B.A. - Doctor of Business Administration[ ] D.C.J. - Doctor of Criminal Justice[ ] D.C.L. - Doctor of Comparative/Civil Law[ ] D.Chem. - Doctor of Chemistry[ ] D.Crim. - Doctor of Criminology[ ] D.D. - Doctor of Dentistry[ ] D.E.D. - Doctor of Environmental Design[ ] D.E.Sc - Doctor of Engineering Science[ ] D.Eng. - Doctor of Engineering[ ] D.Env. - Doctor of Environment[ ] D.F. - Doctor of Forestry


[ ] D.F.A. - Doctor of Fine Arts[ ] D.G.S. - Doctor of Geological Science[ ] D.H.S. - Doctor of Health and Safety[ ] D.I.T. - Doctor of Industrial Technology[ ] D.L.S. - Doctor of Library Science[ ] D.M. - Doctor of Music[ ] D.M.A. - Doctor of Musical Arts[ ] D.M.E. - Doctor of Musical Education[ ] D.M.L. - Doctor of Modern Languages[ ] D.M.Sc. - Doctor of Medical Science[ ] D.Min. - Doctor of Ministry[ ] D.N.Sc. - Doctor of Nursing Science[ ] D.O. - Doctor of Osteopathy[ ] D.P.A. - Doctor of Public Administration[ ] D.P.E. - Doctor of Physical Education[ ] D.P.H. - Doctor of Public Health[ ] D.P.S. - Doctor of Professional Studies[ ] D.R.E. - Doctor of Religious Education[ ] D.Rec./D.R. - Doctor of Recreation[ ] D.S.M. - Doctor of Sacred Music[ ] D.S.Sc. - Doctor of Social Science[ ] D.S.W. - Doctor of Social Work[ ] D.Sc./Sc.D - Doctor of Science[ ] D.Sc.D. - Doctor of Science in Dentistry[ ] D.Sc.H. - Doctor of Science and Hygiene[ ] D.Sc.V.M. - Doctor of Science in Veterinary Medicine[ ] Dr.Des. - Doctor of Design[ ] Ed.D. - Doctor of Education[ ] J.C.D. - Doctor of Canon Law[ ] J.S.D. - Doctor of Juristic Science[ ] L.Sc.D. - Doctor of the Science of Law[ ] Psy.D. - Doctor of Psychology[ ] Rh.D. - Doctor of Rehabilitation[ ] S.J.D. - Doctor of Juridical Science[ ] Th.D. - Doctor of Theology[ ] Other94bb. Other (please specify): __________________________94bbb. Year for degree 2

95. Highest degree completed[ ] Vocational Certification[ ] Associates degree or equivalent[ ] Bachelors degree[ ] Masters degree[ ] Ph.D./J.D./M.D.[ ] Other95a. Other (please specify): _____________


96. Field of study where the highest degree was obtained: __________________ 96a. Year highest degree was obtained97. Years of college completed

[ ] None[ ] Less than or equal to 1 year[ ] 1 – 2 years[ ] 3 – 4 years[ ] 5 – 6 years[ ] More than 6 years

98. College transitions experienced, if any[ ] 2- to 2-year school[ ] 2- to 4-year school[ ] 4- to 2-year school[ ] 4- to 4-year school[ ] Undergraduate program to graduate school[ ] N/A

Comments for Educational Outcomes:

FOLLOW-UP TO CAREER99. Is the participant currently employed?

[ ] Yes[ ] No

99.1 If yes, what is the job related to?[ ] Career goal[ ] Non-career goal

99.1a What type of position is it?[ ] Post-graduate – Fellowship[ ] Post-graduate – Internship[ ] In-school (undergraduate or graduate) – Internship[ ] In-school (undergraduate or graduate) – Externship[ ] In-school (undergraduate or graduate) – Practicum[ ] Other99.1aa Other (please specify): _______________________

100. Did the participant’s position result from an internship?[ ] Yes[ ] No

101. Job title 102. In which field?103. How long have worked at the job:

[ ] 0 – 6 months[ ] 7 – 12 months[ ] 1 – 2 years[ ] Over 2 years


104. Hours per week:[ ] 0 –10[ ] 11 – 20[ ] 21 – 30[ ] 31 – 40[ ] Over 40 hours

105. Wage105a. Hourly (fill in amount) _______________105b. Annual (fill in amount) _______________

106. Are accommodations used at work?[ ] Yes[ ] No106a. If yes, please specify what accommodations: ___________

Comments to Follow-up to Career:

INTERVENTION VALUE107. Have the participant rate the value of any of the following activities in which he/she was involved to his/her preparation for college and careers:

107a. College Transition Workshops and/or Camps[ ] Not valuable[ ] Somewhat valuable[ ] Valuable[ ] Very valuable[ ] Does not apply

107.b Career Transition Workshops and/or Camps[ ] Not valuable[ ] Somewhat valuable[ ] Valuable[ ] Very valuable[ ] Does not apply

107c. Mentoring[ ] Not valuable[ ] Somewhat valuable[ ] Valuable[ ] Very valuable[ ] Does not apply

107d. Internships and other Work-based Learning[ ] Not valuable[ ] Somewhat valuable[ ] Valuable[ ] Very valuable[ ] Does not apply


107e. Access to Computer Technology[ ] Not valuable[ ] Somewhat valuable[ ] Valuable[ ] Very valuable[ ] Does not apply

107f. Other Activities (please specify): ______________________[ ] Not valuable[ ] Somewhat valuable[ ] Valuable[ ] Very valuable[ ] Does not apply

Comments for Intervention Values:


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