58 Education Adult Self-Report

Attachment 58

Education Adult Self-Report

OMB: 0925-XXXX
Expiration Date: XX/XX/XXXX

Education Adult Self-Report
Estimated time burden: 2 minutes
Item Stem

Responses

Responses2

Now we have some questions about
your education.
At ANY TIME IN THE LAST 3 months
have you attended high school or
college?

1=No, I have not attended in the last 3
months
2=Yes, I am a full-time student
3=Yes, I am a part-time student

What is the highest grade or level of
school you have completed or the
highest degree you have received? If
currently enrolled, mark the previous
grade or highest degree received.

00=No formal schooling
01=1st grade
02=2nd grade
03=3rd grade
04=4th grade
05=5th grade
06=6th grade
07=7th grade
08=8th grade
09=9th grade
10=10th grade
11=11th grade
12=12th grade - No diploma
13=High School Diploma, GED, or
alternative credential
14= Some college credit but less than 1
year of college credit

Associate’s degrees (AA’s) can have
an occupational, technical, or
vocational focus or an academic
focus. Occupational, technical, or
vocational AA’s are awarded in fields
such as nursing and consumer services
and typically provide training for
specific jobs. Academic AA’s are
primarily awarded in liberal arts and
the sciences and are typically sought
by students who intend to transfer
into a bachelor’s degree program.
Would you say your AA degree was…?

0=Occupational, technical or vocational
1=Academic1

15=1 or more years of college, no
degree
16=Associates degree (for
example, AA, AS)
17=Bachelor’s degree (for
example: BA, AB, BS)
18=Master’s degree (for example:
MA, MS, MEng, MEd, MSW, MBA)
19=Professional degree beyond a
Bachelor’s degree (for example:
MD, DDS, DVM, LLB, JD)
20=Doctorate degree (for
example: PhD, EdD)

Public reporting burden for this collection of information is estimated to average 2 1/2 hours per response, including
the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it displays a currently valid OMB control number. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions
for reducing this burden to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD
20892-7974, ATTN: PRA (0925-xxxx*) EXP: (xx/xxxx). Do not return the completed form to this address.

OMB: 0925-XXXX
Expiration Date: XX/XX/XXXX
Not including the credits earned for
the associate’s degree, how many
additional years of college credits
have you completed toward a
bachelor’s degree?

Item Stem

0=No additional credits or less than one
year of additional credits completed
toward a bachelor's degree
1=1 year of credits completed toward a
bachelor's degree
2=2 years of credits completed toward a
bachelor's degree
3=3 or more years of credits completed
toward a bachelor's degree
Responses

Which do you have, a high school
diploma, a GED, or an alternative
credential?

0=High School Diploma
1=GED
2=Alternative credential

Please specify alternative credential.
If unknown, enter unknown:
What was the highest grade in school
that you successfully passed?

00=No formal schooling
01=1st grade
02=2nd grade
03=3rd grade
04=4th grade
05=5th grade
06=6th grade
07=7th grade
08=8th grade
09=9th grade
10=10th grade
11=11th grade
12=12th grade - No diploma

Which best describes the amount of
college credit you have successfully
completed toward a bachelor’s
degree?

1=1 year of credits earned toward a
bachelor’s degree
2=2 years of credits earned toward a
bachelor’s degree
3=3 or more years of credits earned
toward a bachelor’s degree

Which best describes the number of
graduate credits that you have
completed in a master’s degree
program, professional degree program
(for example: MD, DDS, DVM, LLB,
JD), or doctoral degree program (for
example: PhD, EdD)?

0=No credits or less than one year of
credits completed toward a graduate
degree
1=1 year of credits completed toward a
graduate degree
2=2 years of credits completed toward a
graduate degree
3=3 or more years of credits completed
toward a graduate degree

Were these graduate credits earned
in…?

1=A master’s degree program
2=A professional degree program (for
example: MD, DDS, DVM, LLB, JD) or a
doctoral program (for example: PhD, EdD)

Which best describes the number of
graduate credits that you completed
beyond your master’s degree in a
master’s degree program,
professional degree program (for
example: MD, DDS, DVM, LLB, JD), or
doctoral degree program (for
example: PhD, EdD)?

0=No graduate credits or less than one
year of graduate credits completed
beyond a master’s degree
1=One or more years of graduate credits
completed beyond a master’s degree

Responses2

OMB: 0925-XXXX
Expiration Date: XX/XX/XXXX
Were these graduate credits beyond
your master’s degree earned in …

1=Another master’s degree program
2=A professional degree program
3=A doctoral degree program
0=No graduate credits earned beyond a
master’s degree