Download:
pdf |
pdfOMB # 0925-XXXX
Expiration Date: XX/XXXX
STEP-UP Feedback Form
Public reporting burden for this collection of information is estimated to average 30 minutes 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*). Do not return
the completed form to this address.
2015 STEP-UP High School Feedback Form
Congratulations on your participation in the 2015 High School STEP-UP Program.
Now that the 2015 High School STEP-UP is over, we would love to gather feedback from you on the quality of the scientific
research symposium and your overall level of satisfaction with the program. Your response to the survey is completely
confidential and voluntary. In the event of any presentation resulting from the survey, no personally identifiable information
will be shared. If you are interested in providing additional feedback regarding your experience, please e-mail us at
niddkstepup@mail.nih.gov .
1
2015 STEP-UP High School Feedback Form
2
* 1. Please rate the quality of the components of the Scientific Research Symposium.
Poor
Fair
Good
Very Good
Excellent
Not Applicable
Overall
Washington, DC Tour
Giving a Scientific
Talk: Dr. Bonnie
Halpern-Felsher
Oral Presentations
Poster Presentations
Career Development:
Dr. Teresa Ramirez
Social Networking
Activity - Dancing &
Jeopardy
Plenary Lecture: Dr.
Robin Broughton
Lunch with a
Researcher
Pearls of Wisdom for
Getting into College:
Dr. Bonnie HalpernFelsher
Strategies for Success
with Seniors: Dolores
Caffey-Fleming
Scientific Career
Research Panel
Career Development:
Dr. Sharon Milgram
Feedback from Judges
Other (please specify)
* 2. What could we do to improve future Scientific Research Symposiums?
3
* 3. What other topic(s) would you like to learn about or discuss at the Scientific Research
Symposium that were not covered?
* 4. What part of Scientific Research Symposium should be removed in future years?
* 5. Overall how satisfied are you with aspects of the STEP-UP Program?
Very Dissatisfied
Dissatisfied
Satisfied
Very Satisfied
Not Applicable
Overall
The application
process
Communication with
NIDDK Program Office
The Mentor-Mentee
matching process
Your interaction with
your research mentor
The interaction with
other staff in your
research lab
Your area of research
Research topic
Your level of
communication with
your coordinating
center
The instruction and
guidance given to you
to successfully
complete the program
requirements
4
* 6. What coordinating center were you part of?
Charles Drew University
Stanford University
University of Hawaii at Manoa
University of Nevada, Los Vegas
* 7. Please provide suggestions to improve communication with your coordinating center.
* 8. Please provide suggestion to improve the program.
* 9. After completing the STEP-UP Program how likely are you to pursue the following:
Extreme Unlikely
Unlikely
Undecided
Likely
Extremely Likely
Apply to the 2016
STEP-UP Program
Consider pursuing a
career in biomedical
research
Major in a Science,
Technology,
Engineering or Math
(STEM) related field at
college
Encourage friends to
apply in the STEP-UP
Program
Participate in research
in the future
* 10. Help us to make STEP-UP better. Please provide any additional comments or recommendations.
5
* 11. Help us with outreach, what would you tell a friend about your STEP-UP experience?
* 12. Please describe what your academic status will be in the Fall 2015. (Select one)
Senior
College Freshman
* 13. How many times have you participated in the STEP-UP program? (Select one)
Once
Twice
* 14. How would you describe your gender? (Select one)
Male
Female
Prefer not to answer
* 15. Please describe your race. (Allow for user to select more than one)
African American/Black
American Indian/Alaska Native
Asian
Native Hawaiian/Pacific Islander
White
* 16. Are you Hispanic or Latino?
Yes
No
6
2015 STEP-UP High School Feedback Form
Thank you! Your input will help to improve the future of the Short-Term Research Experience for
Underrepresented Persons (STEP-UP) program.
If you have any further questions, please e-mail us at niddkstepup@mail.nih.gov, or visit our website at
https://stepup.niddk.nih.gov/.
7
OMB # 0925-XXXX
Expiration Date: XX/XXXX
STEP-UP Feedback Form
Public reporting burden for this collection of information is estimated to average 30 minutes 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*). Do not return
the completed form to this address.
2015 STEP-UP Undergraduate Feedback Form
Congratulations on your participation in the 2015 Undergraduate STEP-UP Program!
Now that the 2015 Undergraduate STEP-UP Scientific Research Symposium is over, we would love to gather feedback from
you on the quality of the scientific research symposium and your overall level of satisfaction with the program. Your response
to the survey is completely confidential and voluntary. In the event of any presentation resulting from the survey, no
personally identifiable information will be shared. If you are interested in providing additional feedback regarding your
experience, please contact us at stepupniddk@mail.nih.gov.
1
2015 STEP-UP Undergraduate Feedback Form
* 1. Please rate the quality of the components of the Scientific Research Symposium.
Poor
Fair
Good
Very Good
Excellent
Not Applicable
Overall
Oral Presentations
Poster Presentations
Opening Plenary –
Erica Richards, M.D.,
Ph.D.
Career Development –
Ed Ramos, Ph.D.
Career Roundtables
Feedback from Judges
Other (please specify)
* 2. What could we do to improve future Scientific Research Symposiums?
2
* 3. What other topic(s) would you like to learn about or discuss at the Scientific Research
Symposium that were not covered?
* 4. What part of Scientific Research Symposium should be removed in future years?
* 5. What coordinating center were you part of?
American Physiological Society
Children’s Hospital Los Angeles
Pennsylvania State University, Hershey
3
* 6. Overall how satisfied are you with aspects of the STEP-UP Program?
Very Dissatisfied
Dissatisfied
Satisfied
Very Satisfied
Not Applicable
Overall
The application
process
Communication with
NIDDK Program Office
The Mentor-Mentee
matching process
Your interaction with
your research mentor
The interaction with
other staff in your
research lab
Your area of research
Research topic
Your level of
communication with
your coordinating
center
The instruction and
guidance given to you
to successfully
complete the program
requirements
* 7. Please provide suggestions to improve communication with your coordinating center.
4
* 8. Please provide suggestion to improve the program.
* 9. After completing the STEP-UP Program how likely are you to pursue the following:
Extreme Unlikely
Unlikely
Undecided
Likely
Extremely Likely
Apply to the 2016
STEP-UP Program
Consider pursuing a
career in biomedical
research
Apply to Graduate
School in a Science,
Technology,
Engineering or Math
related discipline
Apply to Professional
School (Medical,
Dentistry, or
Veterinarian)
Encourage friends to
apply in the STEP-UP
Program
Participate in research
in the future
* 10. Help us to make STEP-UP better. Please provide any additional comments or recommendations.
5
* 11. Help us with outreach, what would you tell a friend about your STEP-UP experience?
* 12. Please describe what your academic status will be in the Fall 2015. (Select one)
Sophomore
Junior
Senior
Graduated recently
* 13. How many times have you participated in the STEP-UP program? (Select one)
Once
Twice
Three
* 14. How would you describe your gender? (Select one)
Male
Female
Prefer not to answer
* 15. Please describe your race. (Allow for user to select more than one)
African American/Black
American Indian/Alaska Native
Asian
Native Hawaiian/Pacific Islander
White
Other (please specify)
6
* 16. Are you Hispanic or Latino?
Yes
No
17. Have you been diagnosed with a disability that substantially limits one or more major life
activities?
Yes
No
Prefer Not to Answer
7
2015 STEP-UP Undergraduate Feedback Form
Thank you! Your input will help to improve the future of the Short-Term Research Experience for
Underrepresented Persons (STEP-UP) program.
If you have any further questions, please email us at niddkstepup@mail.nih.gov, or visit our website at
https://stepup.niddk.nih.gov/.
8
| File Type | application/pdf |
| File Modified | 2016-06-06 |
| File Created | 2016-06-06 |