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OCR for page 224
APPENDIX B
SURVEY OF EARNED DOCTORATES
(Conducted by the National Research Council under the sponsorship
of the National Science Foundation, the Department of Education,
the National Institutes of Health, and the National Endowment for
the Humanities.)
This annual survey of new recipients of Ph.D. or equivalent
research doctorates in all fields of learning contains information
describing their demographic characteristics, educational background,
graduate training, and postgraduation plans. The source file includes
nearly complete data from all 1958-81 doctorate recipients and partial
information for all 1920-57 doctoral graduates.
224
OCR for page 225
225
SURVEY OF EARNED DOCTORATES
This form is to be retr~inccl t<, the GRADUATE DEAN, for forwarding to ...
Please print or type.
NSF Form 558 1977
OMB No. 99-R0290
Approval Expires June 30, 1979
....... I3o;`r~l on [{uman-Resource Data and Analyses
Commission on Human Resources
National Research Council
~101 Constitution Avenue, Washington, D. C. 20418
A. Name in full: (9~30)
(Last Name) (First Name) (Middle Name)
Cross Reference: Maiden name or former name legally changed !
B. Permanent address through which you could always be reached: (Care of, if applicable) ..
.............................................
(Number)
..............................
(street)
, .......................................... .
(city)
............................. ................................................................................... .. . .. .. . . . .. .
(state) (zip Code) (Or Country if not U.S.)
C. U.S. Social Security Number:-
D. Date of birth: .
(41-45 )
E. Sex:
F. Marital status:
G. Citizenship:
(Month)
1 O Male
1 O Married
O O U.S. native
1 O U.S. naturalized
................ Place of birth:
{Day) (Year) (46~7) (State) (Or Country if not U.S.)
2 O Female
2 O Not married (including widowed, divorced)
2 O Non U.S., Immigrant (Permanent Resident)
3 O Non-U.S., Non-Immigrant (Temporary Resident)
If Non-U.S., indicate country of present citizenship ................................................
H. Racial or ethnic group: (Check all that apply.) ~ng origins in—
.................... (31)
( 32-40 )
(48)
(49)
(50)
(5] -52 )
U U American Indian or Alaskan Native . ~h~i~s of North America and who maintain c'IIt',rnl irlentifir~tinn
through tribal affiliation or community recognition.
1 0 Asian or Pacific Islander . any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent. or
the Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine
Islands, and Samoa.
2 O Black, not of Hispanic Origin . any of the black racial groups of Africa.
3 O White, not of Hispanic Origin . any of the original peoples of Europe, North Africa, or the Middle East.
4 O Hispanic . Mexican, Puerto Rican, Central or South American. or other Spanish culture or origins.
regardless of race.
!. Number of dependents: Do not include yourself. (Dependent = someone receiving' at Act onto Elf of his sir her c''nn~rt from V^~1\
J. U.S. veteran status: 0 O Veteran 1 O On active duty
NEDI*~ l ~~''~ - ~ ~ it,
K. High school last attended:
(School Name) (City) (State)
Year of graduation from high school:
— .
( 53-s5)
~ ~ ~ _ ~ ~ ~ ~ ~ ~ · - - - - ( )
2 0 Non-veteran or not applicable (57)
(60-61)
L. List in the table below all collegiate and graduate institutions you have attended including 2-year colleges. List chronologically, and in-
clude your doctoral institution as the last entry.
Institution Name
.
Major Field I Minor
Degree (if any)
__ .
Use Specialties List Title of
Degree
_—
Number
Gral Ted
Mo vl
_
M. Enter below the title of your doctoral dissertation and the most appropriate classification number and field. If a project report or a musical
or literary composition (not a dissertation) is a degree requirement, please check box. O
Title Classify using Specialties List
Number Name of field
N. Name the department (or interdisciplinary committee, center, institute, etc.) and school or college of the university
which supervised your doctoral program: .............................................................................
(Depa rtment/ l nstitute/ Comm iKee/Program) (School)
O. Name of your dissertation adviser: .....
.......... ..................................................................
(Last Name) (First Name) (Middle initial)
continued on next page
(44)
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226
SURVEY OF EARNED DOCTORATES, Cont.
P. Please enter a "1" beside your primary source of support during graduate study. Enter a "2" beside your secondary source of support dur-
ing graduate study. Check all other sources from which support was received.
58 NSF Fellowship 66 GI Bill 72 Research Assistantship 76 Spouses earnings
59 NSF Traineeship 67 Other Federal support 73 Educational fund of 77 Family contribu-
60 NIH Fellowship (specify) industrial or tions
61 NIH Traineeship 68 Woodrow Wilson Fellowship bossiness firm 7g I oans (NDSL
62 NDEA Fellowship 69_Other U.S. nationalfello~ship 74 Otherinstit~tional direct)
63 Other HEW fiends (specify) 79 Other loans
64 AEC/ERDA (specify) ...................... 80_Other (specify)
Fel lowship 70 _ University Fellowship 75 _ Own earnings ...............
65 NASA Traineeship 71 _Teaching Assistantship
Q. Please check the space which most fully describes your status during the year immediately preceding the doctorate.
0 0 Held fellowship
1 0 Held assistantship
2 0 Held own research grant
3 O Not employed
4 O Part-time employed
5 0 College or university teaching
Full-time 6 0 College or university non-tcaching
Employed in: 7 O Elem. or sec. school teaching
(Other than 8 O Elem. or sec. school non-teaching
0, 1, 2) 9 O Industry or business
(11) 0 Other (specify)
(12) Cl Any other (specify) (9)
R. How many years (full-time equivalent basis) of professional work experience did you have prior to the doctorate? (include assistantships as
professional experience) (1o-t l )
. . .
r POSTGI?ADUATION PENS
::
S. How well defined are your postgraduation plans? V.
0 O Have signed contract or made definite comn~itment
1 0 Am negotiating with a specific organi;cation,
or more than one
2 O Am seeking appointment but have no specific prospects
T.
3 O Other (specify) .....................
What are your immediate postgraduation plans?
0 O Postdoctoral fellowship?
1 O Postdoctoral research associateship?
2 O Traineeship? ,
3 O Other study (specify) J
4 O Employment (other than O. 1, 2, 3) ~ Go to
5 O Military service? ~ Item "V"
6 O Other (specify ) ( ~ 3 ) J
U. If you plan to be on a postdoctoral fellowship, associateship,
traineeship or other study
What will be the field of your postdoctoral study?
Classify using Specialties List.
Number Field
..... (12)
. . . ... . . . . . . . . . . . . . . . . .. . .
What will be the primary source of support?
0 O U.S. Government
1 O College or university
2 O Private foundation
3 O Nonprofit, other than private foundation
4 ~ Other (specify)
· ·(14-16)
............................................... (17)
6 O Unknown
Go to Item "W"
W. What is the name and address of the organization with which you will be associated?
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Name of Organization)
X. Please indicate, by circling the highest grade attained, the education of
If you plan to be employed, enter military service, or other—
What will be the type of employer?
0 0 4-year college or university other than medical school
1 O Medical school
2 O Jr. or community college
3 O Elem. or sec. school
4 O Foreign government
5 O U.S. Federal government
6 O U.S. state government
7 O U.S. local government
8 O Nonprofit organization
9 O Industry or business
( 11 ) O Self-employed
(12) O Other (specify) (ha)
Indicate p~i,''<`ry work activity with "1" in appropriate box;
seco'~`lc~ry, work activity (if any) with "2" in appropriate box.
0 0 Research and development
1 O Teaching
2 O Administration
3 0 Professional services to individuals
5 O Other (specify) (~9-20)
In what field.will you be working?
Please enter number front Specialties List (2~-23)
Go to Item "W"
. . . . . . . . . . . . .. .. .. . . . . . . . . . . . . ... ... .. .. ..
(City, State) (Or Country if not U.S.) (24-29)
your father: none 1 2 3 4 5 6 7 8 9 10 11 12 . 1 2 3 4 MA, MD PhD Postdoctoral (30)
Elementary school High school College Graduate
your mother none 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 MA MD PhD Postdoctoral (31
0 1 2 3 4 5 6 7 8 9 (11)
Signature Date completed
..............
(32-34 )
Representative terms from entire chapter:
earned doctorates
