NSHE Sponsored Projects Office - Demographic Data Collection

Fields designated with * are required


*First Name:
Middle Initial:
*Last Name:
*Institution:
Address:
Address 2:
City:
State:
Zip:
Telephone:
*Email:

*Current Position:


 Faculty
Doctoral Student
Undergraduate Student
Technician
Post Doctoral Student
Master's Student
Secretary, Administrative Support
Other (specify)
Highest Degree Obtained: High School
Associate's
Bachelor's
Master's
Doctoral
   

Demographic Data
(Submission of demographic data is voluntary. However, your participation will help the funding agency assure the statistical validity of the data collected.)
 
Gender: Male Female
Ethnicity:  Hispanic/Latino Not Hispanic/Latino
Race: American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
Citizenship: U.S. Citizen Non U.S. Citizen
Non-U.S. Citizens only:  
Permanent Resident Status in the United States:

Yes No
If not a permanent resident, Country of Citizenship:
Disabled: Yes No
   

Funding Information
Are you currently receiving funding from:
(check all that apply)		 The National Science Foundation (non-EPSCoR)
The National Science Foundation EPSCoR
The National Aeronautical & Space Administration(non-EPSCoR)
The National Aeronautical & Space Administration Space Grant
The National Aeronautical and Space Administration EPSCoR
The Department of Energy (non-EPSCoR)
The Department of Energy EPSCoR
The Department of Defense (non-EPSCoR)
The Department of Defense EPSCoR
The National Institutes of Health(non-IDeA, non-BRIN)
The National Institutes of Health BRIN
The Environmental Protection Agency (non-EPSCoR)
The Environmental Protection Agency EPSCoR
Comments?
  I have provided the required information (*) as requested above, but elect to opt out of providing any additional data
 
   

 

 

If you would prefer to provide the required information in hard copy, you may download the form and mail to:

System Sponsored
Projects Office
755 E. Flamingo Dr.
Las Vegas, NV 89119-7363

If you experience technical problems with the form, or have questions about the data you are providing, please contact us at (702)862-5590.

In order that we may accurately report your current publications, please email the Sponsored Projects Office an attached copy of your current CV. Thank you for your cooperation.