MSN Demographic Survey (C)

Thank you for taking this short survey. The results will provide the UMSL College of Nursing with essential information about our graduate students that is required for federal grants, such as our application for nursing traineeships, which are beneficial to many of you.

We are asking for this information from you at this time because of a change in the regulations for training grants passed by the United States Congress.

Your responses will never be reported to anyone on the individual level; they will only be used to describe our graduate students overall.

We appreciate your time and thank you.

1. What is your UMSL email address?

What is your UMSL email address?

2. What best describes your goal in the UMSL Master's Program?

What best describes your goal in the UMSL Master's Program? MSN Degree

Post-MSN Certificate

3. Do you live in Missouri?

Do you live in Missouri? Yes

4. If you live in Missouri, what county do you live in?

	County of Residence
County	If you live in Missouri, what county do you live in? County County of Residence

5. Do you work in Missouri?

Do you work in Missouri? Yes

6. If you work in Missouri, in what county do you work?

If you work in Missouri, in what county do you work?

7. Please check the box which best describes your current employer.

Please check the box which best describes your current employer. Community Health Center

Migrant Health Center

Health Care for the Homeless Grantee

Public Housing Primary Care Grantee

Rural Health Clinic

National Health Service Corps Site

Indian Health Service/Trival Health Site

Federally Qualified Health Center

Health Professional Shortage Area (HPSAs)

State or Local Health Departments

Ambulatory Practice Sites Designated by State Govenors

Other Rural or Underserved Population

Other employer (see below)

Other (please specify)

8. What is your racial background? Please mark all that apply

What is your racial background? Please mark all that apply American Indian or Alaskan Native

Native Hawaiian or other Pacific Islander

Asian

Black or African American

White

Do Not Wish to Provide

Other (please specify)

9. Are you Hispanic?

Are you Hispanic? Yes

10. Is English your primary language?

Is English your primary language? Yes

11. The US government determines economic disadvantage based upon the categories below. In 2006, the following categories were used to define economic disadvantage:

Family Size Annual Income Level

1 $ 10,400

2 $ 14,000

3 $ 17,600

4 $ 21,200

5 $ 24,800

6 $ 28,400

7 $ 32,000``

8 $ 35,600

Given this information, do you consider yourself to be economically disadvantaged?

The US government determines economic disadvantage based upon the categories below. In 2006, the following categories were used to define economic disadvantage:

Family Size	Annual Income Level
1	$ 10,400
2	$ 14,000
3	$ 17,600
4	$ 21,200
5	$ 24,800
6	$ 28,400
7	$ 32,000``
8	$ 35,600

Given this information, do you consider yourself to be economically disadvantaged? Yes

Prefer not to answer

12. Do you have a disability?

Do you have a disability? Yes

Do not wish to provide

13. If you have a disability, which categores describe your disability (ies)?

If you have a disability, which categores describe your disability (ies)? Hearing

Visual

Mobility/Orthopedic impairment

Other

14. If you have additional comments or questions, please include them below.

If you have additional comments or questions, please include them below.