Exit this survey 2016-2017 Workforce Development/STEM Pipeline Question Title * 1. Student Information: Last Name First Name Middle Initial Student ID # Question Title * 2. GPA:(2 decimal places) Question Title * 3. Name of College or University: Azusa Pacific University CalTech CSU, Fresno CSU, Long Beach CSU, Pomona CSU, Sacramento CSU, San Bernardino CSU, San Diego CSU, San Jose CSU, San Luis Obispo CSU, Sonoma Pomona College Santa Clara University Stanford UC, Berkeley UC, Davis UC, Irvine UC, Los Angeles UC, Riverside UC, San Diego UC, Santa Barbara UC, Santa Cruz University of San Diego University of Southern CA Other (please specify) Question Title * 4. Year in College: Freshman Sophomore Junior Senior Masters Level PhD Level Question Title * 5. Project Name: Question Title * 6. Name of Faculty Advisor for This Project: Question Title * 7. Gender: Male Female Question Title * 8. Date of Birth (MM/DD/YYYY) Question Title * 9. Ethnicity (U.S. Census Bureau): Hispanic or Latino Not-Hispanic or Not-Latino Do Not Wish to Provide Question Title * 10. Race (U.S. Census Bureau):Students identifying as Hispanic or Latino may be of any race. American Indian or Alaskan Native Asian Black or African American Native Hawaiian or other Pacific Islander White Some other Race Do Not Wish to Provide Question Title * 11. Have you served in the United States Military Service? Yes No Question Title * 12. U.S. Citizen: Yes No Question Title * 13. Will you or your siblings be the first in your family to graduate fromcollege? Yes No Question Title * 14. Have you ever qualified for subsidized school lunch? Yes No Question Title * 15. Do you have a disability? Yes No Next