Name of Organization Requesting Information

Women's Images of Science and Engineering General Information Survey

The purpose of this survey is to collect information from you about your educational experiences. The results from the survey are strictly confidential and will be analyzed by WISE to help shape its activities. Report results are strictly confidential. If you would like a copy of the report complete question 3 in part A (Personal Information).

This survey is divided into the following sections:

Fill out the information in each section as requested. Then at the end of the form you have the option to supply your name and contact information, and submit the form. You will receive a confirmation message from us shortly.

SECTION A -- Personal Information

Please answer the following questions.

  1. What is your current age?



  2. What is your current educational level?

    grade 7, 8, 9grade 10, 11, 12undergraduategraduate postgraduate

  3. Would you like us to send you some literature? What is your mailing address? 
    Name     
Street   
City     
State    
Zip Code
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SECTION B -- Science and Math Related Experiences

  1. How would you rate the gender fairness of your overall educational experiences?
    Bad Poor Fair Good Excellent
  2. Have you ever been made to feel different from other students in any of your classes? yes no
  3. If yes, please tell us how?
  4. By women teachers? yes no
  5. By men teachers? yes no
  6. By female students? yes no
  7. By male students? yes no
  8. In science classes? yes no
  9. In math classes? yes no
  10. Do you plan to or have you pursued advanced science classes? yes no
  11. If yes, what courses?
  12. Do you plan to or have you pursued advanced math classes? yes no
  13. If yes, which courses?
  14. Have your classroom experiences encouraged you to pursue a career in math or science? yes no
  15. If yes, how?
  16. Have your classroom experiences discouraged you from pursuing a career in math or science? yes no
  17. If yes, how?
  18. Do/Did your parents encourage you to take math/science classes? yes no
  19. If no, why do you think they didn't encourage you?
  20. Do/Did your teachers encourage you to take math/science classes? yes no
  21. If no, why do you think they didn't encourage you?
  22. Do/Did your academic advisors encourage you to take math/science classes? yes no
  23. If no, why do you think they didn't encourage you?

 

Select the subject areas you are most interested in:

Science
Language Arts
Mathematics
Fine Arts
Business

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SECTION C -- Survey Evaluation

Thank you for taking the time to complete the WISE survey. How would you rate the completeness of the survey?

  1. Bad Poor Fair Good Excellent
  2. Please enter any additional questions you think should be included in our survey.



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FORM SUBMISSION

Thank you for taking the time to answer the questions in our survey.

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R. McCord/WISE
Copyright © 1997 [WISE]. All rights reserved.
Revised: .