Institutional Data Collection Form



Name of Institution:__________________________________________


Contact information for person completing survey:

Name: _______________________________ Title __________________

Address: _____________________________________________________

Phone: _______________________ Email: ________________________


Check each category that applies to this institution:

____Two-year     ____Public

____Four-year    ____Private

____Other (specify):__________________________________________


Check the types of degrees your institution grants. 

____Associate     ____Bachelor's     ____Master's

____Doctor's      ____First Professional


Enrollment

Indicate the term and year for which data is reported: _______

Write the total number of students (head count) enrolled in credit-bearing 
classes at your institution for this term. ___________________

Write the number of students enrolled in credit-bearing classes who have 
identified themselves as belonging to each of the following groups:

____White, non-Hispanic (a person having origins in any of the
    original peoples of Europe, North Africa, or the Middle East)

____Black, non-Hispanic (a person having origins in any of the
    black racial groups in Africa)


____Hispanic (a person of Mexican, Puerto Rican, Cuban, Central or
    South American, or other Spanish culture or origin, regardless of
    race)

____Asian or Pacific Islander (a person having origins in any of the
    original peoples of the Far East, Southeast Asia, the Indian
    subcontinent, or the Pacific Islands)


____American Indian or Alaskan Native (a person having origins in any
    of the original peoples of North America and maintaining cultural
    identification through tribal affiliation or community recognition)

____Other or declined to state


    Note: Because some students will check more than one race or 
    ethnicity, this section may total more than the institution headcount.

    ____Male         ____Female            ____Having a disability


Write the number of students who have the following disabilities. Disability 
categories are those used by the U.S. Department of Education National Center 
for Education Statistics (NCES).

    ____Visual impairment

    ____Hearing impairment or deaf Speech impairment 

    ____Orthopedic impairment 

    ____Learning disability 

    ____Other impairment or disability


    Note: Because some students may report multiple disabilities, this
    section may total more than the total number of students reporting a
    disability.

Educational Attainment
Indicate the beginning and ending months for the year for which data 
is reported:
___________, ___________, through ___________, ___________.

Write the total number of the following attained by students at this institution during this time period. 

____Vocational Certificates     ____Associate Degrees 

____Bachelor Degrees            ____Master/Doctor/First Professional Degrees


Write the total number of the following attained by students with
disabilities at this institution during this time period.

____Vocational Certificates     ____Associate Degrees 

____Bachelors Degrees           ____Master/Doctor/First Professional Degrees

Definitions

Four-year institution: An institution legally authorized to offer and offering at least a four-year program of college-level studies wholly or principally creditable toward a baccalaureate degree.

Two-year institution: An institution legally authorized to offer and offering at least a two-year program of college-level studies which terminates in an associate degree or is principally creditable toward a baccalaureate degree.

Public institution: An institution controlled and operated by publicly elected or appointed officials and deriving its primary support from public funds.

Private institution: An institution which is controlled by an individual or agency other than a state, a subdivision of a state, or the federal government, which is usually supported primarily by other than public funds, and the operation of

whose program rests with other than publicly elected or appointed officials. Private schools and institutions include both nonprofit and proprietary institutions.

Associate degree: A degree granted for the successful completion of a sub-baccalaureate program of studies, usually requiring at least two years (or equivalent) of full-time college-level study. This includes degrees granted in a cooperative or work-study program.

Bachelor's degree: A degree granted for the successful completion of a baccalaureate program of studies, usually requiring at least four years (or equivalent) of full-time college-level study. This includes degrees granted in a cooperative or work-study program.

Master's degree: A degree awarded for successful completion of a program generally requiring one or two years of full-time college-level study beyond the bachelor's degree.

Doctoral degree: An earned degree carrying the title of Doctor. The Doctor of Philosophy degree (Ph.D.) is the highest academic degree and requires mastery within a field of knowledge and demonstrated ability to perform scholarly

research. Other doctorates are awarded for fulfilling specialized requirements in professional fields, such as education (Ed.D.), musical arts (D.M.A.), business administration (D.B.A.), and engineering (D.Eng. or D.E.S.). First Professional degrees, such as M.D. and D.D.S., are not included under this heading.

First Professional degree: A degree that signifies both completion of the academic requirements for beginning practice in a given profession and a level of professional skill beyond that normally required for a bachelor's degree. This degree usually is based on a program requiring at least two academic years of work prior to entrance and a total of at least six academic years of work to complete the degree program, including both prior-required college work and the professional program itself. First Professional degrees are awarded in the fields of dentistry (D.D.S. or D.M.D.), medicine (M.D.), optometry (O.D.), osteopathic medicine (D.O.), pharmacy (D.Phar.), podiatric medicine (D.P.M.), veterinary medicine (D.V.M.), chiropractic (D.C. or D.C.M.), law (J.D.), and theological professions (M.Div. or M.H.L.).

Enrollment: The total number of students registered in a given school unit at a given time, generally in the fall of a year.

Vocational Education: Organized educational programs, services, and activities which are directly related to the preparation of individuals for paid or unpaid employment, or for additional preparation for a career, requiring other than a baccalaureate or advanced degree. Vocational education includes trade, industrial, and technical education.

Source: National Center for Education Statistics (NCES) Digest of Education Statistics.