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Exit Survey
 
 
What is your current year of study? (3rd year, undergraduate junior)
   
 
 
 
Do you consider yourself to be one or more of the following (check all that apply):
 
Straight
 
Gay
 
Lesbian
 
Bisexual
 
Transgender
 
Other
 

 
 
 
How would you describe your ethnicity/race? [Mark one or more]
 
White, Caucasian
 
Black, African American
 
American Indian or Alaska native
 
Native Hawaiian or other Pacific Islander
 
Hispanic or Latino(a)
 
Asian
 
Other
 

 
 
 
How many children do you currently have?
 
0
 
1
 
2
 
3
 
4
 
5
 
6 or more
 
 
 
Do you plan/hope to have children in the future?
 
Yes
 
No
 
 
 
What is the name of your current major of study? (i.e. Mechanical Engineering)
   
 
 
 
What is your Gender?
 
Male
 
Female
 
 
 
What is your current marital status?
 
Married/ Committed Relationship
 
Separated
 
Divorced
 
Widowed
 
Never married
 
 
 
Date of Birth: (MM/DD/YEAR)
   
 
 
 
PARTICIPANT CONSENT

Achievement Aspirations of STEM Students: The Contribution of Anticipated Work-Family Conflict

I am graduate student under the direction of Dr. Bianca Bernstein in the Counseling Psychology Doctoral Program at Arizona State University. I am conducting a research study to explore the career and educational aspirations of science, technology, engineering, and mathematics (STEM) majors.

I am inviting your participation, which will involve a brief online questionnaire, which will take approximately 20 minutes to complete. You have the right not to answer any question, and to stop participation at any time.

Your participation in this study is voluntary. If you choose not to participate or to withdraw from the study at any time, there will be no penalty, for example, it will not affect your academic standing in any way or grade in any course. You must be 18 or older to participate in the study.
There are no foreseeable risks or discomforts to your participation. You will either have the opportunity to receive extra credit for one of your STEM courses (your professor would have informed your class of this opportunity), or, if you complete the questionnaire in the absence of an extra-credit opportunity, you have the chance to be entered into a raffle to win one of three Amazon Kindles.

Your responses will be anonymous and confidential. The results of this study may be used in future reports, presentations, or publications but your name will not be used. Any results that are used will only be shared in the aggregate form.

The following disclosure applies to all participants using online survey tools: This server may collect information and your IP address indirectly and automatically via “cookies”.

If you have any questions concerning the research study, please contact the researcher, Amy Dawson, at: [email protected]. If you have any questions about your rights as a subject/participant in this research, or if you feel you have been placed at risk, you can contact the Chair of the Human Subjects Institutional Review Board, through the ASU Office of Research Integrity and Assurance, at (480) 965-6788.

By clicking “I accept” below you are agreeing to be part of the study. If you wish to decline, you may do so by exiting this page on your web browser.