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One of the purposes of the CCLI program is to increase the participation and success of women, underrepresented minorities, and persons with disabilities in science, technology, engineering, and mathematics (STEM) disciplines. We invite you to fill out the following form that will help us document and evaluate how well this project is addressing this purpose. The data collected will only be used in a statistical sense to help evaluate the success of the project. The data collected will not be used for any other purposes. Your cooperation is greatly appreciated.


 

1. What is your gender?

        Male        Female

2. What is your Race/Ethnicity? (Please select one category only. If two or more racial/ethnic categories are applicable, choose the one category with which you most closely identify.)


          White (not of Hispanic origin)

          Black/African-American(not of Hispanic origin)

          Asian/Pacific Islander

          Hispanic

          American/Indian or Alaskan Native


3. Do you have any disability?

          No           Yes

 

4. If yes, please specify:

         

5. How did you learn about this website?

        

6. Do you have any comments about this website? Any suggestions for improvement?

        

 

Thank you for your time!!!

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