The code block below illustrates how one might use # and // as comments in your logic and calculations.

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Travel Award - Demographics Reporting

Please complete the form below. The following anonymous information will be used for NIH Reporting Purposes.

Please let us know if you have any questions at scc.research.training@gowustl.onmicrosoft.com.

Thank you!

First Name

* must provide value

Last Name

* must provide value

WUSTL Email Address

* must provide value

Sex at Birth
General NIH definition of sex: "A biological category based on reproductive, anatomical, and genetic characteristics, generally defined as male, female, and intersex."

* must provide value

Other Category

Gender

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Please Specify:

Sexual Orientation

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Please specify other orientation:

Race

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American Indian/Alaska Native

Asian

Black/African American

Middle Eastern/North African

Native Hawaiian/Other Pacific Islander

White

Prefer not to disclose

Ethnicity

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Please indicate which of the following apply to you:

* must provide value

I have a disability, physical or mental impairment, that substantially limits one or more major life activities as described in the Americans with Disabilities Act of 1990, as amended;

Prefer not to say

None of the above

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Please select your preferred response listed on the right:

Federal disadvantaged status qualifiers are listed below -

Were or currently are homeless, as defined by the McKinney-Vento Homeless Assistance Act (Definition: https://nche.ed.gov/mckinney-vento/);
Were or currently are in the foster care system, as defined by the Administration for Children and Families (Definition: https://www.acf.hhs.gov/cb/focus-areas/foster-care);
Were eligible for the Federal Free and Reduced Lunch Program for two or more years (Definition: https://www.fns.usda.gov/school-meals/income-eligibility-guidelines);
Have/had no parents or legal guardians who completed a bachelor's degree;
Were or currently are eligible for Federal Pell grants (Definition: https://www2.ed.gov/programs/fpg/eligibility.html);
Received support from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) as a parent or child (Definition: https://www.fns.usda.gov/wic/wic-eligibility-requirements).
Grew up in one of the following areas: a) a U.S. rural area, as designated by the Health Resources and Services Administration (HRSA) Rural Health Grants Eligibility Analyzer, or b) a Centers for Medicare and Medicaid Services-designated Low-Income and Health Professional Shortage Areas (qualifying zipcodes are included in the file). Only one of the two possibilities listed can be used as a criterion for the disadvantaged background definition.

* must provide value

I have two or more of the disadvantaged status qualifiers and do not wish to indicate which

I have two or more of the disadvantaged status qualifiers and wish to indicate which

Prefer not to say

None of the above

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Please indicate which of the following apply to you:

* must provide value

1) Were or currently are homeless, as defined by the McKinney-Vento Homeless Assistance Act (Definition: https://nche.ed.gov/mckinney-vento/);

2) Were or currently are in the foster care system, as defined by the Administration for Children and Families (Definition: https://www.acf.hhs.gov/cb/focus-areas/foster-care);

3) Were eligible for the Federal Free and Reduced Lunch Program for two or more years (Definition: https://www.fns.usda.gov/school-meals/income-eligibility-guidelines);

4) Have/had no parents or legal guardians who completed a bachelor's degree;

5) Were or currently are eligible for Federal Pell grants (Definition: https://www2.ed.gov/programs/fpg/eligibility.html);

6) Received support from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) as a parent or child (Definition: https://www.fns.usda.gov/wic/wic-eligibility-requirements).

7) Grew up in one of the following areas: a) a U.S. rural area, as designated by the Health Resources and Services Administration (HRSA) Rural Health Grants Eligibility Analyzer, or b) a Centers for Medicare and Medicaid Services-designated Low-Income and Health Professional Shortage Areas (qualifying zipcodes are included in the file). Only one of the two possibilities listed can be used as a criterion for the disadvantaged background definition.

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