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

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

qPnd5VYUREUdkM5ILjcHamnhRA4nI6eDPBnk3D5BEJWNEKh3dypJ3FR82QEkxuigPcptGHDmtEgwaqQNohA6jRmpKfZAgFvXiZdTZkLiasn

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

* must provide value

Please Specify:

Sexual Orientation

* must provide value

Please specify other orientation:

Race

* must provide value

American Indian/Alaska Native

Asian

Black/African American

Middle Eastern/North African

Native Hawaiian/Other Pacific Islander

White

Prefer not to disclose

Ethnicity

* must provide value

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

reset

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

reset

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.

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.