Survey

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Scholarship Award Survey
Please take a few minutes to answer the questions below.
Your answers will be used by G.E.M. Environmental staff to learn more about our scholarship recipients and identify what improvements we can make for the future.

* Indicates required field

Name *

First

Last

Email *

How did you hear about G.E.M. Environmental and this scholarship opportunity? *

My major/area of focus is: *

Aeronautics Archaeology/Anthropology Biology Chemistry Earth Science Engineering Geology Geography Math Physics Space science Technology Other science field

If other science field, please explain here: *

I am: *

In high school an undergraduate student a graduate student a recent graduate (within 2 years)

I used/plan to use my scholarship funding from G.E.M. Environmental for: *

Books/School Supplies Field Experience/Travel To Pay For Classes To Pay Down Student Loan Debt Other

If other, please explain: *

I identify as a: *

Male Female Other

What is your age? *

Under 18 18-20 21-25 26-30 31-35 Over 35

Are you a veteran? *

Yes No

I describe myself as: *

African American Asian Caucasion/White Chinese Filipino Hawaiian Hispanic/Latino Indian Japanese Native American Pacific Islander Other Asian Mixed Race (other than white) Other

Select one or multiple responses.

If you identify as other in the above category, will you please share what you describe youself as? *

What is your current living situation? *

Campus housing/dorm Rented home or apartment With family or friends I own my home Reservation Shelter Homeless Other

If you selected other in the above category, will you please share where you live? *

Have any of your parents/ guardians earned a college degree? *

Yes No Unsure

If one or both of your parents/guardians completed a college degree, what was their major? *

This question helps us determine if you're the first, or one of the first people in your family to work on or complete a STEM degree.

What is your individual income? *

Less than $25,000 $25,001 - $40,000 $40,001 - $70,000 Greater than $70,000

Our organization is required to provide 51% of our programs to low income individuals. Answering this question may help us expand our programs and ensure we are adhering to our Mission. Low income in Arizona is described as 150% above the nation poverty line.

Do you remember ever having a guest speaker come into classes to talk about science or science related careers? (K-12) *

Yes No Don't Remember

If a guest science speaker spoke to one of your classes, how were you inspired? Do you remember their name? *

Anything else you want to add (compliment, share a success story, concern, or question): *

I understand that my identity will remain anonymous and that any personal information I share here will not be intentionally released to the public aside from my name and the school I am attending when the organization announces awardees. I also understand that the information collected through this survey will be used for internal demographic reporting to ensure the organization is operating within our mission and that any statistics released to the public will not be connected to my name or my identity. *

I agree

Submit

We value you taking the time to complete the above demographic survey.
Please consider sharing your success story, which will be featured on our blog and social media to promote your work.
Click here for more information and instructions on how to submit your success story.

G.E.M. Environmental NFP
Geology - Engineering - Minerals - Environmental - Not for Profit

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