Personal History

1. Name (Last) (First) (Middle or Maiden)

2. Address (Number) (Street) (City) (State) (Zip)

3. Sex: (circle one) Male 1 Female 2

4. In what year were you born? (Year)

5. Are you: (circle one)

White/Caucasian	1
Black/Negro/Afro-American	2
Oriential	3
American Indian	4
Mexican American	5
Puerto-Rican American	6
Other	7
(specify)

 

6. Where were you and your parents born? (circle one in each column)

	You	Your Father	Your Mother
USA	1	1	1
Canada	2	2	2
Central or S. America	3	3	3
Western Europe	4	4	4
Eastern Europe	5	5	5
Africa	6	6	6
Far East	7	7	7
Middle East	8	8	8

 

7. Your religion. (circle one in each column)

Religion	Religion in which	Present Religion
	you were reared	preference
Protestant	1	1
Roman Catholic	2	2
Jewish	3	3
Quaker	4	4
None	5	5
Other	6	6
(specify)

 

8. Your political orientation. (circle one)

Very Conservative	1
Conservative	2
Moderate (middle of the road)	3
Liberal	4
Left	5
Far Left	6
Other	7

 

9. Marital Status. (circle one)

Single	1
Religious order	2
Married	3
Separated	4
Divorced	5
Widowed	6

 

10. Children

None	1
One	2
Two	3
Three	4
Four or more	5

 

Educational History

11. When did you receive your BA? (year)

12. At what institution. (Name)

13. What was your undergraduate major? (Specify)

14. When did you begin your graduate study? (Month) (Year)

14A. If you received a Master's Degree prior to your doctorate indicate:

Year received
Field of specialization
Institution (Name) (Location)

15. Doctoral degree granting institution. (Name) (Location)

 

16. What is your general field of history? (circle one)

American	1
European	2
English	3
Russian	4
Japanese	5
Indian	6
Other	7
(specify)

 

17. What is your special emphasis within your field? (circle one)

Social	1
Political	2
Intellectual	3
Economic	4
Cultural	5
Agricultural	6
Other	7
(specify)

 

18. Have you at any time interrupted your graduate study?

Yes	1
No	2
If No (go to 20)

 

19. Indicate the importance of each reason (if you have interrupted your studies more than once, check the reasons for the longest interruption).

	Major Reason	Minor Reason	No Reason
Need to Support family	3	2	1
Need to assist spouse to complete grad work	3	2	1
Childbirth	3	2	1
Family and/or children requiring my attention at home	3	2	1
Desire to secure teaching experience before degree	3	2	1
Illness	3	2	1
Other	3	2	1
(specify)	3	2	1

 

20. What was your stipend source during graduate study? (mark each one)

Source	Major Source	Minor Source	Not a source
Fellowship/scholarship	3	2	1
Teaching or res. assistantship	3	2	1
loan	3	2	1
Personal Savings	3	2	1
Support from spouse	3	2	1
Other	3	2	1
(specify)	3	2	1

 

Occupational History and Plans

21. Are you presently employed?

Yes	1
No	2
If No (go to 30)

 

22. Is your appointment in; (circle one)

Teaching	1
Academic Administration	2
Research	3
Other	4
(specify)

 

23. Is your employer a : (circle one)

Two-year college	1
Fou-year, coeduc. college	2
Four-year women's college	3
Four-year men's college	4
Private University	5
State University	6
Other	7
(specify)

 

24. Indicate your rank or title:

Visiting lecturer or instructor	1
lecturer	2
Instructor	3
Acting Assistant Prof.	4
Assistant Prof.	5
Associate Prof.	6
Full Prof.	7
Department Chairman	8
Other	9
(Specify)

 

25. My salary before deductions is: (circle one)

less than 7,000	1
7,000 -9,999	2
10,000-11,999	3
12,000-13,999	4
14,000-15,999	5
16,000-17,999	6
18,000-19,999	7
20,000-or more	8

 

26. Is this salary based on : (circle one)

9/10 month appointment	1
11/12 month appointment	2

 

27. In accepting this job, indicate whether it was: (circle one)

The first and only offer	1
One of two or three firm offers	2
One of more than three firm offers	3
Other	4
(specify)

 

28. Are you employed at the institution at which you received your doctoral training?

Yes	1
No	2

 

28a. What source do you consider to have been the most effective aid to you in securing your first position.

Dissertation supervisor	1
Departmental placement	2
University placement	3
Professional association	4
Other	5
(specify)

 

29. Indicate the importance of each reason in your decision to your present job offer. (circle one in each column)

Reason	Very Important	Somewhat Important	Not Important
Job scarcity (only offer)	3	2	1
Salary	3	2	1
Prestige of Institution	3	2	1
Prospects of promotion	3	2	1
Library facilities	3	2	1
Location of institution	3	2	1
Institution or employer willing to employ spouse	3	2	1
Could not relocate because of spouses employment	3	2	1
(GO TO 32)

 

30. IF NOT EMPLOYED I am not currently employed because. (circle one)

I did not receive an offer	1
I received an offer but it was not commensurate with my ability or Training	2
I did not want to teach	3
I was unable to find a suitably located College	4
I have decided not to work this year because of family responsibilities	5
I could not find domestic help	6
I had to rest because of health reasons	7
I did not want to work	8
Other	9
(specify)

 

31. When do you plan to return to work? (circle one)

As soon as I find employment	1
Within the year	2
In a few years	3
Never again	4

 

32. Have you been employed before? Yes 1 No 2

33. IF YES, Indicate:

Dates: From To
Title or position
Employer

34. From your experience and/or observation, what treatment was accorded to female students by your graduate department. (circle one in each row)

	Favored Strongly	Favored Somewhat	Neutral	Discriminate Somewhat	Discriminate Strongly
In gaining admission	5	4	3	2	1
In gaining fellowship support	5	4	3	2	1
In gaining opportunity to teach for self-support	5	4	3	2	1
In securing employment aid from faculty and placement officers	5	4	3	2	1
In securing faculty sponsor for dissertation	5	4	3	2	1
In professional and scholarly contact with fellow students	5	4	3	2	1
In other ways	5	4	3	2	1
(specify)	5	4	3	2	1

 

35. From your experience and/or observation what treatment was to:

	Favored Strongly	Favored Somewhat	Neutral	Discriminate Somewhat	Discriminate Strongly
Black Students	5	4	3	2	1
Spanish speaking students	5	4	3	2	1
Students from lower socio-economic background	5	4	3	2	1
Students who participated in protests	5	4	3	2	1
Students who wore unconventual clothes and hairsytles	5	4	3	2	1
Students strongly committed to some organized religion	5	4	3	2	1
Foreign students	5	4	3	2	1
(specify)	5	4	3	2	1