Faculty Questionnaire

Thank you for providing us with this important information. The Bureau of Health Professions (BHPr) is requiring this data for on-going funding of many of our teaching and research programs. The BHPr is asking us to track the diversity of the faculty and trainees supported by their grants. This is the first year that this data have been required on all applications and progress reports.

Entries marked with * are required.

Are you Primary Care?:

Primary Care Specialization:

Were you economically disadvantaged?:



Includes individuals who come from families with incomes below federally-specified levels. Such as:

  • Growing up in a low-income family ($23,880 for two people, $36,200 for four people, $48,520 for a family of six or more)
  • Growing up in a family that received public assistance

    • Were you educationally disadvantaged?:



    Examples include:

  • Graduating from a high school district where 50% or less of graduates go to college.
  • Being in the 1st generation in your family to attend college.
  • Having a diagnosed physical or mental impairment that substantially limited your participation in educational experiences.
  • Graduating from a high school with average SAT scores below the state mean.

    • What is your racial/ethnic background?:










    First Name*:

    Last Name*:

    Birth Month:

    Birth Year: