Basic Information
Title Mr. Ms. Mrs. Miss Dr.
First Name		Last Name
Major Discipline Agricultural Sciences Engineering and Technology Humanities Medical Sciences Natural Sciences Social Sciences		Field of Study
Sector Government Higher Education K-12 Non- Profit Non-profit Private Private
Location	State
Phone Number	Email Address
Personal Website	Ethnicity African American Asian/Pacific Islander Caucasian Hispanic Native American Other
Gender Male Female	Birth Date (mm/dd/yyyy)
Highest Education High School Bachelor Masters Certificate Post Graduate Doctor of Philosophy MD MD PhD	Picture
Questionaire
Did anyone influence your choice to become a scientist? Please explain.
Why did you go into science?
Why is science interesting?
At what age did you decide to become a scientist?
What classes did you especially like as a child?
What are you current interests and hobbies, other than science?
What is exciting about sicience to you? State it so that youth in middle and high school can relate it to their lives.
What do you consider the most important scientific concept that children need to know?
How is the work you're doing addressing health disparities?