Resource Directory

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Resource Directory of Scientists and Engineers with Disabilities

Thank you for your interest in the Resource Directory of Scientists and Engineers with Disabilities. The American Association for the Advancement of Science (AAAS) began its effort to expand opportunities for scientists and engineers with disabilities in 1975. The first Resource Directory was published in 1978. It became a critical resource for many groups who wanted or needed role models, mentors, and peer reviewers. Subsequent editions of the Directory were published in 1983 and 1995. The current effort is greatly enhanced by the availability of technology and hardware that allows for more careful analysis. The Directory is an alphabetical listing of people with disabilities who have achieved at least a bachelor’s degree in a science, technology, engineering, or mathematics field. We list the name, contact information, discipline(s), degree(s) attained, current or most recent position, disability, and age of onset. We will also be adding age of diagnosis this year which is not always the same, especially for those with non-apparent disabilities.

Should you wish further information regarding the significance of these categories for policy, programs, or practice, we would be more than happy to speak with you further.

Even if you do not wish to be listed in the Directory, or do not want your disability to be identified, we ask that you indicate those options and complete the questionnaire. You have the option of choosing not to disclose.

At the end you will be able to print out your completed questionnaire. If you do not wish to complete the questionnaire online, you may download it as a Word file of the questionnaire or as a PDF (Adobe Acrobat Reader) file of the questionnaire and mail it to AAAS. The AAAS address is listed at the bottom of the downloadable questionnaire. If you have any problems using the Word, PDF or online form, please contact Sabira Mohamed at 202-326-8974 who would be happy to help solve any problem or do a phone interview with you.

AAAS Resource Directory
of
Scientists and Engineers with Disabilities

Questionnaire

The asterisk symbol before the field denotes required fields ( i.e. *).

SECTION 1

This section pertains to personal information. Please indicate, below, whether you would like to be listed in the Directory.

[ I am willing to be listed in the Directory, with my disability identified.]
[ I am willing to be listed in the Directory, with my disability identified only as “nonapparent.”]
[ I am willing to be listed in the Directory, without my disability identified.]
[ I do not want to be listed in the Directory, but am willing to participate in AAAS research.]

SECTION 2

This section is for research purposes. (The information will be used in aggregates only, and confidentiality will be maintained.)

Gender:
Birth Date:		Birth Month: Birth Day: Birth Year:
Marital Status:

Do you have any children that live with you at least 50% of the time?
[Yes, I have children that live with me at least 50% of the time ]
[ No , I do not have children that live with me at least 50% of the time]

If yes, how many of these children living with you as part of your family are:
Children under age 2:
Children aged 2-5:
Children aged 6-11:
Children aged 12-18:
Children aged 19 or older:

U.S. Citizen:	[ Yes, I am a U.S. Citizen] [No, I am not a U.S. Citizen ]
If not, specify country of citizenship:
Are you a Permanent Resident?	[Yes, I am a Permanent Resident ] [ No, I am not a Permanent Resident ]

Please indicate your Race and/or Ethnic Group. (Mark all that apply):

American Indian / Native American / Alaskan Native

Asian / Pacific Islander

Black / African American

Hispanic / Latino

White / Caucasian

Other: Other, Please Specify:

Indicate your level of employment:

Employed Full-Time
Employed Part-Time
Self-Employed
Student
Retired
Unemployed

If you are unemployed...

Is the unemployment voluntary?
[ Yes, unemployment is voluntary ]
[ No, unemployment is not voluntary ]

Is the unemployment for personal / family reasons?
[Yes, unemployment for personal/family reasons ]
[ No, unemployment not for personal/family reasons ]

Is the unemployment for medical reasons?
[ Yes, unemployment for medical reasons ]
[ No, unemployment not for medical reasons ]

Are you currently seeking work?
[ Yes, I am currently seeking work ]
[ No, I am not currently seeking work ]

SECTION 3

The information that follows will be in the Directory if you have indicated approval. Otherwise it will be retained in the AAAS research database.

First Name:	*
Middle Name:
Last Name:	*

Home Address

Home Street 1:
Home Street 2:
Home Street 3:
City:
State:
ZIP:
Country:
Home Phone:

Work or School Address

Work/School Street 1:
Work/School Street 2:
Work/School Street 3:
City:
State:
ZIP:
Country:
Work/School Phone:
Fax:

Preferred Email:
Secondary Email:

Please indicate which address you prefer listed in the Directory:
Home address in the Directory should be listed
Work / School address in the Directory should be listed
I do not wish to be listed

Scientific Discipline

1. Discipline:	*	1. Specialization(s):	*
2. Discipline:		2. Specialization(s):
3. Discipline :		3. Specialization(s):

Education and Employment

Please list / describe the following:
Graduate and undergraduate school attended and degrees awarded in chronological order:

1. Degree Title	1. Degree Year	1. Subject	1. Institution Name & Location	1. Years Attended
*	*	*	*	*
2. Degree Title	2. Degree Year	2. Subject	2. Institution Name & Location	2. Years Attended

3. Degree Title	3. Degree Year	3. Subject	3. Institution Name & Location	3. Years Attended

4. Degree Title	4. Degree Year	4. Subject	4. Institution Name & Location	4. Years Attended

5. Degree Title	5. Degree Year	5. Subject	5. Institution Name & Location	5. Years Attended

Other Training:
Please enter any additional training here.

Current or Most Recent Position Title:*

Current or Most Recent Employer Name:

Type of Organization:
[ I work for Government]
[ Educational Institution]
[ Industry]
[ Non-Profit]
[ Other: Other, Please Specify: ]

Other Professional Interests:
Please enter any additional professional interests here.

Disability

Please indicate your disability(ies). (If possible, list in order of significance / impact, most significant to least):

1. Disability	1. Age of Onset	1. Age of Diagnosis

2. Disability	2. Age of Onset	2. Age of Diagnosis

3. Disability	3. Age of Onset	3. Age of Diagnosis

4. Disability	4. Age of Onset	4. Age of Diagnosis

5. Disability	5. Age of Onset	5. Age of Diagnosis

If you wish to comment about anything regarding your work or education, please do so here:
Please enter any additional comments regarding your work or education here.

Thank you very much for your time and participation in the AAAS Resource Directory. We hope that you will participate in future activities and / or researchÍ projects of AAAS.

THE DEADLINE FOR APPLICATION HAS PASSED AND WE ARE NO LONGER ACCEPTING APPLICATIONS.