NATIONAL SCIENCE FOUNDATION
                         APPLICANT SURVEY

Vacancy Ann. # _________________   

Position Status temporary/permanent):_________________________________

Position Title/Series/Grade: _________________________________________ 

INSTRUCTIONS

Your completion of this form will be appreciated. Submission of this 
Information is voluntary and it will have no effect on the processing 
of your application. The data collected will be used only for 
statistical purposes to ensure that agency personnel practices meet 
the requirements of Federal law. NSF estimates that each respondent 
should take about 3 minutes to complete this survey, including time to 
read the instructions. You may have comments regarding this burden 
estimate or any other aspect of this survey, including suggestions for 
reducing this burden. If so, please send them to NSF Reports Clearance 
Officer, Information Dissemination, NSF, 4201 Wilson Blvd., Arlington, 
VA. 22230.

PRIVACY ACT INFORMATION

GENERAL - This information is provided pursuant to Public Law 93-579 
(Privacy Act of 1974), December 31, 1974, for individuals completing 
Federal records and forms that solicit personal information .
AUTHORITY - Section 7201 of title 5 of the U.S. Code and Section 
2000e-16 of title 42 of the U.S. Code.

PURPOSE AND ROUTINE USES

The information is used for research and for a Federal Equal 
Opportunity Recruitment Program (FEORP) to help insure that agency 
personnel practices meet the requirements of Federal law. Address 
questions concerning this form and its uses to the Privacy Act 
Officer, National Science Foundation, Arlington, VA 22230.

1. Today's Date: ____________________________________            

2. Year of Birth: _____________________

3. How did you learn about the particular position for which you are 
applying? (Circle appropriate number.)
     01 - Newspaper (specify)_______________________________
     02 - Contact with NSF Personnel Office 
          (Agency Bulletin Board or other Announcement)
     03 - NSF-initiated personal contact     
     04 - Science Magazine, or other professional journal or magazine
          (specify) _________________________________________
     05 - Affirmative Action Register
     06 - Attendance at conference, meeting or job fair
          (specify) _________________________________________
     07 - NSF recruitment at school or college
     08 - Colleague referral
     09 - NSF Bulletin
     10 - Federal, State or local job information center
     11 - State vocational rehabilitation agency or 
          Veterans Administration
     12 - State employment office
     13 - School or college counselor or other official
     14 - Private job Information service
     15 - Private employment service
     16 - Friend or relative working at NSF
     17 - Friend or relative not working at NSF
     18 - Other (specify) ________________________________________

4. Please select the racial/ethnic category with which you most 
closely identify yourself. (Circle the appropriate letter)

   A. American Indian or Alaskan Native. A person having origins in    
      any of the original peoples of North America, who maintains 
      cultural identification through tribal affiliation or community 
      recognition.

   B. Asian or Pacific Islander. A person having origins in any of the 
      original peoples of the Far East, Southeast Asia, the Indian 
      subcontinent, or the Pacific Islands. This area includes, for 
      example, China, India, Korea, the Philippine Islands, and Samoa

   C. Black, not of Hispanic origin. A person having origins in any of 
      the Black racial groups of Africa. This does not include persons 
      of Mexican, Puerto Rican, Cuban, Central or South American, or 
      other Spanish cultures or origins.

   D. Hispanic. A person of Mexican, Puerto Rican, Cuban, Central or 
      South American or other Spanish culture or origin, regardless of 
      race.

   E. White, not of Hispanic origin. A person having origins in any of 
      the original peoples of Europe, North Africa or the Middle East. 
      This does not include persons of Mexican, Puerto Rican, Cuban, 
      Central or South American, or other Spanish cultures or origin.
 
5. Sex (Circle the appropriate letter.)    F - Female    M - Male

6.  Please provide Information on your disability status by circling 
the appropriate category below:

  1. I do not have a disability; 
  2. Hearing impairment; 
  3. Vision impairment; 
  4. Missing extremities; 
  5. Partial paralysis; 
  6. Complete paralysis; 
  7. Convulsive disorder; 
  8. Mental retardation; 
  9. Mental or emotional illness;
  10.Severe distortion of limbs and/or spine; 
  11.I have a disability but it is not listed.

FOR AGENCY USE

Agency Code: __________________ __________________ _________________ 

             __________________ __________________ __________________ 


                   AN EQUAL EMPLOYMENT OPPORTUNITY EMPLOYER
NSF Form 1232 (8/97)