As part of continuing your work on your EBP proposal, you create a demographics tool that you use to capture data on participants who will be part of your EBP project. Here is a Demographics Questionnaire (Word) example of a demographics tool section. Keep in mind that you should include only information that is important to include in data analysis and write-up. Asking extraneous questions is burdensome for participants; thus, your demographics questions need to be meaningful, relevant, and as brief as possible.

Assignment Instructions

Using a Word document, create a demographics tool that has a minimum of eight questions but a maximum of 20 questions.

Writing Assignment Rubric

Note: Scholarly resources are defined as evidence-based practice, peer-reviewed journals; textbook (do not rely solely on your textbook as a reference); and National Standard Guidelines. Review assignment instructions, as this will provide any additional requirements that are not specifically listed on the rubric.

Writing Assignment Rubric – 100 PointsCriteriaExemplary
Exceeds ExpectationsAdvanced
Meets ExpectationsIntermediate
Needs ImprovementNovice
InadequateTotal PointsContent of PaperThe writer demonstrates a well-articulated understanding of the subject matter in a clear, complex, and informative manner. The paper content and theories are well developed and linked to the paper requirements and practical experience. The paper includes relevant material that fulfills all objectives of the paper.

Cites five or more references, using at least two new scholarly resources that were not provided in the course materials.

All instruction requirements noted.

30 pointsThe writer demonstrates an understanding of the subject matter, and components of the paper are accurately represented with explanations and application of knowledge to include evidence-based practice, ethics, theory, and/or role. Course materials and scholarly resources support required concepts. The paper includes relevant material that fulfills all objectives of the paper.

Cites four references.

All instruction requirements noted.

26 pointsThe writer demonstrates a moderate understanding of the subject matter as evidenced by components of the paper being summarized with minimal application to evidence-based practice, theory, or role-development. Course content is present but missing depth and or development.

Cites three references.

Most instruction requirements are noted.

23 pointsAbsent application to evidence-based practice, theory, or role development. Use of course content is superficial.

Demonstrates incomplete understanding of content and/or inadequate preparation.

Content of paper is inaccurately portrayed or missing.

Cites two or fewer references.

Missing some instruction requirements.

20 points30Analysis and Synthesis of Paper Content and MeaningThrough critical analysis, the submitted paper provides an accurate, clear, concise, and complete presentation of the required content.

Information from scholarly resources is synthesized, providing new information or insight related to the context of the assignment by providing both supportive and alternative information or viewpoints.

All instruction requirements noted.

30 pointsPaper is complete, providing evidence of further synthesis of course content via scholarly resources.

Information is synthesized to help fulfill paper requirements. The content supports at least one viewpoint.

All instruction requirements noted.

26 pointsPaper lacks clarification or new information. Scholarly reference supports the content without adding any new information or insight. The paper’s content may be confusing or unclear, and the summary may be incomplete.

Most instruction requirements are noted.

23 pointsSubmission is primarily a summation of the assignment without further synthesis of course content or analysis of the scenario.

Demonstrates incomplete understanding of content and/or inadequate preparation.

Missing some instruction requirements.

Submits assignment late.

20 points30Application of KnowledgeThe summary of the paper provides information validated via scholarly resources that offer a multidisciplinary approach.

The student’s application in practice is accurate and plausible, and additional scholarly resource(s) supporting the application is provided.

All questions posed within the assignment are answered in a well-developed manner with citations for validation.

All instruction requirements noted.

30 pointsA summary of the paper’s content, findings, and knowledge gained from the assignment is presented.

Student indicates how the information will be used within their professional practice.

All instruction requirements noted.

26 pointsObjective criteria are not clearly used, allowing for a more superficial application of content between the assignment and the broader course content.

Student’s indication of how they will apply this new knowledge to their clinical practice is vague.

Most instruction requirements are noted.

23 pointsThe application of knowledge is significantly lacking.

Student’s indication of how they will apply this new knowledge to their clinical practice is not practical or feasible.

Demonstrates incomplete understanding of content and/or inadequate preparation.

Application of knowledge is incorrect and/or student fails to explain how the information will be used within their personal practice.

Missing several instruction requirements.

Submits assignment late.

20 points30OrganizationWell-organized content with a clear and complex purpose statement and content argument. Writing is concise with a logical flow of ideas.

5 pointsOrganized content with an informative purpose statement and supportive content and summary statement. Argument content is developed with minimal issues in content flow.

4 pointsPoor organization, and flow of ideas distract from content. Narrative is difficult to follow and frequently causes reader to reread work.

Purpose statement is noted.

3 pointsIllogical flow of ideas. Missing significant content. Prose rambles. Purpose statement is unclear or missing.

Demonstrates incomplete understanding of content and/or inadequate preparation.

No purpose statement.

Submits assignment late.

2 points5APA, Grammar, and SpellingCorrect APA formatting with no errors.

The writer correctly identifies reading audience, as demonstrated by appropriate language (avoids jargon and simplifies complex concepts appropriately).

Writing is concise, in active voice, and avoids awkward transitions and overuse of conjunctions.

There are no spelling, punctuation, or word-usage errors

5 pointsCorrect and consistent APA formatting of references and cites all references used. No more than two unique APA errors.

The writer demonstrates correct usage of formal English language in sentence construction. Variation in sentence structure and word usage promotes readability.

There are minimal to no grammar, punctuation, or word-usage errors.

4 pointsThree to four unique APA formatting errors.

The writer occasionally uses awkward sentence construction or overuses/inappropriately uses complex sentence structure. Problems with word usage (evidence of incorrect use of thesaurus) and punctuation persist, often causing some difficulties with grammar. Some words, transitional phrases, and conjunctions are overused.

Multiple grammar, punctuation, or word usage errors.

3 pointsFive or more unique formatting errors or no attempt to format in APA.

The writer demonstrates limited understanding of formal written language use; writing is colloquial (conforms to spoken language).

The writer struggles with limited vocabulary and has difficulty conveying meaning such that only the broadest, most general messages are presented.

Grammar and punctuation are consistently incorrect. Spelling errors are numerous.

Submits assignment late.

2 points5Total Points100 

Example of a word Document:

Demographic Questionnaire

1. Are you male or female? 

1. Male 

2. Female 

2. Do you consider yourself Hispanic or Latino/Latina? 

1. Yes 

2. No 

3. What race do you consider yourself to be? Please select one or more of the following: 

1. White 

2. Black/African American
3. American Indian/Alaska Native 

4. Asian
5. Hawaiian Native/Pacific Islander 

6. Some other race 

(specify): ___________________

4. What is your primary language? 

1. English 

2. Spanish
3. Some other language 

(specify): ______________ 

5. What is your date of birth? 

__ __ / __ __ / __ __ __ __ Mo Day Year 

6. Which of the following educational credentials do you have (check all that apply): 

a. A high school diploma 

b. A GED certificate
c. An Associate’s degree
d. A technical credential or degree 

e. A Bachelor’s degree
f. A Master’s degree
g. Another advanced degree 

7. What is your current employment status?

1. Working for pay at a job or business
2. Looking for work, not currently employed
3. Not currently working and not looking for work 

(Specify): ________________ 

(Specify): ________________ 

8. In 2006, what was your total family income from all sources? Was it: 

1. Less than $25,000,
2. $25,000 to $49,999,
3. $50,000 to $100,000, or 

4. More than $100.000?

 9. What is your current marital status? 

a. Are you currently married or unmarried? 

· Married (SKIP TO b)

· Unmarried  (SKIP TO c)

b. If married, are you and your spouse currently living together or living separately? 

· Living together (SKIP OUT)

· Living separately (SKIP TO e)

c. If not married, have you ever been married? 

· Yes (SKIP TO d)

· No (SKIP TO e)

d. Are you widowed or divorced? 

· Widowed 

· Divorced 

e. Are you currently living with a partner, boyfriend, or girlfriend as married? 

· Yes 

· No 

10. How many children do you have? (specify)

______ Biologic or adopted children 

______ Step children
______ Foster children 

11. How many children with muscular dystrophy do you have? (specify) ______________________ 

12. How old is/are your child/children with muscular dystrophy? (specify) ______________________ 

13. At what age was your child with muscular dystrophy first assessed by a primary care provider? (specify)

______________________

14. How much of the care, roughly, do you provide to your child with muscular dystrophy? 

1. 0-24% 

2. 25-49% 

3. 50-74% 

4. 75-99% 

5. 100% 

15. How would you rate your health? 

1. Excellent 

2. Very good 

3. Good
4. Fair
5. Poor 

16. Have you ever been diagnosed with one of the following disorders (select all that apply): 

1. Bipolar disorder
2. Schizophrenia
3. Dissociative Identity Disorder (Multiple Personality Disorder) 

4. Physical addiction (alcohol, drugs) 

5. None of the above 

17. Does anyone in your family or household have an illness or disability that demands a lot of your attention and makes it hard for you to work or go to school? 

1. Yes 

2. No