Form 4 DSRTP Feedback Form

OMB # 0925-XXXX
Expiration Date: XX/XXXX
DSRTP Feedback Form

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2015 NIDDK/ Diversity Summer Research Training Program (DSRTP) Feedback Form

Congratulations on your participation in the 2015 NIDDK/ Diversity Summer Research Training Program (DSRTP) for
undergraduate students. We would like to gather feedback from you on the quality of the NIDDK/ Diversity Summer
Research Training Program (DSRTP) and your overall level of satisfaction with the program. Your information will only be
shared with the DSRTP Program Director and is voluntary. If you are interested in providing additional feedback regarding
your experience, please email Ms. Winnie Martinez at [email protected].

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2015 NIDDK/ Diversity Summer Research Training Program (DSRTP) Feedback Form
Demographic Questions

* 1. What is your gender?
Female
Male

* 2. Which of these best describes your ethnicity (choose one)?
Hispanic or Latino
Not Hispanic or Latino

* 3. Which of these best describes your race (choose one or more)?
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Other (please specify)

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2015 NIDDK/ Diversity Summer Research Training Program (DSRTP) Feedback Form

* 4. What year do you expect to graduate?

* 5. Which, if any, degrees do you plan to pursue in the future?
Master's degree
Ph.D
M.D
D.D.S.
M.D./Ph.D.
Undecided about advanced degree
Other (please specify)

* 6. Which of the following careers do you plan to pursue in the future?
Engineering
Dentistry
Medicine
Nursing
Pharmacy
Public health
Other (please specify)

* 7. Do you plan to pursue a career in biomedical research?
Yes
No

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* 8. Which of the following research focuses are you most interested in?
Basic research
Clinical research
Other (please specify)

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2015 NIDDK/ Diversity Summer Research Training Program (DSRTP) Feedback Form

The following questions will be about your experience in the 2015 NIDDK/ Diversity Summer Research
Training Program (DSRTP) for undergraduate students.
* 9. Overall, how satisfied are you with the following?
Neither
Very
Dissatisfied

Dissatisfied

Somewhat
Dissatisfied

Satisfied or
Dissatisfied

Somewhat
Satisfied

Satisfied

Very
Satisfied

The application
Process
Your interaction with
your research mentor
The interaction with
other staff in your
research lab
Your area of
research/research
topic
The housing location
Bi-weekly Meetings
with Program Director
Dr. Shauna Clark:
Biomedical Research
Training Programs at
NIH
Dr. Kristina Rother:
Medical
Professionalism
Oral Presentations
NIH Poster
Presentations
Overall, how satisfied
were you with your
experience in
NIDDK/DSRTP?

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* 10. How likely are you to encourage your friends to apply in the NIDDK/DSRTP program?
Extreme Unlikely
Unlikely
Undecided
Likely
Extremely Likely

* 11. Which location did you participate in?
Bethesda, Maryland
Phoenix, Arizona

* 12. Were you a travel award recipient for one of the followings?
NIDDK/ Association of American Indian Physicians (AAIP)
NIDDK/ National Hispanic Medical Association (NHMA)
Not applicable
Other (please specify)

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* 13. How did you hear about NIDDK/ DSRTP program?
DSRTP Alumni
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Website
The NIH Office of Intramural Training & Education (OITE) Website
University/School
Professor/Academic Advisor
American Indian Science and Engineering Society (AISES) Conference
Annual Biomedical Research Conference for Minority Students (ABCRMS) Conference
Association of American Indian Physicians (AAIP) Conference
Hispanic Association of Colleges and Universities (HACU) Conference
National Hispanic Medical Association (NHMA) Conference
Society for Advancement of Hispanics/Chicanos and Native Americans in Science (SACNAS) Conference
Other Professional Conference
Other (please specify)

14. If you heard about NIDDK/DSRTP at another conference not mentioned above, please list the
conference name below.

* 15. After completing the NIDDK/ DSRTP program how likely are you to pursue the following:
Extreme
Unlikely

Unlikely

Undecided

Likely

Extremely

Likely

2016 NIDDK/DSRTP
NIH
Postbaccalaureate
Research Programs
NIH Academy
Outside
Postbaccalaureate
Research Programs
Do you plan to apply for other NIH Programs? (please specify)

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* 16. Help us to make NIDDK/DSRTP better. Please provide any additional comments or
recommendations.

* 17. Help us with outreach, what would you tell a friend about your NIDDK/DSRTP experience?

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2015 NIDDK/ Diversity Summer Research Training Program (DSRTP) Feedback Form

Thank you! Your input will help to improve the future of NIDDK/ DSRTP program.
If you have any further questions, please email Ms. Winnie Martinez at [email protected]

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