Form 13 NIH NHMA Feedback Form

NIH/NHMA Academic Career Development Workshop Follow-up

OMB #0925-0748
Expiration Date 2/2023
NIH/NHMA Feedback Form
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NIH/NHMA Academic Career Development Workshop Follow-up
Academic Career Development Workshop

* 1. Please rate the following:
Poor Fair Good Very Good Excellent

N/A

Early Years in Academia: Diversity Supplements
Speaker
Comments:

Early Years in Academia: NIH Loan Repayment Program (LRP)
Speaker
Comments:

Early Years in Academia: LRP for Health Disparities Research
Speaker
Comments:

Navigating the NIH Grant Application and Peer Review Processes
Speaker
Comments:

Lunch
Comments:

Biomedical Research Careers Talk
Speaker

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Poor Fair Good Very Good Excellent

N/A

Comments:

Understanding the Tenure Process for Success in Academic Medicine
Speaker
Comments:

* 2. What other topic areas would be particularly useful for you that was not covered during the workshop?

* 3. What components of the Academic Career Development Workshop did you think were most helpful?

* 4. What components of the Academic Career Development Workshop did you think were least helpful?

* 5. What components of the Academic Career Development Workshop would you change and how?

* 6. Overall, did the workshop meet your expectations?
Below expectations
Met expectations
Exceeded expectations

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* 7. How likely are you to pursue a career in academic medicine?
Unlikely
Somewhat unlikely
Undecided
Somewhat likely
Extremely Likely

* 8. How would you rate the influence of the Academic Career Development Workshop on your previous
response?
Very little influence
Some influence
Great deal of influence
Unsure

9. Any other comments?

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NIH/NHMA Academic Career Development Workshop Follow-up
Research Funding & Membership

* 10. To date, have you been supported by an NIH grant or contract?
Yes
No

* 11. Have you every applied for an NIH funding opportunity but were not awarded?
Yes
No

* 12. Are you a member of the National Hispanic Medical Association?
Yes
No

* 13. Does participation in this workshop make you more likely to become a member if not a member already?
Yes
No

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NIH/NHMA Academic Career Development Workshop Follow-up
Demographic Information

* 14. How would you classify your current career status?
Resident
Fellow
Instructor
Assistant Professor
Post-doctoral Researcher
Other (please specify)

* 15. What is your primary specialty?

* 16. How would you describe your gender?
Male
Female
Prefer not to answer
Other (please specify)

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

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

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NIH/NHMA Academic Career Development Workshop Follow-up

Thank you for your feedback!
Stay in touch and let us know how we can be partners in your career development.

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