3 survey

OMB#0925-XXXX Exp. Date: XX-XXXX

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Please complete this voluntary survey. We welcome your feedback and appreciate your honesty.

1. Clinical Research Curriculum Certificate Questions: (already approved by OMB)

   1. What year did you complete the program?

   2. Please rate the following question: On a scale of 1-5 (1=no impact, 5=considerable impact), please indicate the impact this program has had on your professional career.

   3. Please provide the following demographic data:

      1. Name

      2. Company

      3. Address

      4. Address2

      5. City/town

      6. State

      7. Zip Code

      8. Country

      9. Email address

      10. Phone number

4. Please provide an alternative email

5. What professional degrees do you hold?

6. Are you currently performing clinical research, yes/no, other

7. What is your professional title?

8. What organization and/or department do you work for?

9. What is your primary field of concentration?

10. What is your academic status?

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11. What is your current appointment?

12. What are your funding sources:

    1. None

    2. K01 mentored Research Scientist Development

    3. K08 Mentored Clinical Scientist Development

    4. K12 Mentored Clinical Scientist Development

    5. K22 Career Transition Award

    6. K23 Mentored patient Oriented Research

    7. K24 Midcareer Investigator Award in patient Oriented Research

    8. K30 Clinical Research Curriculum Award

    9. R01 Grants

    10. Private Foundations

    11. Industry

13. What is the dollar amount of your grant(s)?

    1. None

    2. Less than $50K

    3. $50K to $100K

    4. $100K to $250K

    5. $250K to $500K

    6. $500K to $1M

    7. Greater than $1M

14. Please list your publications

15. What could the Office of Clinical Research Training and Medical Education Improve on regarding the content of the program?

16. What are the most important clinical research challenges facing you in your career this year?

17. Please provide any additional comments.