Form 7 NMRI Survey

OMB #0925-XXXX
Expiration Date: XX/XXXX

Network of Minority Health Research Investigators (NMRI) Survey
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address.

NETWORK OF MINORITY HEALTH RESEARCH INVESTIGATORS (NMRI)
SURVEY
Please take a moment to answer these questions that will help make the Network more helpful for all
members.
As a member of NMRI you are expected to seek the opportunity to participate in the NMRI mentorship program for at least one
calendar year. This survey will help to identify how you can participate in this program.

If you are returning and would like to make changes to your Questionnaire answers, click here.
Name:
Address:

Email:
Phone:
1. What is
your highest
degree?
What year
did you
reach your
highest
degree?
2. What is
your current
status?

Graduate or Medical Student
Post Doc Fellow
Instructor

Assistant Professor
Associate Professor
Full Professor
Other:
What year
did your
begin your
current
status?
3. What year
did you
become a
member of
the NMRI:
What was
your status
at that time?

Graduate or Medical Student
Post Doc Fellow
Instructor
Assistant Professor
Associate Professor
Full Professor
Other:

4. Are you
tenured?

Yes
No

If Yes –
indicate year
this began
If No – are
you tenure
track?

Yes
No

If Yes –
indicate year
this began
5. How did
Website
you become
Email
informed
Member of NMRI
about the
NMRI? Other:
6. How often
I have attended all of the meetings
have you
I have attended X number of meetings, the last one was in the year [Supply number of
attended the
NMRI meetings and year below]
meetings?
X = number of meetings attended:
Year Last Attended:

7. Are you
planning to
attend a
future NMRI
meeting? If
no proceed
to # 13

Yes

8. What
motivates
you to attend
the NRMI
meeting?
(check all
that apply)

Networking opportunities

No

Mentorship opportunities
Leadership opportunities
Identifying collaborations
Opportunities for oral or poster presentations
Assistance in applying for promotion or tenure
Enhancing grant or manuscript writing skills
Developing management skills
Other:

9. On a scale
of 1-10, with
10 being the
most
opportunity
for
professional
growth, rate
your
professional
development
associated
with
attending the
annual
NMRI
meetings:

1

2

3

4

5

6

7

8

9

Indicate the
Found collaborator(s)
most
Found mentor(s)
important
Helped with success in grant application
ways that
NMRI has
Helped with success in manuscript publication
helped you in
Helped develop management skills
your career
Assisted in applying for promotion or tenure
development
Also, Other:
indicate if
any grants or
publications
have
resulted:
Have any
grants or

Yes
No

10

publications
have
resulted:
If you are
tenured, give
up to three
specific
examples of
how NMRI
has
contributed
to
supporting
your tenure
process
10. Have you
participated
in the NMRI
mentorship
program?
11. All NMRI
members are
encouraged
to be
mentors.
Please list 3
or more
areas of
research
interest,
expertise, or
special
assistance
that you are
willing to
share with
another
NMRI
member.
12. If you are
interested in
working with
an NMRI
mentor for
one year and
documenting
your
progress,
please list
which field,
area of
expertise, or

Yes
No

technique
you are
seeking
assistance
with
13. If you are
not planning
to attend a
future NMRI
meeting,
please state
why.
14. List other
national or
regional
meetings that
you have
attended
over the past
year.

If you elected
to attend
another
national or
regional
meeting
instead of the
NMRI
meeting
explain why.
Please
provide
other
comments.

[Note: If you are submitting your CV and this contains the following information, you may skip to question 19]
15. List all
grants
submitted
since April

Gran

Year of
Funding
First
Year
Submission

2002, and
indicate the
year of first
submission
and the year
of funding, if
funded.
16. List the 5
most
important
oral or
podium
presentations
since April
2002

17. List the 5
most
important
poster
presentations
since April
2002

18. List the 5
most
important
manuscripts
since April
2002

19. Final
comments

Add New

(YYYY)

(YYYY)

Please
submit your
current CV
(PDF, DOC,
RTF, or TXT
please)

Choose File No file chosen

Submit