Form 1 Feedback Form

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NIH/NHMA Feedback Form
OMB #0925-0748
Expiration Date: 08/2023

 Public reporting burden for this collection of information is estimated to average 30 minutes per response, including
the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless it displays a currently valid OMB control number. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions
for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD
20892-7974, ATTN: PRA (0925-0748). Do not return the completed form to this address.

Please rate the following:
Early Years in Academia: NIH Loan Repayment Program

Very poor
Poor
Acceptable
Good
Very good

Navigating the NIH Grant Application and Peer Review
Process

Very poor
Poor
Acceptable
Good
Very good

Keynote address

Very poor
Poor
Acceptable
Good
Very good

Understanding the Tenure Process for Success in
Academic Medicine

Very poor
Poor
Acceptable
Good
Very good

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

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

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

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

03/10/2023 9:25am

__________________________________________

__________________________________________

__________________________________________

__________________________________________

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Overall, how satisfied were you with the workshop?

Very dissatisfied
Dissatisfied
Neutral
Satisfied
Very satisfied

How likely are you to pursue a career in academic
medicine?

Very unlikely
Unlikely
Undecided
Likely
Very likely

How influential was the Academic Career Development
Workshop on your previous response?

Not at all influential
Slightly influential
Somewhat influential
Very influential
Extremely influential

Any other comments?
__________________________________________
To date, have you been supported by an NIH grant or
contract?

Yes
No

Have you ever applied for an NIH funding opportunity?

Yes
No

If you applied for an NIH funding opportunity, were
you awarded?

Yes
No

Are you a member of the National Hispanic Medical
Association?

Yes
No

Does participation in this workshop make you more
likely to become a member if not a member already?

Yes
No
N/A

How would you classify your current career status?

Resident
Fellow
Instructor
Assistant Professor
Post-doctoral Researcher
Other

Please specify other career status:

__________________________________

What is your primary specialty?
__________________________________________
How would you describe your gender?

03/10/2023 9:25am

Male
Female
Prefer not to answer
Other

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Please specify other gender:

__________________________________

Which of these best describes your ethnicity (choose
one)?

Hispanic or Latino
Not Hispanic or Not Latino

Which of these best describes your race (choose one or
more)?

African American/Black
American Indian/Alaska Native
Asian
Native Hawaiian/Pacific Islander
White
Other

Please specify other race:

03/10/2023 9:25am

__________________________________

projectredcap.org