Survey for former participants in the Minority Programs (i.e. MBRS, SUBE Program)

Purpose: We need to collect some important information from you as a requirement for NIH that will allow us to continue future funding to support training pograms from Minority Students.

Instruction: Complete the following questions and send the survey via email or fax. The fax number is 787-764-8209.

I. General Information

Complete Name:

1. Please indicate any degrees that you have completed.

Degree	Field of Study	Institution	Year Conferred
Bachelor
Masters
PhD
Post Doctoral
Professional Degree (Specify)
Other (Specify)

II. Information about the federal Research Program

2. Specify the Federal Research Program, the institution and the year(s) in which you work or study while you received funding.

Federal Research Program	Institution	Years
Traditional MBRS
MBRS SCORE
MBRS RISE
MARC (U*STAR or predoctoral fellowship)
SUBE (UPR-Rio Piedras)
NSF
Other(s) (Specify)

III. Information about your current job

3. How would you describe your current position in the Medical Sciences Campus? (Check all that apply).

	Lab Technician Research (Yes / No)
	Graduate Student (Yes / No)
	Doctor in Medicine (Specify Specialty)
	Resident (MD) (Specify Specialty)
	Faculty (Specify Department)
	Other (Specify)

4. Have you ever received external funding for research?. (Yes / No)

Thank you very much for your time and cooperation!!!!