12Award Details3Future Publications/Grants4Current Practice5Demographics and Training6 Optional Questions Thank you very much for participating in this AHNS Awards Survey which will take approximately 12 minutes to complete. The results will help illustrate the impact on the career trajectory and research activity of Foundation grant recipients. For questions regarding the survey, please contact Colleen Elkins by email: [email protected], or by phone: 310-437-0559, ext 114 Award DetailsHave you been the principle investigator on more than one AHNS funded grant?YesNoPlease complete the remainder of the survey RE: The first grant for which you were PI. We will provide a new link/survey RE: The second grant for which you were the PI. What year were you awarded?Name of AHNS Award:Resident research grantPilot research grantSurgeon scientist Career Development AwardTranslational Innovator AwardI can’t rememberDuration of Awards (Years):General Topic of Study:BasicTranslationalClinicalHealth ServicesOutcomesAt the time you received the award, were you a:Medical studentResidentFacultyFellowAttendingOtherOther:If attending: Please list faculty rank if applicableIf you were faculty when awarded, please indicate rank:InstructorAssistantAssociateFull ProfessorNA Future Publications/GrantsDid the AHNS grant support publication(s)?YesNoIf so how many?Did the AHNS grant contribute to subsequent successful grant applications?YesNoIf so how many?Check all that apply for subsequent grants received:If you received a foundation award, if desired please choose "other" and list foundation (e.g. ACS, ASCO, V foundation etc.) K08 K23 RO1 Internal/Institutional Grant Foundation Career Development Award Foundation Merit Award Industry/Private Funding Other Other:How much time passed between the conclusion of the work on the AHNS Award and a subsequent grant from another organization? Current PracticeAre you currently engaged in research? Yes/NoYesNoIf yes, is it related to your CORE grant research? Yes/NoYesNoCurrent research is (check all that apply): Basic Translational Clinical Health Services Outcomes What is your current practice?Private PracticeGroup PracticeEmployed hospital physician (non-academic)Academic Faculty PracticeOtherOtherCurrent Faculty Rank:Do you currently have protected research time?YesNoIf so, what percentage of effort?Did you have protected research time during your grant?YesNoIf so, what percentage? Demographics and TrainingName: First Last Gender:Year of medical school graduation:Year of residency graduation:Are you an Otolaryngologist?YesNoIf not, please indicate your specialty:Year of completion of all training, including fellowship:Are you fellowship trained?YesNoIn what field? Head and Neck Surgery and Reconstruction Plastics/Reconstruction only Rhinology/Skull Base Otology/Neurotology Pediatric Other Other: Optional QuestionsPlease list the best email for future contact: Please provide a mailing address for future contact. Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country How did the CORE grant help you with your career?How did the CORE grant help you with future grants (if applicable)?May we contact you with further questions about your success following the CORE grant?YesNoIs there anything about your AHNS grant experience you would like to communicate?Thank you for taking the time to complete this survey. 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