AHNS Awards Survey1 2 Award Details3 Future Publications/Grants4 Current Practice5 Demographics 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: colleen@ahns.info, or by phone: 310-437-0559, ext 114Award 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 ProfessorNAFuture 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 OtherOther: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 OutcomesWhat 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 OtherOther:Optional QuestionsPlease list the best email for future contact: Please provide a mailing address for future contact. 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