AHNS Awards Survey1 Demographics and Training2 Award Details3 Downstream4 Current Practice5 Optional Questions 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 OtherOther:If you were faculty when awarded, please indicate rank:InstructorAssistantAssociateFull ProfessorNAAward DetailsWhat 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 ServicesOutcomesWhen your grant started, were you a:Medical studentResidentFellowAttendingOtherIf attending: Please list faculty rank if applicableOther:DownstreamDid the AHNS grant support publication(s)? If so how many?Did the AHNS grant support future grants? If so, how many?Check all that apply for future grants received: K08 K23 RO1 Internal/Institutional Grant Foundation Career Development Award Foundation Merit Award Industry/Private FundingCurrent 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 PracticeCurrent Faculty Rank:Do you have protected research time?YesNoIf so, what percentage of effort?Did you have protected research time during your grant? What percentage?Optional QuestionsPlease list a better email for future contact if desired: Please provide a mailing address for your practice, if desired. Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe 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? Share:FacebookTwitterLinkedIn