Please allow approximately
10 minutes to complete.
Which
CDC-sponsored training program did you participate in?
Section
A: Demographics
First Name
Middle
Initial
Last
Name
What
is your age?
What
is your gender?
Are
you of Hispanic or Latina origin or descent?
What
ethnic group do you identify with?
If
you are not a US citizen, of what country or countries are you a citizen?
What
is your current home address?
Street
or P.O. Box
City
State
Zip
Code
Country
What
is your current email address?
What
is your current phone number?
Please
list a person who would have your most current contact information, if we needed
to contact you in the future for the purpose of program evaluation.
Contact
name:
Contact phone:
Contact email:
If
you do not wish to be contacted in the future, please check this box:
Section
B: Education
In what year did you complete
the traineeship?
What
degrees have you earned?
Degree
/ Specialization
Year
Completed
School
Name
Degree
/ Specialization
Year
Completed
School
Name
Degree
/ Specialization
Year
Completed
School
Name
Degree
/ Specialization
Year
Completed
School
Name
Are
you currently a student?
If Yes , what degree/studies
are you pursuing?
Do
you plan to pursue other degrees?
If Yes , what are they?
Section
C: Fellowship / Internship Questions
On
a scale of 1-5 with five being very positive and one being very negative, how
would you describe your training experience?
Please check any of the following
that you feel your training experience contributed to.
Overall knowledge in your specific field of interest
Networking with colleagues
Obtaining Employment
Furthering your research interests
Publications
Affiliation with public health organizations
Other
How
well did your training experience relate to your current and previous employment
experience?
Current:
Previous:
On
a scale of 1-5 with five being completely satisfied and one being completely unsatisfied,
please rate how you feel about the following fellowship / internship program aspects.
Application
Process
Orientation
Financial
Support
Mentoring
Evaluation
Continued
Affiliation
Would you recommend the
traineeship to other students and early career professionals in your discipline?
Yes
Do
you feel the traineeship opened doors and/or assisted in developing your career
path?
Yes
Do
you maintain a relationship with CDC colleagues that you worked with during your
traineeship?
Yes
Did
you / would you seek employment at the CDC on a permanent basis?
Yes
What
are the three most practical things you learned at the CDC?
1.
2.
3.
What
suggestions do you have for improvements?
On
a scale of 1-5 with one being "not at all" and five being "completely", overall,
did the traineeship meet your expectations?
Section
D: Employment History
What type of employment
have you worked in since the completion of your traineeship? Mark all that apply.
Health Policy
Health Services
Epidemiology or Biostatistics
Behavioral Sciences
Health Communications
Environmental/Occupational Health
Family Health (Local Health Officer, Nurse Educator, Nutritionist)
International/Global Health
Maternal and Child Care
Laboratory
Clinical Medicine/Nursing
Pharmaceuticals
Law
Other
None of the Above
Please list your employment
history in chronological order form the time you completed your CDC-sponsored
traineeship.
Place of
employment and location
Title and description
Time
in position (years)
Section
E: Alumni Questions
Would you be interested
in an alumni association or alumni group for networking purposes?
Yes
What
would you like your sponsoring organization (ASPH, ATPM, AAMC, MHPF) to provide
for alumni in the network? Please check all that apply.