RIG Event Attendee Feedback Survey

RIG Event Attendee Feedback Survey
Date of Event:*

MonthDayYear
Date
RIG Name*
Type of event*
If other:
Type of event if "Other" was chosen above
Location of Event:*
What is your current role/position?*
If student, when do you expect to graduate?
If student, what is your major/area of study?
If resident, what year do you expect to complete your residency?
If resident, what is your specialty?
If fellow, what kind of fellowship are you doing?
If fellow, when do you complete your fellowship?
If 'Other' was chosen above, please specify.
Are you a current SMSNA member?:*

YesNo
If no, are you considering joining the SMSNA ?:

YesNoPrefer not to answer
How many RIG events have you attended?*

This is my 1st event*2-3 events3-4 events4-6 events7 or more
* If this was your 1st event, please fill out the following:
Your Name:

First NameLast Name
Designation:
(MD, DO, PhD, etc.)
Email:
example@example.com
How did you hear about the program?
Are you interested in mentorship/being a mentor?:*

Yes * (please provide your email below)No
* Are you seeking a mentor?:

YesNo
* Are you interested in being a mentor?:

YesNo
* Email:
example@example.com

How would you characterize the support you found at this RIG program meeting?*

	1	2	3	4	5

1 is Poor, 5 is Exceptional

How would you rate this meeting for its opportunity to network?*

	1	2	3	4	5

1 is Poor, 5 is Exceptional