Post-Doctoral Questionnaire

Name of Institution:

Name of Program::

Program Objectives (as stated in published program materials):

Program Focus: (Particular disciplinary focus or related areas, e.g., anthropology, economics, medicine, operations research, outcomes and effectiveness research, political science, sociology, etc., and emphasis on health issues, e.g., quality, cost, access, financing, and organization of services.)

Program Structure: Check all that apply.
Full-time
Part-time
Evening
Off-campus programs
Continuing Education
Distance/online learning
Summer Institute
Other (please specify)

Application/Admission requirements, if any are applicable:

Application fee:
Application deadline(s):
Required interview: Yes No.
If yes, check one below:
In person interview
Telephone interview

Prior training or course work required/desired:
Personal essay:	Yes No
Experience:

Please check where applicable. Are candidates required to be one of the following:
U.S. Citizen yes no
Permanent Resident Alien yes no

Other requirements (please list below):

Please list program contact information below:

First Name
Last Name
Degree(s)
Title
Address
City
State/Province
Zip/Postal Code
Country
Phone
Fax
E-mail
Website

Program Director(s) and Title(s):

Number of program faculty actively involved in the program:
Full-time institutional faculty
Part-time institutional faculty

Please list below up to ten key faculty members and their areas of research.

Faculty Member	Areas of Research
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

What are the main sources of support for your postdoctoral training program? Please check all that apply:
fellowships
traineeships
research grant
other (please specify)

What is the average stipend?

What benefits are available to postdocs (e.g., health insurance, retirement, etc.) Please list below.

Are there limits on the amount of time a person can be in this postdoctoral position (e.g., two years)?
yes no.
If yes, please note the number of years.