Center for Development & Disability Trainee Entry Survey

The Center's federal funders require us to collect basic demographic information about people who participate in Center programs and activities. Your individual answers will not be seen by anyone other than CDD evaluation staff, and will not be shared with anyone else. Your answers will be combined with answers from everyone who has an educational experience at the Center and reported in aggregate form.

If you are unsure of how to answer a question, please answer the questions that you can and contact Heidi Fredine at hfredine@salud.unm.edu.

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* 1. Contact Information:

First Name *

Last Name *

Email Address

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* 2. Who is your primary supervisor at the Center?

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* 3. What will you be doing at the Center? (Check all that apply)

Clinical Internship, Practicum or Observation (CDD Clinic - ASEC, ECEP, FASD, etc.)

Practicum for academic degree program (e.g., public health, public policy, special education)

Pediatric Resident

Psychiatry Residency or Fellowship

Psychology Intern

Psychology Post-Doc

Post-Doc in another discipline

Long-Term LEND Fellow (August-May)

Undergraduate College of Nursing Practicum

Social Work Intern/Practicum (BSW, MSW)

Advocate at LEND Advocacy Workshop

Other (please specify)

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* 4. What is your discipline? (Either current discipline or discipline of your last degree. If you are currently a high school student, please select High School).