PGY-1 Survey

POST GRADUATE YEAR ONE QUESTIONNAIRE

Student Financial Services (SFS) at the Boston University Henry M. Goldman School of Dental Medicine is currently re-applying for federal funding from the Department of Health and Human Services (HHS). Part of the application process requires that we report on the activities of our graduates during PGY-1. For this reason, we ask that you complete the short questionnaire below.

We understand that you are very busy. However, the few minutes it will take to complete and return the questionnaire to our office, and the information you provide, will mean a great deal in our efforts to obtain the additional funding for future dental students.

You may submit the information to SFS by completing the sections below and clicking on the “Send Form” button at the bottom of your screen.

If you have any questions about our request or the questionnaire, please contact our office at (617) 638-5130. Thank you very much for your time and consideration.

Name
Home Address
Home Telephone #
Beeper #
Work Address
Work Telephone #
E-Mail
Where Were You Practicing Between July 1, 2013 and June 30, 2014?
Did You Practice In Primary Care?
Were You Practicing In An Underserved Area?
Comments
By submitting this form, I certify that the information supplied is accurate.
Primary teaching affiliate
of BU School of Medicine