Postdoc Database Postdoctoral Form Please complete the following form telling us a little about your background and current position in order to start gathering information to serve you better. 1. Personal InformationName* First Last BU ID* Gender* Male Female Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Telephone*Mobile PhoneEthnicity* Hispanic/Latino ethnicity (one or more races) Non-Hispanic/Latino (one or more races) One race, American Indian/Alaska Native One race, Asian One race, Black/African American One race, Native Hawaiian/Other Pacific Islander One race, White More than one race (non-Hispanic/Latino) Ethnicity/race unknown or not stated 2. EducationLast Institution Attended* Major* Year of Graduation* Highest Professional DegreeMDDDSDODPTDVMMD/PhDNoneHighest Graduate DegreePhDScDDEng3. ProfessionalBU Affiliation*BUMCBUSMBUSPHCharles River CampusGSDMDepartment*Anatomy & NeurobiologyBiochemistryBiostatisticsCardiologyCVIClinical EpidemiologyComputational BiomedicineDermatologyEndocrinologyGastroenterologyGeneral Internal MedicineGenetics & GenomicsHematology – OncologyInfectious DiseasesMicrobiologyNeurologyNeuropathologyOphthalmologyPathology & Laboratory MedicinePharmacology & Experimental TherapeuticsPhysiology & BiophysicsPreventive MedicinePsychiatry/PsychologyPulmonaryRadiologyRheumatologyVascular BiologyCalciumSPH: Community Health SciencesSPH: Environmental HealthSPH: EpidemiologySPH: Health Policy & ManagementSPH: International HealthSPH: Health & DisabilityGSDM: Cell & Molecular BiologyGSDM: Oral HealthPI Name* Year entered BU as Postdoc*Source of Funding*Federal Dept. of DefenseFederal HHS-NIH onlyFederal NSFFederal Dept. of AgricultureFederal NASAFederal Dept. of EnergyOther federal sourcesNonfederal Institutional, state/local governmentNonfederal other U.S. sourcesNonfederal non-U.S. sourcesPersonal resourcesUnknown or not statedMechanism of Financial Support*FellowshipsTraineeshipsResearch GrantsOther SupportOther Support, Please specify* Employment Status*ContractFull Time RegularLimited TermStipendOtherJob Title*Visiting ResearcherVisiting FellowResearch FellowPostdoctoral FellowPostdoctoral AssociateSr. Postdoctoral AssociateResearch ScientistResearch EngineerAcademic ResearcherSr. Research ScientistSr. Research EngineerSr. Academic ResearcherResearch AssistantSalary Range0 - $5,0005k - 10k10k - 15k15k - 20k20k - 25k25k - 30k30k - 35k35k - 40k40k - 45k45k - 50k50k - 55k55k - 60k60k - 65k65k - 70k70k - 75k75k - 80k80k - 85kThree Top Priorities Professional Development Benefits Recognition Funding Opportunities Salaries Mentoring Years as Postdoc at BU*less than a year1 year2 years3 years4 years5 years6 yearsmore than 6 years4. InternationalCitizenship or visa status*U.S. citizens & permanent residents (non-U.S. citizens holding green cards)Foreign nationals holding temporary visasInstitution Visa Obtained From* Visa TypeJ-visaF-visaH1-B visaOtherCountry of Citizenship* 5. OutcomeOutcomeAcademiaIndustryNon TraditionalOther, Please SpecifyOther, Please Specify