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New Jersey SEARCH Program
Follow-up Questionnaire
In an effort to measure the effectiveness of the SEARCH (Student/Resident Experiences and Rotations in Community Health) Program and as part of the program participant's requirement we need to hear from you. Please provide us with the following information:
After graduation were you able to secure employment?
Yes
No
Are you participating in a primary care residency program?
Yes
No
Practice Site
Name:
Location:
Is the site in an underserved area?
Yes
No
Is the site in an underserved population?
Yes
No
Type of practice (e.g. Primary ambulatory care, hospital, other):
Does the practice site fit any of the following categories?
Community Health Center
FQHC
Migrant Health Center
Public Houseing
Homeless
Health Department
HIV/AIDS
Private
Other
Did your SEARCH experience contribute to your practice selection?
Yes
No
If you are not currently working in a primary care practice, can you see yourself working for the underserved sometime in the future?
Yes
No
Name:
Address:
Phone:
E-mail:
NHSC Scholar:
Yes
No
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