Please do not provide any identifying information other than in response to the questions below. Responses will be presented to the committee to inform the study report.

What is your race/ethnicity?

Please indicate the highest degree you have attained:

What is the nature of your present work?

___ Primarily research (laboratory, clinical, or field-based)

___ Primarily teaching

___ Primarily clinical practice

___ Primarily health policy

___ Other (please indicate): ___

Your employer is:

___ Federal, state or local Government

___ Non-profit educational or research institution

___ Health care service

___ Other (please indicate): ___

Have you ever submitted a research proposal to NIH or its Institutes?

Have you ever responded to an NIH Request for Applications or Program Announcement?

Have you ever received funding from NIH or its Institutes for a research program?

If so, please describe the nature of the research:

Have you ever received research training funds from NIH or its Institutes?

If so, please describe the nature of the funding:

If you have applied for funding at NIH (other than training funds), how would you rate the experience (please circle one)?

Please describe your experience:

How familiar are you with the research priority-setting process at NIH?

Have you ever been asked to sit on an NIH advisory body (e.g., Board of Scientific Counselors)?

If so, which one?

Have you ever attempted to provide input into the research priority-setting process at NIH?