AACAP Trainee Advocate Program
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1
. Please provide the following information.
Please provide the following information.
Full name
Degree
Email address
Phone number
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2
. What year are you in training?
What year are you in training?
PGY-1
PGY-2
PGY-3
PGY-4
PGY-5
PGY-6
MS1
MS2
MS3
MS4
MS4
Other (please specify)
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3
. Please enter your training program name.
Please enter your training program name.
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4
. Please choose the category of advocacy activity.
Please choose the category of advocacy activity.
Community
Legislative
Media
Other (please specify)
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5
. Please describe your activity in 1-2 paragraphs.
Please describe your activity in 1-2 paragraphs.
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6
. How many CAP Fellows, General Residents, and medical students were involved?
How many individuals and/or organizations did you interact with?
How many hours did your project take to complete?
How much time did it take to prepare for your project?
How many CAP Fellows, General Residents, and medical students were involved? How many individuals and/or organizations did you interact with? How many hours did your project take to complete? How much time did it take to prepare for your project?
CAP Fellows
General Residents
Medical Students
Individuals/Organizations
Hours to complete
Hours to prepare
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7
. How will you share the project with other AACAP members/trainees (e.g. ROCAP meeting, Advocacy Day, Assembly Meeting, Annual Meeting, etc.)?
How will you share the project with other AACAP members/trainees (e.g. ROCAP meeting, Advocacy Day, Assembly Meeting, Annual Meeting, etc.)?
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8
. How would you rate your satisfaction with your participation in this project?
How would you rate your satisfaction with your participation in this project?
Extremely satisfied
Very satisfied
Moderately satisfied
Slightly satisfied
Not at all satisfied
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9
. What were the most and least satisfying aspects of this project/experience?
What were the most and least satisfying aspects of this project/experience?
Most
Least
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10
. Please describe how your project/activity will impact children with mental illness.
Please describe how your project/activity will impact children with mental illness.
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11
. How likely are you to participate in future AACAP advocacy activities, such as Advocacy Day, action alerts, and advocacy trainings?
How likely are you to participate in future AACAP advocacy activities, such as Advocacy Day, action alerts, and advocacy trainings?
Extremely likely
Very likely
Moderately likely
Somewhat likely
Not at all likely
12
. Please add any comments to improve the AACAP Trainee Advocate Program, or any other questions/suggestions.
Please add any comments to improve the AACAP Trainee Advocate Program, or any other questions/suggestions.
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