NASPGHAN Mentorship/Coaching Survey Demographics: Please answer the following questions around your demographics and life work integration. Question Title * 1. Gender identification: (Required.) Female Male Prefer not to answer Other (please describe if desired) Question Title * 2. Do you have children under the age of 13 years at home? (Required.) No If yes, how many children? Question Title * 3. Are you the sole caregiver for an elderly person and/or an adult with a disability? (Required.) Yes No Question Title * 4. Do you have any support with children/elderly? (Required.) No If yes, (au pair, babysitter, family in the area)? Question Title * 5. Areas of clinical concentration: (Required.) General GI IBD Motility Hepatology Other (please specify) Question Title * 6. Describe your current role: (Required.) Educator Clinician Medical Director Private Practice Other (please specify) Question Title * 7. If you are in private practice, are you on partnership track? Yes No Question Title * 8. How many years after fellowship have you been in practice? (Required.) 1-5 years 6-12 years Longer than 13 years Question Title * 9. Are you considering applying for promotion in the next 5 years? If yes: (Required.) < 1 year 1-2 years 3-5 years None of the above Next
