2015 New Intern Information Survey Question Title * 1. Please answer some demographic information. First Name: Middle Name - required for Medicare and Medicaid reimbursement purposes. If you do not have a middle name, please put N/A. Last Name: Birth Location (Bar Harbour, ME; Rome, Italy; etc.). This is needed for Medicare/Medicaid reimbursement paperwork Personal Email Address - we need to use personal emails since many med school ones expire at graduation. Med School Graduation Date Question Title * 2. Vacation Dates - please list what dates you will be out of the country/incommunicado between now and June 15. There have been major problems in the past with getting licenses processed in time for interns who did not allot enough time for the paperwork before they left on vacation. Having your vacation dates will help us know when you are available for questions and clarification. Question Title * 3. Ladies, are you getting married between now and June 15? Will you be changing your name? If so, please let me know what your new name will be. Please note, you must have an updated Social Security card by the start of Orientation for us to use your married name. If you will not have an updated card by that date, we will have to use your maiden name and go through the name change process once you are here (it stinks, but it is an HR rule). Question Title * 4. What size scrubs will you need? Small Medium Large Extra Large Question Title * 5. Categorical and Med-Peds interns - how would you like your name to appear on your business cards that you will give to your continuity clinic patients? Please list exactly how you would like your name to appear, i.e. Robert William Smith, III, M.D., Ph.D. or Robert Smith, III, M.D., Ph.D. Question Title * 6. What is the best phone number you can be reached at? Done