Fall 2001

xxAACP Newsletter, Volume 15, Number 4, Fall 2001

Home

2001 MEMBERSHIP SURVEY

Thank you for taking a few minutes to complete this survey. The membership survey is needed in order to know who our members are, and how the organization can best represent members’ interests and serve members’ needs. This survey is for current AACP members only. Please mail it to: Francis M. Roton, PO Box 570218, Dallas, Texas 75228-0218, or visit the website at http://www.wpic.pitt.edu/aacp/survey/survey.htm to complete the survey on-line.

1. Name: ________________________________________________________________

2. Phone number:( ) Email address: _______________________

3. Gender: M F

(circle one)

4. Age: ________

5. Which best describes your race/ethnicity? (check all which apply)

_____ a. African American

_____ b. Asian American/Pacific Islander

_____ c. Caucasian

_____ d. Hispanic/Latino

_____ e. Native American/Alaska Native/Native Hawaiian

_____ f. Other______________________________(please specify)

6. What is your Psychiatric training career status?

_____ a. > 5 years since training

_____ b. < 5 years since training

_____ c. Currently in training

_____ d. Medical student

_____ e. Not applicable

7. In which language are you fluent? (please circle all that apply)

English Spanish French Russian Vietnamese Mandarin

Japanese Other______________________________(please specify)

8. Practice Locality:

_____ a. Large Urban (> 500,000)

_____ b. Urban (< 500,00)

_____ c. Suburban

_____ d. Rural

9. Primary Work Setting

_____ a. CMHC

_____ b. University Hospital

_____ c. General Hospital

_____ d. Psychiatric Hospital

_____ e. HMO

_____ f. State Facility

_____ g. VA/Federal Facility

_____ h. Private Practice

_____ i. Pharmaceutical Industry

_____ j. Other ( please specify)

10. Age Groups of Patient Populations — circle all that apply

Child Adolescent Adult Geriatric

11. What are your professional interests?

______________________________________________________________________

12. Do you have any specific training or educational needs that AACP could help with?

_______________________________________________________________________

13. Do you agree to share your AACP contact information with the APA?

YES NO

14. Should AACP use pharmaceutical industry funding?

_____ a. Yes, without restriction

_____ b. Only for educational purposes

_____ c. Not at all

_____ d. Other__________________________(please specify)

15. What should AACP’s priorities be? (please rank in order of importance)

_____ a. Member support

_____ b. Forum for members

_____ c. Advocacy

_____ d. Information and education about public and community Psychiatry issues

_____ e. Other______________________________(please specify)

16. Suggestions for new members:

Name Contact number

Back to Fall 2001 Table Of Contents