Annual Progress Report Va 10-1314
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1
2DATE COMPLETED
Health Services Research and Development Service
Career Development Awardee
ANNUAL PROGRESS REPORT
TO BE COMPLETED BY THE AWARDEE
Response should only include updates, changes and activities since the last report. If additional space is needed, continue onto a separate
sheet. Attach reprints (if available) of any publications listed. (Please type or print.)
AWARDEE NAME, DEGREES (Print)
LOCATION OF PRIMARY OFFICE AND WORK SITE
ROUTING SYMBOL
(City, State)
VA TITLE
VA MEDICAL CENTER
ACADEMIC RANK, DEPARTMENT AND AFFILIATION
E-MAIL ADDRESS
TELEPHONE NUMBER
FAX NUMBER
1. SPECIFY ANY CHANGES TO MENTORING, RESEARCH OR CAREER PLANS, INTEREST OR FOCUS SINCE LAST REPORT.
2. LIST ALL NON-RESEARCH ACTIVITIES FOLLOW ED BY PER CENT OF AW ARDEES TIM E COM M ITM ENT TO EACH
Non-Research Role or Activity
%Time
Non-Research Role or Activity
%Time
A
C
B
D
3. TRAINING SINCE LAST REPORT (formal courses, seminars, data sessions, lab meetings, journal clubs, lecture series, etc.)
Training Received
Time Period
Training Received
Time Period
A
D
B
E
C
F
4. PARTICIPATION IN NATIONAL OR INTERNATIONAL SCIENTIFIC MEETINGS
Meeting
Date
Meeting
Date
A
C
B
D
5. PUBLISHING EFFORT SINCE LAST REPORT, LIST ARTICLES SUBMITTED (attach extra page if necessary), IN-PRESS, OR PUBLISHED
Name of Journal
Peer Review
1st or 2nd Author?
Topic of Article
Publication Date or Status
Y
N
Y
N
A
Y
N
Y
N
B
Y
N
Y
N
C
Y
N
Y
N
D
Y
N
Y
N
E
Y
N
Y
N
F
6. SPECIAL ACHIEVEMENTS OR RECOGNITION SINCE LAST REPORT
Please refer to the Health Services Research and Development Service Capacity Building Handbook, for a complete description of the Career
Development Program and instructions for preparing annual reports.
10-1314
VA FORM
Page 1 of 2
JAN 2002
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