1.How long have you been a CSMS member?

Under 1 year

1- 2 years

3-5 years

5+ years

Non-member

2.Are you currently on any CSMS committees?

Yes

No

Interested

3.How many CSMS events or meetings do you attend yearly?

1

2-3

4-5

6+

Non-member

4.How often would you participate in a CSMS WINS in-person event?

Monthly

Quarterly

Annually

Depends on topic

Depends on run time

5.How often would you participate in a CSMS WINS virtual event?

Monthly

Quarterly

Annually

Depends on topic

Depends on run time

6.NETWORK: Each program of the Lecture and Networking Series will address 2-3 topics while providing networking opportunities. The topic for May 4th was Communication. Which of the following topics would you like to learn about during the Lecture and Networking Series? (Check all that apply)

Negotiation and Contracting with Healthcare Plans

How to Connect in the Virtual Age

Authorship (academic & non-academic writing)

Data Driven Decision Making & Management Metrics

Understanding Leadership & Cultures within an Organization

Advocacy

Imposter Syndrome

Equity

Time Management

Team Building

7.ADVANCE: CSMS will offer in the Fall of 2023 a Career Advancement Training Certificate program in partnership with the Women’s Leadership Center at the University of St. Joseph. (Email Layne for more info: lgakos@csms.org). Would you be interested in applying to this program?

Yes

No

8.What stage are you at in your career? (please include

Trainee

Early career

Mid-career

Late career

Retired

9.LEARN: Through Research Projects, we would like to understand where CT women in medicine are in their careers, the missing pieces, and how to empower them to reach their professional goals. Through skill building, sharing lessons learned and developing a strong network. What other services and opportunities would you like to see offered by CSMS WINS?

10.ELEVATE: The mentorship programs aim to elevate women both personally and professionally. Would you participate in a 1:1 mentor-mentee program?

Yes, as a mentor

Yes, as a mentee

No

11.Would you participate in women’s peer group mentoring program? Small groups of women at similar career stages meet to learn, share ideas and collaborate.

Yes

No

12.Name (first/last)

13.Title

14.Organizational affiliation

15.Email

16.Phone Number (optional)