Free VA Form 10-1314 - HSR&D Carer Development Awardee Annual Progress Report- fillable - Federal

Health Services Research and Development Service Career Development Awardee ANNUAL PROGRESS REPORT
TO BE COMPLETED BY THE AWARDEE

DATE COMPLETED

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

VA TITLE

VA MEDICAL CENTER (City,

State)

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
A B

%Time
C D

Non-Research Role or Activity

%Time

3. TRAINING SINCE LAST REPORT (formal courses, seminars, data sessions, lab meetings, journal clubs, lecture series, etc.)

Training Received
A B C

Time Period
D E F

Training Received

Time Period

4. PARTICIPATION IN NATIONAL OR INTERNATIONAL SCIENTIFIC MEETINGS

Meeting
A B

Date
C D

Meeting

Date

5. PUBLISHING EFFORT SINCE LAST REPORT, LIST ARTICLES SUBMITTED (attach extra page if necessary), IN-PRESS, OR PUBLISHED

Name of Journal
A B C D E F

Peer Review Y Y Y Y Y Y N N N N N N

1st or 2nd Author? Y Y Y Y Y Y N N N N N N

Topic of Article

Publication Date or Status

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.
VA FORM JAN 2002

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7. NEW PROJECTS AND PROPOSALS SINCE LAST REPORT (Attach completed VA Forms 10-1313-7 and 10-1313-8)

Project Number
A

Role

Source

Budget

Status

B

C

D

E

F 8. PRESENTATIONS AND INVITED LECTURES SINCE LAST REPORT

Description
A

Occasion

Location

Date

B

C

D

E

F 9 . NAM ES OF M ENTORS AND DESCRIPTION OF LEVEL OF INTERACTIONS WITH AWARDEE (%

time, days/week, days/month, etc.)

Primary Mentor

Secondary Mentor

Tertiary Mentor
10. SIGNATURE(Signature

of Awardee)

DATE

11. NAME AND SIGNATURE OF AWARDEE' S ACOS FOR RD (I

have reviewed the awardees progress and found it satisfactory.)

DATE

12. COMMENTS (Awardee or ACOS for RD)

VA FORM JAN 2002

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