1. Name of respondent
Last Name
First Name
2. Current mailing address:
E-mail:
3. Year of birth:
4. Sex:
Male Female
5. What is your occupation?
6. What is you highest level of educational attainment?
Post-grad degree(s)
Field
Degree(s)
Other (please specify)
7. Describe your most relevant training/experience
Experience years
Area(s) of expertise
Specialized training
8. Tell us about your accomplishments
Number of refereed publications:
Number of patents:
Titles:
Awards received:
9. Where are you employed?
Name:
City and State:
10. What is your connection to the Caribbean?
Please select one... I was born in a Caribbean country I am a naturalized citizen of a Caribbean country I have at least one parent who is a national of a Caribbean country
Please state which country
11. How long have you lived abroad? years
12. Current country of residence
13. Do you plan to return to the Caribbean?
Yes, in about years
Probably not
No
14. Would you like to be contacted by other professionals from the Caribbean?
Yes
Information will be held in the strictest confidence
Thank you for your time
