UVA Traineeship Scholarship Survey and Application
Sponsored by Tyco Healthcare/Kendall

(Two winners will be chosen by UVA from a random drawing of those who complete this survey. Your answers will not affect your chance of winning.)

Scholarship winner will have one year from date of drawing to make scheduling arraingments with the University of Viginia to attend the course, otherwise the scholarship will be forfieted and a new winner will be drawn.

The first UVA Traineeship Scholarship winner is Sheryl De Santos from Fresno, California.

The second UVA Traineeship Scholarship winner is Aaron Jones from Rutland Regional Medical Center.
 Click Here for full details on this training program
 Click Here for a program summary
1. What is your discipline?
RD   RN   Pharmacist   MD   Physician’s assistant
 
2. How many years of nutrition support experience do you have?
 
3. Who places the majority of short-term (NG, ND, or NJ) tubes at your facility?
RD   RN   MD   PA   Radiology
 
4. Who places the majority of long-term (PEG/ PEG J/ DPEG) Enteral access at your facility?
GI   Surgery   Radiology   CT   Bob from maintenance   Other
If other ...
 
5. What brand of feeding tubes do you currently use in your facility?
DOBBHOFF™   ENTRIFLEX®   Corpak®*/Viasys™*   FlexiFlo®*/Ross   Other
If other ...
 
6. What brand of enteral feeding pumps are currently used in your facility?
KANGAROO®   Flexiflo®*   Corflo®*   Compat®*   Other
If other ...
 
7. Are you involved in selecting feeding tubes and pumps in your facility?
Yes   No  
If not, who generally makes this decision?
 
TO REGISTER - Please enter the following information
8. Facility Information:
Facility Name
Address
Address (con't)
City
State
Postal Code

9. Personal Contact Information:
Name
Phone Number
Email

10. Would you like your Kendall Sale’s Rep to visit you to discuss Enteral Feeding Pumps & Tubes?
Yes   No, Send Info on Pumps/Tubes   No, Do Not Send Info

11. If you win, can we post your name on our website?
Yes   No Keep Confidential

12. How did you learn about this scholarship?
UVA Web site   Kendall Web-site   Nutritional Web-site   Sales Rep   Other
If other ...
 
Please, only one submission per applicant per drawing.
® U.S. registered trademark of Tyco Healthcare Group LP or its affiliate
™ Trademark of Tyco Healthcare Group LP or its affiliate
®* Corpak and Corflo are U.S. registered trademarks of Corpak, Inc.
Flexiflo is a U.S. registered trademark of Abbott Laboratories/Ross Products
Compat is a U.S. registered trademark of Novartis Nutrition Corp.
™* Viasys is a trademark of Sensormedics Corp.
 
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