Annual Exam Survey

Name*
Your role:*
- Program/Clerkship Coordinator/Administrator
- Program/Clerkship Director
- Exam Coordinator
Your Email*
Name of your program’s Clerkship/Program Coordinator:*
Clerkship/Program Coordinator Email:*
Your Program*
Other
Official Program Name
ie. Case Western Reserve University Physician Assistant Program
Which exam(s) will you use this upcoming academic year?*
- Aquifer Calibrate for Family Medicine
- Aquifer Calibrate for Internal Medicine
- Aquifer Calibrate for Pediatrics
- Aquifer Calibrate for Radiology
- Clinical Decision-Making Exam
When does your academic year begin?*
How many weeks is your program/rotation?*
4 weeks, 8 weeks, 12 weeks, etc
Who is/are your Program/Clerkship Director(s)?*
Program/Clerkship Director's email address(es)*
How many students are in your clerkship/rotation/course?*
What type of students will be taking the exam?*
- 1st year allopathic
- 2nd year allopathic
- 3rd year allopathic
- 4th year allopathic
- 1st year osteopathic
- 2nd year osteopathic
- 3rd year osteopathic
- 4th year osteopathic
- NP/DNP
- PA
- Resident
- Other [Please specify]
Do you require your students to complete any Aquifer cases?*
- Yes
- No
How many cases (if any) do you require your students to complete?
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.

"*" indicates required fields

First Name*

Last Name*

Email*

Enter Email Confirm Email

Program/School Name*

Phone

School Name*

Anticipated start date*

Date when you want to start your subscription

Program type:*

I'm interested in:

Accessing a demo case

Scheduling a full demo

Pricing information

Comments or questions:

Name

This field is for validation purposes and should be left unchanged.

"*" indicates required fields

First Name*

Last Name*

Email*

Enter Email Confirm Email

Program/School Name*

Phone

School Name*

Anticipated start date*

Date when you want to start your subscription

Program type:*

I'm interested in:

Accessing a demo case

Scheduling a full demo

Pricing information

Comments or questions:

Phone

This field is for validation purposes and should be left unchanged.

"*" indicates required fields

First Name*

Last Name*

Email*

Enter Email Confirm Email

Program/School Name*

Phone

School Name*

Anticipated start date*

Date when you want to start your subscription

Program type:*

I'm interested in:

Accessing a demo case

Scheduling a full demo

Pricing information

Comments or questions:

Comments

This field is for validation purposes and should be left unchanged.

"*" indicates required fields

First Name*

Last Name*

Email*

Enter Email Confirm Email

Program/School Name*

Phone

School Name*

Anticipated start date*

Date when you want to start your subscription

Program type:*

I'm interested in:

Accessing a demo case

Scheduling a full demo

Pricing information

Comments or questions:

Comments

This field is for validation purposes and should be left unchanged.

"*" indicates required fields

First Name*

Last Name*

Email*

Enter Email Confirm Email

Program/School Name*

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