Which year of training are you currently in?	PGY1		PGY2	PGY3	PGY4
What is your sex?	Male			Female
How old are you?	____________ years
What state is your pediatric residency program located in?
What is the name of your pediatric residency training program?
Do you speak another language other than English to speak to patients (If yes there will be more questions that ask how well you speak these languages)?	No			Yes
(If yes) Which language do you speak (there will be an opportunity to add up to 3 languages)?
How well do you speak it?	Not well	Well	Very well	Are you a native speaker? Yes No
Do you speak any other languages?	No		Yes
Which language do you speak?
How well do you speak it?	Not well	Well	Very well	Are you a native speaker? Yes No
Do you speak any other languages?	No		Yes
Which language do you speak?
How well do you speak it?	Not well	Well	Very well	Are you a native speaker? Yes No