Shomer Shabbos Database

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

What is your name? *

Where are you holding in your training? *

If you are a med student, resident, or fellow, please write what year you are.

For example, PGY-3, fellowship year 2, MS4...

Which institution are you in? *

And what sort of specialty/subspecialty are you in, if applicable?

What is the status of Shabbos? *

(This question is primarily for trainees. If in med school, click on SS guaranteed/friendly, as applicable. If an attending, please use the free text in the next question to discuss your training experience and shabbos)

Shomer Shabbos Guaranteed; I've never had to work on Shabbos

Shomer Shabbos Friendly; I have to work it out on my own, but I've never had to work on Shabbos

Shomer Shabbos Friendly; I work it out on my own, but occasionally I work on Shabbos.

There is no Shabbos accommodation at all.

Have you been in any other institutions?

If yes, can you please comment briefly what level in your training that was, and what your Shabbos situation was?

Can we make your information available on the database, which is accessible to everyone on the network? *

Please make my name and email available.

Please make my name only available

Please do not make my name or email available, but a database manager can contact me if needed.

I would prefer not to be contacted at all.

Any other comments you'd like to share?

What is your email address?

(Please provide your gmail, not your institutional email. This is for our personal records, and will not be shared without permission, per above)

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms