Thank you for your interest in, and accessing the application survey for, the project, Improving Continuity of Care for Children and Families Affected by Prenatal Alcohol Exposure (PAE). The following application may be completed by your clinic’s Lead Preceptor or other designated representative. The survey will take you approximately ten minutes to complete. Please use the survey's "previous" and "next" arrow buttons to navigate within the survey. If you are unable to finish the survey in one sitting, you may return to the survey later. However, to retrieve your previous responses, you must use the same computer. (Assuming that your computer will accept cookies, the program will save the pages that you have previously completed until you finish the survey or the survey closes.)

The deadline for submitting applications is June 5, 2020. However, we strongly encourage you to complete your application as early as possible. Completed applications will be accepted on a first-come, first-served basis. The project is scheduled to run from October 2020 through January 2021.

**NOTE: To complete the survey, you’ll need to have certain information handy. Specifically, you will need to provide: 
 

• Contact information for your continuity clinic (address, phone, etc.), the resident program director, and lead precepting attending physician (Name, email address, and telephone number).
• The number (or approximate number) of pediatric precepting attending physicians in your practice.
• The number (or anticipated number) of first year pediatric residents (interns) in your practice during the project timeline, October 2020-January 2021.

If you have questions about eligibility, please contact Josh Benke at 630/626-6081 or jbenke@aap.org, or Rachel Daskalov at 630/626-6063 or rdaskalov@aap.org. Thank you!