Evaluation of the Fellowship

Fellow:

Year (circle one):            1            2

Date of Rating:

NOTE: Fellow to identify how goals were facilitated and/or hindered

SCALE

3 The program exceeded my training goals/needs

2 The program met my training goals/needs

1 The program did not meet training goals/needs

GOAL (1): Assessment

Rating:                3            2            1

Comments:

GOAL (2): Intervention

Rating:                3            2            1

Comments:

GOAL (3): Consultation

Rating:                3            2            1

Comments:

GOAL (4): Advanced Knowledge

Rating:                3            2            1

Comments:

GOAL (5): Research

Rating:                3            2            1

Comments:

GOAL (6): Licensure/ABPP Preparation

Rating:                3            2            1

Comments:

Fellow Signature (Date)

Training Lead Signature (Date)